<\/p>

<\/ul><\/div>\n
\n

\n\n\n\n\n\n\n<\/div>\n

Name\n<\/p>\n

<\/span>\n<\/p>\n

Email\n<\/p>\n

<\/span>\n<\/p>\n

Phone\n<\/p>\n

<\/span>\n<\/p>\n

Date of birth\n<\/p>\n

<\/span>\n<\/p>\n

Gender\n<\/p>\n

—Please choose an option—<\/option>Male<\/option>Female<\/option><\/select><\/span>\n<\/p>\n

Smoker\n<\/p>\n

—Please choose an option—<\/option>Non-smoker<\/option>Smoker<\/option><\/select><\/span>\n<\/p>\n

Preferred date\n<\/p>\n

<\/span>\n<\/p>\n

Preferred time\n<\/p>\n

08:00 am<\/option>08:30 am<\/option>09:00 am<\/option>09:30 am<\/option>10:00 am<\/option>10:30 am<\/option>11:00 am<\/option>11:30 am<\/option>12:00 pm<\/option>12:30 pm<\/option>01:00 pm<\/option>01:30 pm<\/option>02:00 pm<\/option>02:30 pm<\/option>03:00 pm<\/option>03:30 pm<\/option>04:00 pm<\/option>04:30 pm<\/option>05:00 pm<\/option>05:30 pm<\/option>06:00 pm<\/option>06:30 pm<\/option>07:00 pm<\/option>07:30 pm<\/option>08:00 pm<\/option>08:30 pm<\/option>09:00 pm<\/option><\/select><\/span>\n<\/p>\n

Preferred venue\n<\/p>\n

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