<form id="formExtEventsAPAC" accept-charset="UTF-8" action="https://m.info.wiley.com/webApp/formExtEventsAPAC?" method="post"> <div class="form-group"> <label for="salutation">Salutation</label> <select id="salutation" name="salutation" class="custom-select"> <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 class="form-group"> <label for="firstName">First Name*</label> <input id="firstName" name="firstName" type="text" class="form-control" required="required"> </div> <div class="form-group"> <label for="lastName">Last Name*</label> <input id="lastName" name="lastName" type="text" class="form-control" required="required"> </div> <div class="form-group"> <label for="email">E-mail Address*</label> <input id="email" name="email" type="email" required="required" class="form-control"> </div> <div class="form-group"> <label for="businessPhone">Business Phone</label> <input id="businessPhone" name="businessPhone" type="text" class="form-control"> </div> <div class="form-group"> <label for="phone">Mobile Phone</label> <input id="phone" name="phone" type="text" class="form-control"> </div> <div class="form-group"> <label for="country">Country/Location*</label> <div> <select id="country" name="country" class="custom-select" required="required"> <option value="">Please select...</option> <option value="AF">Afghanistan</option> <option value="AX">Aland Islands</option> <option value="AL">Albania</option> <option value="DZ">Algeria</option> <option value="AS">American Samoa</option> <option value="AD">Andorra</option> <option value="AO">Angola</option> <option value="AI">Anguilla</option> <option value="AQ">Antartica</option> <option value="AG">Antigua and Barbuda</option> <option value="AR">Argentina</option> <option value="AM">Armenia</option> <option value="AW">Aruba</option> <option value="AU">Australia</option> <option value="AT">Austria</option> <option value="AZ">Azerbaijan</option> <option value="BS">Bahamas</option> <option value="BH">Bahrain</option> <option value="BD">Bangladesh</option> <option value="BB">Barbados</option> <option value="BY">Belarus</option> <option value="BE">Belgium</option> <option value="BZ">Belize</option> <option value="BJ">Benin</option> <option value="BM">Bermuda</option> <option value="BT">Bhutan</option> <option value="GW">Bissau</option> <option value="BO">Bolivia</option> <option value="BA">Bosnia and Herzegovina</option> <option value="BW">Botswana</option> <option value="BV">Bouvet island</option> <option value="BR">Brazil</option> <option value="IO">British Indian Ocean Territory</option> <option value="VG">British Virgin Islands</option> <option value="BN">Brunei Darussalam</option> <option value="BG">Bulgaria</option> <option value="BF">Burkina Faso</option> <option value="BI">Burundi</option> <option value="KH">Cambodia</option> <option value="CM">Cameroon</option> <option value="CA">Canada</option> <option value="CV">Cape Verde</option> <option value="KY">Cayman islands</option> <option value="CF">Central Africa Republic</option> <option value="TD">Chad</option> <option value="CL">Chile</option> <option value="CN">China</option> <option value="CX">Christmas Island</option> <option value="CC">Coco Islands</option> <option value="CO">Colombia</option> <option value="KM">Comoros</option> <option value="CK">Cook Islands</option> <option value="CR">Costa Rica</option> <option value="HR">Croatia</option> <option value="CU">Cuba</option> <option value="CY">Cyprus</option> <option value="CZ">Czech Republic</option> <option value="CD">Democratic Republic of Congo</option> <option value="DK">Denmark</option> <option value="DJ">Djibouti</option> <option value="DM">Dominica</option> <option value="DO">Dominican Republic</option> <option value="EC">Ecuador</option> <option value="EG">Egypt</option> <option value="SV">El Salvador</option> <option value="GQ">Equatorial Guinea</option> <option value="ER">Eritrea</option> <option value="EE">Estonia</option> <option value="ET">Ethiopia</option> <option value="FO">Faeroe Islands</option> <option value="FK">Falkland Islands</option> <option value="FJ">Fiji</option> <option value="FI">Finland</option> <option value="FR">France</option> <option value="GF">French Guiana</option> <option value="PF">French Polynesia</option> <option value="TF">French Southern Territories</option> <option value="GA">Gabon</option> <option value="GM">Gambia</option> <option value="GE">Georgia</option> <option value="DE">Germany</option> <option value="GH">Ghana</option> <option value="GI">Gibraltar</option> <option value="GR">Greece</option> <option value="GL">Greenland</option> <option value="GD">Grenada</option> <option value="GP">Guadeloupe</option> <option value="GU">Guam</option> <option value="GT">Guatemala</option> <option value="GN">Guinea</option> <option value="GY">Guyana</option> <option value="HT">Haiti</option> <option value="HM">Heard Island and McDonald Islands</option> <option value="HN">Honduras</option> <option value="HK">Hong Kong (SAR China)</option> <option value="HU">Hungary</option> <option value="IS">Iceland</option> <option value="IN">India</option> <option value="ID">Indonesia</option> <option value="IR">Iran</option> <option value="IQ">Iraq</option> <option value="IE">Ireland</option> <option value="IL">Israel</option> <option value="IT">Italy</option> <option value="CI">Ivory Coast</option> <option value="JM">Jamaica</option> <option value="JP">Japan</option> <option value="JO">Jordan</option> <option value="KZ">Kazakhstan</option> <option value="KE">Kenya</option> <option value="KI">Kiribati</option> <option value="KR">Korea</option> <option value="KW">Kuwait</option> <option value="KG">Kyrgyzstan</option> <option value="LA">Lao</option> <option value="LV">Latvia</option> <option value="LB">Lebanon</option> <option value="LS">Lesotho</option> <option value="LR">Liberia</option> <option value="LY">Libya</option> <option value="LI">Liechtenstein</option> <option value="LT">Lithuania</option> <option value="LU">Luxembourg</option> <option value="MO">Macau (SAR China)</option> <option value="MK">Macedonia</option> <option value="MG">Madagascar</option> <option value="MW">Malawi</option> <option value="MY">Malaysia</option> <option value="MV">Maldives</option> <option value="ML">Mali</option> <option value="MT">Malta</option> <option value="MH">Marshall Islands</option> <option value="MQ">Martinique</option> <option value="MR">Mauritania</option> <option value="MU">Mauritius</option> <option value="YT">Mayotte</option> <option value="MX">Mexico</option> <option value="FM">Micronesia</option> <option value="MD">Moldova</option> <option value="MC">Monaco</option> <option value="MN">Mongolia</option> <option value="ME">Montenegro</option> <option value="MS">Montserrat</option> <option value="MA">Morocco</option> <option value="MZ">Mozambique</option> <option value="MM">Myanmar</option> <option value="NA">Namibia</option> <option value="NR">Nauru</option> <option value="NP">Nepal</option> <option value="NL">Netherlands</option> <option value="AN">Netherlands Antilles</option> <option value="NC">New Caledonia</option> <option value="NZ">New Zealand</option> <option value="NI">Nicaragua</option> <option value="NE">Niger</option> <option value="NG">Nigeria</option> <option value="NU">Niue</option> <option value="NF">Norfolk Island</option> <option value="KP">Northern Korea</option> <option value="MP">Northern Mariana Islands</option> <option value="NO">Norway</option> <option value="OM">Oman</option> <option value="PK">Pakistan</option> <option value="PW">Palau</option> <option value="PS">Palestinian territories</option> <option value="PA">Panama</option> <option value="PG">Papua New Guinea</option> <option value="PY">Paraguay</option> <option value="PE">Peru</option> <option value="PH">Philippines</option> <option value="PN">Pitcairn</option> <option value="PL">Poland</option> <option value="PT">Portugal</option> <option value="PR">Puerto Rico</option> <option value="QA">Qatar</option> <option value="CG">Republic of Congo</option> <option value="RO">Romania</option> <option value="RU">Russia</option> <option value="RW">Rwanda</option> <option value="RE">Réunion</option> <option value="KN">Saint Kitts and Nevis</option> <option value="LC">Saint Lucia</option> <option value="PM">Saint Pierre and Miquelon</option> <option value="VC">Saint Vincent and the Grenadines</option> <option value="SH">Saint elena</option> <option value="WS">Samoa</option> <option value="SM">San Marino</option> <option value="ST">Sao Tome and Principe</option> <option value="SA">Saudi Arabia</option> <option value="SN">Senegal</option> <option value="RS">Serbia</option> <option value="SC">Seychelles</option> <option value="SL">Sierra Leone</option> <option value="SG">Singapore</option> <option value="SK">Slovakia</option> <option value="SI">Slovenia</option> <option value="SB">Solomon Islands</option> <option value="SO">Somalia</option> <option value="ZA">South Africa</option> <option value="GS">South Georgia and the South Sandwich Islands</option> <option value="ES">Spain</option> <option value="LK">Sri Lanka</option> <option value="SD">Sudan</option> <option value="SR">Suriname</option> <option value="SJ">Svalbard and Jan Mayen</option> <option value="SZ">Swaziland</option> <option value="SE">Sweden</option> <option value="CH">Switzerland</option> <option value="SY">Syria</option> <option value="TW">Taiwan</option> <option value="TJ">Tajikistan</option> <option value="TZ">Tanzania</option> <option value="TH">Thailand</option> <option value="TL">Timor-Leste</option> <option value="TG">Togo</option> <option value="TK">Tokelau</option> <option value="TO">Tonga</option> <option value="TT">Trinidad and Tobago</option> <option value="TN">Tunisia</option> <option value="TR">Turkey</option> <option value="TM">Turkmenistan</option> <option value="TC">Turks and Caicos Islands</option> <option value="TV">Tuvalu</option> <option value="VI">U.S. Virgin Islands</option> <option value="UG">Uganda</option> <option value="UA">Ukraine</option> <option value="AE">United Arab Emirates</option> <option value="GB">United Kingdom</option> <option value="US">United States</option> <option value="UM">United States Minor Outlying Islands</option> <option value="UY">Uruguay</option> <option value="UZ">Uzbekistan</option> <option value="VU">Vanuatu</option> <option value="VA">Vatican</option> <option value="VE">Venezuela</option> <option value="VN">Vietnam</option> <option value="WF">Wallis and Futuna</option> <option value="EH">Western Sahara</option> <option value="YE">Yemen</option> <option value="ZM">Zambia</option> <option value="ZW">Zimbabwe</option> </select> </div> </div> <div class="form-group"> <label for="companyName">Institution/Organisation*</label> <input id="companyName" name="companyName" type="text" class="form-control" required="required"> </div> <div class="form-group"> <label for="department">Faculty/Department</label> <input id="department" name="department" type="text" class="form-control"> </div> <div class="form-group"> <label for="title">Job Title</label> <input id="title" name="title" type="text" class="form-control"> </div> <div class="form-group"> <label for="jobRole">Job Role*</label> <div> <select id="jobRole" name="jobRole" class="custom-select" required="required"> <option value="">Please select...</option> <option value="(DG APAC) Dean/ Department Chair/ Programme Head/ Department Head">Dean/ Programme Head / 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 class="form-group"> <label for="orgType">Organisation Type*</label> <div> <select id="orgType" name="orgType" class="custom-select" required="required"> <option value="">Please select...</option> <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 class="form-group"> <label for="orgTypeOther">Others, please specify (Organisation Type)</label> <input id="orgTypeOther" name="orgTypeOther" type="text" class="form-control"> </div> <div class="form-group"> <label>Will you be joining us for the networking drinks reception after the seminar?</label> <div> <div class="custom-control custom-radio custom-control-inline"> <input name="networkingDrinks" id="networkingDrinks_y" type="radio" class="custom-control-input" value="Yes"> <label for="networkingDrinks_y" class="custom-control-label">Yes</label> </div> <div class="custom-control custom-radio custom-control-inline"> <input name="networkingDrinks" id="networkingDrinks_n" type="radio" class="custom-control-input" value="No"> <label for="networkingDrinks_n" class="custom-control-label">No</label> </div> </div> </div> <div class="form-group"> <label>Do you have any special dietary requirements?</label> <div> <div class="custom-control custom-radio custom-control-inline"> <input name="specialDietary" id="specialDietary_y" type="radio" class="custom-control-input" value="Yes"> <label for="specialDietary_y" class="custom-control-label">Yes</label> </div> <div class="custom-control custom-radio custom-control-inline"> <input name="specialDietary" id="specialDietary_n" type="radio" class="custom-control-input" value="No"> <label for="specialDietary_n" class="custom-control-label">No</label> </div> </div> </div> <div class="form-group"> <label for="specialDietaryText">Special Dietary</label> <input id="specialDietaryText" name="specialDietaryText" type="text" class="form-control"> </div> <div class="form-group"> <label>Do you have any accessibility requirements or requests?</label> <div> <div class="custom-control custom-radio custom-control-inline"> <input name="accessibility" id="accessibility_y" type="radio" class="custom-control-input" value="Yes"> <label for="accessibility_y" class="custom-control-label">Yes</label> </div> <div class="custom-control custom-radio custom-control-inline"> <input name="accessibility" id="accessibility_n" type="radio" class="custom-control-input" value="No"> <label for="accessibility_n" class="custom-control-label">No</label> </div> </div> </div> <div class="form-group"> <label for="accessibilityText">Accessibility</label> <input id="accessibilityText" name="accessibilityText" type="text" class="form-control"> </div> <div class="form-group"> <label for="webFormComments">Let us know if you have any questions for the speakers</label> <textarea id="webFormComments" name="webFormComments" cols="40" rows="5" class="form-control"></textarea> </div> <div class="form-group"> <div> <div class="custom-controls-stacked"> <div class="custom-control custom-checkbox"> <input name="privacyPolicy" id="privacyPolicy" type="checkbox" required="required" class="custom-control-input" value="true"> <label for="privacyPolicy" class="custom-control-label">Yes, I have read and agree to Wiley&rsquo;s <a href="https://www.wiley.com/privacy" target="_blank">Privacy Policy</a>, Wiley&rsquo;s <a href="https://www.wiley.com/terms-of-use" target="_blank">Terms of Use</a> and <a href="https://res6.info.wiley.com/res/tracking/b40bf76e5065f566ee03a0e81f2ce40a32344500409a804ebb84dd5cfaabd345.pdf" target="_blank">Mode Release</a>.*</label> </div> </div> </div> </div> <div class="form-group"> <div> <div class="custom-controls-stacked"> <div class="custom-control custom-checkbox"> <input name="consent" id="consent" type="checkbox" class="custom-control-input" value="true"> <label for="consent" class="custom-control-label">Yes, I would like to receive promotions from Wiley about Wiley&rsquo;s products, services, and events.</label> </div> </div> </div> </div> <input id="vid" name="vid" type="hidden" value=""> <input id="utm_campaign" name="utm_campaign" type="hidden" value=""> <input id="utm_content" name="utm_content" type="hidden" value=""> <input id="utm_medium" name="utm_medium" type="hidden" value=""> <input id="utm_source" name="utm_source" type="hidden" value=""> <input id="utm_term" name="utm_term" type="hidden" value=""> <div class="form-group"> <button name="submit" type="submit" class="btn btn-primary">Submit</button> </div> <div class="form-group"><p>(*)These fields are mandatory.</p></div> </form>