<style type="text/css"> .hidden{display: none !important} .form-element-instruction{ font-size:10px} </style> <form method="post" name="APAC_Form_2020_Uniday" action="https://s1133198723.t.eloqua.com/e/f2" onsubmit="return handleFormSubmit(this)" id="form4791" class="elq-form"> <input value="APAC_Form_2020_Uniday" type="hidden" name="elqFormName"> <input value="1133198723" type="hidden" name="elqSiteId"> <input name="elqCampaignId" type="hidden"> <div class="layout container-fluid"> <div class="row"> <div class="grid-layout-col"> <div class="layout-col col-sm-12 col-xs-12"> <div id="formElement0" class="elq-field-style form-element-layout row"> <div style="text-align:left;" class="col-sm-12 col-xs-12"> <label class="elq-label " for="fe66343">Salutation </label> </div> <div class="col-sm-12 col-xs-12"> <div class="row"> <div class="col-xs-12"> <div class="field-control-wrapper"> <select class="elq-item-select" id="fe66343" name="salutation" style="width:100%;" data-value="~~eloqua..type--emailfield..syntax--AUT_GM_Salutation1~~"> <option value="">Please select... </option> <option value="Miss">Miss </option> <option value="Mr.">Mr. </option> <option value="Mrs.">Mrs. </option> <option value="Ms.">Ms. </option> <option value="Mx.">Mx. </option> <option value="Dr.">Dr. </option> <option value="Prof.">Prof. </option> </select> </div> </div> </div> </div> </div> </div> </div> </div> <div class="row"> <div class="grid-layout-col"> <div class="layout-col col-sm-12 col-xs-12"> <div id="formElement1" class="elq-field-style form-element-layout row"> <div style="text-align:left;" class="col-sm-12 col-xs-12"> <label class="elq-label " for="fe65332">First Name <span class="elq-required">* </span> </label> </div> <div class="col-sm-12 col-xs-12"> <div class="row"> <div class="col-xs-12"> <div class="field-control-wrapper"> <input type="text" class="elq-item-input" name="firstName" id="fe65332" value="" style="width:100%;"> </div> </div> </div> </div> </div> </div> </div> </div> <div class="row"> <div class="grid-layout-col"> <div class="layout-col col-sm-12 col-xs-12"> <div id="formElement2" class="elq-field-style form-element-layout row"> <div style="text-align:left;" class="col-sm-12 col-xs-12"> <label class="elq-label " for="fe65333">Last Name <span class="elq-required">* </span> </label> </div> <div class="col-sm-12 col-xs-12"> <div class="row"> <div class="col-xs-12"> <div class="field-control-wrapper"> <input type="text" class="elq-item-input" name="lastName" id="fe65333" value="" style="width:100%;"> </div> </div> </div> </div> </div> </div> </div> </div> <div class="row"> <div class="grid-layout-col"> <div class="layout-col col-sm-12 col-xs-12"> <div id="formElement3" class="elq-field-style form-element-layout row"> <div style="text-align:left;" class="col-sm-12 col-xs-12"> <label class="elq-label " for="fe65331">Email Address <span class="elq-required">* </span> </label> </div> <div class="col-sm-12 col-xs-12"> <div class="row"> <div class="col-xs-12"> <div class="field-control-wrapper"> <input type="text" class="elq-item-input" name="emailAddress" id="fe65331" value="" style="width:100%;"> </div> </div> </div> </div> </div> </div> </div> </div> <div class="row"> <div class="grid-layout-col"> <div class="layout-col col-sm-12 col-xs-12"> <div id="formElement5" class="elq-field-style form-element-layout row"> <div style="text-align:left;" class="col-sm-12 col-xs-12"> <label class="elq-label " for="fe65356">Business Phone </label> </div> <div class="col-sm-12 col-xs-12"> <div class="row"> <div class="col-xs-12"> <div class="field-control-wrapper"> <input type="text" class="elq-item-input" name="busPhone" id="fe65356" value="" style="width:100%;"> </div> </div> </div> </div> </div> </div> </div> </div> <div class="row"> <div class="grid-layout-col"> <div class="layout-col col-sm-12 col-xs-12"> <div id="formElement6" class="elq-field-style form-element-layout row"> <div style="text-align:left;" class="col-sm-12 col-xs-12"> <label class="elq-label " for="fe65341">Country <span class="elq-required">* </span> </label> </div> <div class="col-sm-12 col-xs-12"> <div class="row"> <div class="col-xs-12"> <div class="field-control-wrapper"> <select class="elq-item-select" id="fe65341" name="country" style="width:100%;" data-value="~~eloqua..type--emailfield..syntax--Country~~"> <option value="">Please select... </option> <option value="Afghanistan">Afghanistan </option> <option value="Aland Islands">Åland Islands </option> <option value="Albania">Albania </option> <option value="Algeria">Algeria </option> <option value="American Samoa">American Samoa </option> <option value="Andorra">Andorra </option> <option value="Angola">Angola </option> <option value="Anguilla">Anguilla </option> <option value="Antarctica">Antarctica </option> <option value="Antigua and Barbuda">Antigua and Barbuda </option> <option value="Argentina">Argentina </option> <option value="Armenia">Armenia </option> <option value="Aruba">Aruba </option> <option value="Australia">Australia </option> <option value="Austria">Austria </option> <option value="Azerbaijan">Azerbaijan </option> <option value="Bahamas">Bahamas </option> <option value="Bahrain">Bahrain </option> <option value="Bangladesh">Bangladesh </option> <option value="Barbados">Barbados </option> <option value="Belarus">Belarus </option> <option value="Belgium">Belgium </option> <option value="Belize">Belize </option> <option value="Benin">Benin </option> <option value="Bermuda">Bermuda </option> <option value="Bhutan">Bhutan </option> <option value="Bolivia">Bolivia (Plurinational State of) </option> <option value="Bonaire">Bonaire, Sint Eustatius and Saba </option> <option value="Bosnia and Herzegovina">Bosnia and Herzegovina </option> <option value="Botswana">Botswana </option> <option value="Bouvet Island">Bouvet Island </option> <option value="Brazil">Brazil </option> <option value="British Indian Ocean Territory">British Indian Ocean Territory </option> <option value="Brunei Darussalam">Brunei Darussalam </option> <option value="Bulgaria">Bulgaria </option> <option value="Burkina Faso">Burkina Faso </option> <option value="Burundi">Burundi </option> <option value="Cape Verde">Cabo Verde </option> <option value="Cambodia">Cambodia </option> <option value="Cameroon">Cameroon </option> <option value="Canada">Canada </option> <option value="Cayman Islands">Cayman Islands </option> <option value="Central African Republic">Central African Republic </option> <option value="Chad">Chad </option> <option value="Chile">Chile </option> <option value="People's Republic of China">China </option> <option value="Christmas Island">Christmas Island </option> <option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands </option> <option value="Colombia">Colombia </option> <option value="Comoros">Comoros </option> <option value="Congo">Congo </option> <option value="Congo, Democratic Republic of the">Congo, Democratic Republic of the </option> <option value="Cook Islands">Cook Islands </option> <option value="Costa Rica">Costa Rica </option> <option value="Cote d'Ivoire">Côte d'Ivoire </option> <option value="Croatia">Croatia </option> <option value="Cuba">Cuba </option> <option value="Curacao">Curaçao </option> <option value="Cyprus">Cyprus </option> <option value="Czech Republic">Czechia </option> <option value="Denmark">Denmark </option> <option value="Djibouti">Djibouti </option> <option value="Dominica">Dominica </option> <option value="Dominican Republic">Dominican Republic </option> <option value="Ecuador">Ecuador </option> <option value="Egypt">Egypt </option> <option value="El Salvador">El Salvador </option> <option value="Equatorial Guinea">Equatorial Guinea </option> <option value="Eritrea">Eritrea </option> <option value="Estonia">Estonia </option> <option value="Swaziland">Eswatini </option> <option value="Ethiopia">Ethiopia </option> <option value="Falkland Islands (Malvinas)">Falkland Islands (Malvinas) </option> <option value="Faroe Islands">Faroe Islands </option> <option value="Fiji">Fiji </option> <option value="Finland">Finland </option> <option value="France">France </option> <option value="French Guiana">French Guiana </option> <option value="French Polynesia">French Polynesia </option> <option value="French Southern Territories">French Southern Territories </option> <option value="Gabon">Gabon </option> <option value="Gambia">Gambia </option> <option value="Georgia">Georgia </option> <option value="Germany">Germany </option> <option value="Ghana">Ghana </option> <option value="Gibraltar">Gibraltar </option> <option value="Greece">Greece </option> <option value="Greenland">Greenland </option> <option value="Grenada">Grenada </option> <option value="Guadeloupe">Guadeloupe </option> <option value="Guam">Guam </option> <option value="Guatemala">Guatemala </option> <option value="Guernsey">Guernsey </option> <option value="Guinea">Guinea </option> <option value="Guinea-Bissau">Guinea-Bissau </option> <option value="Guyana">Guyana </option> <option value="Haiti">Haiti </option> <option value="Heard Island and McDonald Islands">Heard Island and McDonald Islands </option> <option value="Vatican City State">Holy See </option> <option value="Honduras">Honduras </option> <option value="Hong Kong">Hong Kong </option> <option value="Hungary">Hungary </option> <option value="Iceland">Iceland </option> <option value="India">India </option> <option value="Indonesia">Indonesia </option> <option value="Iran">Iran (Islamic Republic of) </option> <option value="Iraq">Iraq </option> <option value="Ireland">Ireland </option> <option value="Isle of Man">Isle of Man </option> <option value="Israel">Israel </option> <option value="Italy">Italy </option> <option value="Jamaica">Jamaica </option> <option value="Japan">Japan </option> <option value="Jersey">Jersey </option> <option value="Jordan">Jordan </option> <option value="Kazakhstan">Kazakhstan </option> <option value="Kenya">Kenya </option> <option value="Kiribati">Kiribati </option> <option value="Democratic People's Republic of Korea">Korea, Democratic People's Republic of </option> <option value="Republic of Korea">Korea, Republic of </option> <option value="Kuwait">Kuwait </option> <option value="Kyrgyzstan">Kyrgyzstan </option> <option value="Lao People's Democratic Republic">Lao People's Democratic Republic </option> <option value="Latvia">Latvia </option> <option value="Lebanon">Lebanon </option> <option value="Lesotho">Lesotho </option> <option value="Liberia">Liberia </option> <option value="Libya">Libya </option> <option value="Liechtenstein">Liechtenstein </option> <option value="Lithuania">Lithuania </option> <option value="Luxembourg">Luxembourg </option> <option value="Macao">Macao </option> <option value="Madagascar">Madagascar </option> <option value="Malawi">Malawi </option> <option value="Malaysia">Malaysia </option> <option value="Maldives">Maldives </option> <option value="Mali">Mali </option> <option value="Malta">Malta </option> <option value="Marshall Islands">Marshall Islands </option> <option value="Martinique">Martinique </option> <option value="Mauritania">Mauritania </option> <option value="Mauritius">Mauritius </option> <option value="Mayotte">Mayotte </option> <option value="Mexico">Mexico </option> <option value="Micronesia">Micronesia (Federated States of) </option> <option value="Moldova">Moldova, Republic of </option> <option value="Monaco">Monaco </option> <option value="Mongolia">Mongolia </option> <option value="Montenegro">Montenegro </option> <option value="Montserrat">Montserrat </option> <option value="Morocco">Morocco </option> <option value="Mozambique">Mozambique </option> <option value="Myanmar">Myanmar </option> <option value="Namibia">Namibia </option> <option value="Nauru">Nauru </option> <option value="Nepal">Nepal </option> <option value="Netherlands">Netherlands </option> <option value="New Caledonia">New Caledonia </option> <option value="New Zealand">New Zealand </option> <option value="Nicaragua">Nicaragua </option> <option value="Niger">Niger </option> <option value="Nigeria">Nigeria </option> <option value="Niue">Niue </option> <option value="Norfolk Island">Norfolk Island </option> <option value="Macedonia">North Macedonia </option> <option value="Northern Mariana Islands">Northern Mariana Islands </option> <option value="Norway">Norway </option> <option value="Oman">Oman </option> <option value="Pakistan">Pakistan </option> <option value="Palau">Palau </option> <option value="Palestine">Palestine, State of </option> <option value="Panama">Panama </option> <option value="Papua New Guinea">Papua New Guinea </option> <option value="Paraguay">Paraguay </option> <option value="Peru">Peru </option> <option value="Philippines">Philippines </option> <option value="Pitcairn Group of Islands">Pitcairn </option> <option value="Poland">Poland </option> <option value="Portugal">Portugal </option> <option value="Puerto Rico">Puerto Rico </option> <option value="Qatar">Qatar </option> <option value="Reunion">Réunion </option> <option value="Romania">Romania </option> <option value="Russian Federation">Russian Federation </option> <option value="Rwanda">Rwanda </option> <option value="Saint Barthelemy">Saint Barthélemy </option> <option value="Saint Helena">Saint Helena, Ascension and Tristan da Cunha </option> <option value="Saint Kitts and Nevis">Saint Kitts and Nevis </option> <option value="Saint Lucia">Saint Lucia </option> <option value="Saint Martin (French part)">Saint Martin (French part) </option> <option value="Saint Pierre and Miquelon">Saint Pierre and Miquelon </option> <option value="Saint Vincent and the Grenadines">Saint Vincent and the Grenadines </option> <option value="Samoa">Samoa </option> <option value="San Marino">San Marino </option> <option value="Sao Tome and Principe">Sao Tome and Principe </option> <option value="Saudi Arabia">Saudi Arabia </option> <option value="Senegal">Senegal </option> <option value="Serbia">Serbia </option> <option value="Seychelles">Seychelles </option> <option value="Sierra Leone">Sierra Leone </option> <option value="Singapore">Singapore </option> <option value="Saint Martin">Sint Maarten (Dutch part) </option> <option value="Slovakia">Slovakia </option> <option value="Slovenia">Slovenia </option> <option value="Solomon Islands">Solomon Islands </option> <option value="Somalia">Somalia </option> <option value="South Africa">South Africa </option> <option value="South Georgia and the South Sandwich Islands">South Georgia and the South Sandwich Islands </option> <option value="South Sudan">South Sudan </option> <option value="Spain">Spain </option> <option value="Sri Lanka">Sri Lanka </option> <option value="Sudan">Sudan </option> <option value="Suriname">Suriname </option> <option value="Svalbard and Jan Mayen">Svalbard and Jan Mayen </option> <option value="Sweden">Sweden </option> <option value="Switzerland">Switzerland </option> <option value="Syrian Arab Republic">Syrian Arab Republic </option> <option value="Taiwan (Republic of China)">Taiwan </option> <option value="Tajikistan">Tajikistan </option> <option value="United Republic of Tanzania">Tanzania, United Republic of </option> <option value="Thailand">Thailand </option> <option value="Timor-Leste">Timor-Leste </option> <option value="Togo">Togo </option> <option value="Tokelau">Tokelau </option> <option value="Tonga">Tonga </option> <option value="Trinidad and Tobago">Trinidad and Tobago </option> <option value="Tunisia">Tunisia </option> <option value="Turkey">Turkey </option> <option value="Turkmenistan">Turkmenistan </option> <option value="Turks and Caicos Islands">Turks and Caicos Islands </option> <option value="Tuvalu">Tuvalu </option> <option value="Uganda">Uganda </option> <option value="Ukraine">Ukraine </option> <option value="United Arab Emirates">United Arab Emirates </option> <option value="United Kingdom">United Kingdom </option> <option value="United States Minor Outlying Islands">United States Minor Outlying Islands </option> <option value="United States">United States </option> <option value="Uruguay">Uruguay </option> <option value="Uzbekistan">Uzbekistan </option> <option value="Vanuatu">Vanuatu </option> <option value="Venezuela">Venezuela (Bolivarian Republic of) </option> <option value="Vietnam">Viet Nam </option> <option value="Virgin Islands">Virgin Islands (British) </option> <option value="Virgin Islands (U.S.)">Virgin Islands (U.S.) </option> <option value="Wallis and Futuna">Wallis and Futuna </option> <option value="Western Sahara">Western Sahara </option> <option value="Yemen">Yemen </option> <option value="Zambia">Zambia </option> <option value="Zimbabwe">Zimbabwe </option> </select> </div> </div> </div> </div> </div> </div> </div> </div> <div class="row"> <div class="grid-layout-col"> <div class="layout-col col-sm-12 col-xs-12"> <div id="formElement7" class="elq-field-style form-element-layout row"> <div style="text-align:left;" class="col-sm-12 col-xs-12"> <label class="elq-label " for="fe65335">Institution/Organisation <span class="elq-required">* </span> </label> </div> <div class="col-sm-12 col-xs-12"> <div class="row"> <div class="col-xs-12"> <div class="field-control-wrapper"> <input type="text" class="elq-item-input" name="organisation" id="fe65335" value="" style="width:100%;"> </div> </div> </div> </div> </div> </div> </div> </div> <div class="row"> <div class="grid-layout-col"> <div class="layout-col col-sm-12 col-xs-12"> <div id="formElement8" class="elq-field-style form-element-layout row"> <div style="text-align:left;" class="col-sm-12 col-xs-12"> <label class="elq-label " for="fe65357">Faculty/Department </label> </div> <div class="col-sm-12 col-xs-12"> <div class="row"> <div class="col-xs-12"> <div class="field-control-wrapper"> <input type="text" class="elq-item-input" name="faculty" id="fe65357" value="" style="width:100%;"> </div> </div> </div> </div> </div> </div> </div> </div> <div class="row"> <div class="grid-layout-col"> <div class="layout-col col-sm-12 col-xs-12"> <div id="formElement9" class="elq-field-style form-element-layout row"> <div style="text-align:left;" class="col-sm-12 col-xs-12"> <label class="elq-label " for="fe65337">Job Title </label> </div> <div class="col-sm-12 col-xs-12"> <div class="row"> <div class="col-xs-12"> <div class="field-control-wrapper"> <input type="text" class="elq-item-input" name="title" id="fe65337" value="" style="width:100%;"> </div> </div> </div> </div> </div> </div> </div> </div> <div class="row"> <div class="grid-layout-col"> <div class="layout-col col-sm-12 col-xs-12"> <div id="formElement10" class="elq-field-style form-element-layout row"> <div style="text-align:left;" class="col-sm-12 col-xs-12"> <label class="elq-label " for="fe65338">Job Role <span class="elq-required">* </span> </label> </div> <div class="col-sm-12 col-xs-12"> <div class="row"> <div class="col-xs-12"> <div class="field-control-wrapper"> <select class="elq-item-select" id="fe65338" name="jobRole1" style="width:100%;" data-value="~~eloqua..type--emailfield..syntax--Job_Role1~~"> <option value="">Please select… </option> <option value="(DG APAC) Dean/ Department Chair/ Programme Head/ Department Head">Dean/ Programme Head&nbsp;/ Department Head </option> <option value="(DG APAC) Director/Manager">Director/Manager </option> <option value="(DG APAC) Faculty">Faculty </option> <option value="(DG APAC) Head of Research">Head of Research </option> <option value="(DG APAC) Lecturer">Lecturer </option> <option value="(DG APAC) Librarian">Librarian </option> <option value="(DG APAC) Library Director">Library Director </option> <option value="(DG APAC) Postgraduate Student">Postgraduate Student </option> <option value="(DG APAC) President/ Rector/ Chancellor">President/ Rector/ Chancellor </option> <option value="(DG APAC) Professor">Professor </option> <option value="(DG APAC) Provost">Provost </option> <option value="(DG APAC) Researcher">Researcher </option> <option value="(DG APAC) Undergraduate Student">Undergraduate Student </option> <option value="(DG APAC) University Research Administrator">University Research Administrator </option> <option value="(DG APAC) Vice President/ Vice-Rector/ Vice Chancellor">Vice President/ Vice-Rector/ Vice Chancellor </option> </select> </div> </div> </div> </div> </div> </div> </div> </div> <div class="row"> <div class="grid-layout-col"> <div class="layout-col col-sm-12 col-xs-12"> <div id="formElement11" class="elq-field-style form-element-layout row"> <div style="text-align:left;" class="col-sm-12 col-xs-12"> <label class="elq-label " for="fe65339">Organisation Type </label> </div> <div class="col-sm-12 col-xs-12"> <div class="row"> <div class="col-xs-12"> <div class="field-control-wrapper"> <select class="elq-item-select" id="fe65339" name="organisationType" style="width:100%;" data-value=""> <option value="Academic ">Academic </option> <option value="Corporate">Corporate </option> <option value="Healthcare">Healthcare </option> <option value="Government">Government </option> <option value="Society/Association">Society/Association </option> <option value="Other">Other </option> </select> </div> </div> </div> </div> </div> </div> </div> </div> <div class="row"> <div class="grid-layout-col"> <div class="layout-col col-sm-12 col-xs-12"> <div id="formElement12" class="elq-field-style form-element-layout row"> <div style="text-align:left;" class="col-sm-12 col-xs-12"> <label class="elq-label " for="fe65361">Others, please specify (Organisation Type) </label> </div> <div class="col-sm-12 col-xs-12"> <div class="row"> <div class="col-xs-12"> <div class="field-control-wrapper"> <input type="text" class="elq-item-input" name="organisationTypeOthers" id="fe65361" value="" style="width:100%;"> </div> </div> </div> </div> </div> </div> </div> </div> <div class="row"> <div class="grid-layout-col"> <div class="layout-col col-sm-12 col-xs-12"> <div id="formElement19" class="elq-field-style form-element-layout row"> <div style="text-align:left;" class="col-sm-12 col-xs-12"> <label class="elq-label " for="fe84916">Let us know if you have any questions for the speakers </label> </div> <div class="col-sm-12 col-xs-12"> <div class="row"> <div class="col-xs-12"> <div class="field-control-wrapper"> <textarea class="elq-item-textarea" style="width:100%;" name="questionSpeaker" id="fe84916"> </textarea> </div> </div> </div> </div> </div> </div> </div> </div> <div class="row"> <div class="grid-layout-col"> <div class="layout-col col-sm-12 col-xs-12"> <div id="formElement20" class="elq-field-style form-element-layout row"> <div class="col-sm-12 col-xs-12"> <div class="row"> <div class="col-xs-12"> <div> <div class="single-checkbox-row row"> <input type="checkbox" name="consent" id="fe92956"> <label 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