<form method="post" name="APAC_Form_2020_SubscribeNewsletters" action="https://s1133198723.t.eloqua.com/e/f2" id="form4946" class="elq-form"><input name="elqFormName" type="hidden" value="APAC_Form_2020_SubscribeNewsletters"> <input name="elqSiteId" type="hidden" value="1133198723"> <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 class="col-sm-12 col-xs-12" style="text-align: left;"> <label class="elq-label " for="fe68382">Salutation <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 id="fe68382" class="elq-item-select" data-value="~~eloqua..type--emailfield..syntax--AUT_GM_Salutation1~~" name="salutation" style="width: 100%;"> <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 class="col-sm-12 col-xs-12" style="text-align: left;"> <label class="elq-label " for="fe68383">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 id="fe68383" class="elq-item-input" name="firstName" style="width: 100%;" type="text" value=""> </div> </div> </div> </div> </div> </div> </div> </div> <div class="row"> <div class="grid-layout-col"> <div class="layout-col col-sm-12 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name="emailAddress" style="width: 100%;" type="text" value=""> </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="formElement4" class="elq-field-style form-element-layout row"> <div class="col-sm-12 col-xs-12" style="text-align: left;"> <label class="elq-label " for="fe68386">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 id="fe68386" class="elq-item-input" name="organisation" style="width: 100%;" type="text" value=""> </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 class="col-sm-12 col-xs-12" style="text-align: left;"> <label class="elq-label " for="fe68387">Job Title <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 id="fe68387" class="elq-item-input" name="title" style="width: 100%;" type="text" value=""> </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="fe89590">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="fe89590" name="jobRole" 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> 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<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 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<option value="Equatorial Guinea">Equatorial Guinea</option> <option value="Eritrea">Eritrea</option> <option value="Estonia">Estonia</option> <option value="Ethiopia">Ethiopia </option> <option value="Falkland Islands">Falkland Islands</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 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value="Philippines">Philippines </option> <option value="Pitcairn Group of Islands"> Pitcairn Group of Islands</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="Republic of Korea">Republic of Korea</option> <option value="Reunion">Reunion</option> <option value="Romania">Romania</option> <option value="Russian Federation">Russian Federation</option> <option value="Rwanda">Rwanda</option> <option value="Saint Barthelemy">Saint Barthelemy </option> <option value="Saint Helena">Saint Helena </option> <option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option> <option value="Saint Lucia">Saint Lucia </option> <option value="Saint Martin">Saint Martin </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 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</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 class="col-sm-12 col-xs-12" style="text-align: left;"> <label class="elq-label " for="fe89493">What type of emails would you like to receive from us? </label> </div> <div class="col-sm-12 col-xs-12"> <div class="row"> <div class="col-xs-12"> <div id="fe89493" class="field-control-wrapper"> <div class="list-order one-column"> <input id="checkbox-Wiley Events &amp; Webinars_ngidj21k" name="emailType" type="checkbox" value="Wiley Events &amp; Webinars"> <label class="checkbox-aligned elq-item-label" for="checkbox-Wiley Events &amp; Webinars_ngidj21k"> Wiley Events &amp; Webinars </label> <br></div> <div class="list-order one-column"> <input id="checkbox-Wiley News_s6d3gfu" name="emailType" type="checkbox" value="Wiley News"> <label class="checkbox-aligned elq-item-label" for="checkbox-Wiley News_s6d3gfu"> Wiley News </label><br></div> <div class="list-order one-column"> <input id="checkbox-Products_fd23aqxh" name="emailType" type="checkbox" value="Products"> <label class="checkbox-aligned elq-item-label" for="checkbox-Products_fd23aqxh"> Products </label><br></div> <div class="list-order one-column"> <input id="checkbox-None of the above_y6jdmaqi" name="emailType" type="checkbox" value="None of the above"> <label class="checkbox-aligned elq-item-label" for="checkbox-None of the above_y6jdmaqi"> None of the above </label><br></div> </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 class="col-sm-12 col-xs-12" style="text-align: left;"> <label class="elq-label " for="fe89494">Please select your subject interest </label></div> <div class="col-sm-12 col-xs-12"> <div class="row"> <div class="col-xs-12"> <div id="fe89494" class="field-control-wrapper"> <div class="list-order one-column"> <input id="checkbox-Earth &amp; Environmental Sciences_8p5wqqf4" name="subjectInterest" type="checkbox" value="Earth &amp; Environmental Sciences"> <label class="checkbox-aligned elq-item-label" for="checkbox-Earth &amp; Environmental Sciences_8p5wqqf4"> Earth &amp; Environmental Sciences </label><br></div> <div class="list-order one-column"> <input id="checkbox-Life Sciences_swbzv8pg" name="subjectInterest" type="checkbox" value="Life Sciences"> <label class="checkbox-aligned elq-item-label" for="checkbox-Life Sciences_swbzv8pg"> Life Sciences </label><br></div> <div class="list-order one-column"> <input id="checkbox-Medicine_htj1vqv8" name="subjectInterest" type="checkbox" value="Medicine"> <label class="checkbox-aligned elq-item-label" for="checkbox-Medicine_htj1vqv8"> Medicine </label><br></div> <div class="list-order one-column"> <input id="checkbox-Nursing, Dentistry &amp; Healthcare_g1tu6vrb" name="subjectInterest" type="checkbox" value="Nursing, Dentistry &amp; Healthcare"> <label class="checkbox-aligned elq-item-label" for="checkbox-Nursing, Dentistry &amp; Healthcare_g1tu6vrb"> Nursing, Dentistry &amp; Healthcare </label><br></div> <div class="list-order one-column"> <input id="checkbox-Physical Sciences &amp; Engineering_dc6va03p" name="subjectInterest" type="checkbox" value="Physical Sciences &amp; Engineering"> <label class="checkbox-aligned elq-item-label" for="checkbox-Physical Sciences &amp; Engineering_dc6va03p"> Physical Sciences &amp; Engineering </label><br></div> <div class="list-order one-column"> <input id="checkbox-Social Sciences &amp; Humanities_as9jh33l" name="subjectInterest" type="checkbox" value="Social Sciences &amp; Humanities"> <label class="checkbox-aligned elq-item-label" for="checkbox-Social Sciences &amp; Humanities_as9jh33l"> Social Sciences &amp; Humanities 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id="fe89495" class="elq-item-input" name="subjectInterestOthers" style="width: 100%;" type="text" value=""> </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 class="col-sm-12 col-xs-12"> <div class="row"> <div class="col-xs-12"> <div style="text-align: left;"> <h4 class="elq-heading form-element-form-text"> Let’s Stay in Touch… </h4> </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 class="col-sm-12 col-xs-12"> <div class="row"> <div class="col-xs-12"> <div> <div class="single-checkbox-row row"> <input id="fe68390" name="consent" type="checkbox"> <label class="checkbox-aligned elq-item-label" for="fe68390"> Yes, I consent to receive 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