
    <input type="checkbox"  class="country-check"  name="country[]" value="Afghanistan"> Afghanistan<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Albania"> Albania<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Algeria"> Algeria<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="American Samoa"> American Samoa<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Andorra"> Andorra<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Angola"> Angola<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Anguilla"> Anguilla<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Antartica"> Antarctica<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Antigua and Barbuda"> Antigua and Barbuda<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Argentina"> Argentina<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Armenia"> Armenia<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Aruba"> Aruba<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Australia"> Australia<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Austria"> Austria<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Azerbaijan"> Azerbaijan<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Bahamas"> Bahamas<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Bahrain"> Bahrain<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Bangladesh"> Bangladesh<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Barbados"> Barbados<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Belarus"> Belarus<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Belgium"> Belgium<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Belize"> Belize<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Benin"> Benin<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Bermuda"> Bermuda<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Bhutan"> Bhutan<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Bolivia"> Bolivia<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Bosnia and Herzegowina"> Bosnia and Herzegowina<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Botswana"> Botswana<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Bouvet Island"> Bouvet Island<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Brazil"> Brazil<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="British Indian Ocean Territory"> British Indian Ocean Territory<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Brunei Darussalam"> Brunei Darussalam<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Bulgaria"> Bulgaria<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Burkina Faso"> Burkina Faso<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Burundi"> Burundi<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Cambodia"> Cambodia<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Cameroon"> Cameroon<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Canada"> Canada<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Cape Verde"> Cape Verde<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Cayman Islands"> Cayman Islands<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Central African Republic"> Central African Republic<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Chad"> Chad<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Chile"> Chile<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="China"> China<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Christmas Island"> Christmas Island<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Cocos Islands"> Cocos (Keeling) Islands<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Colombia"> Colombia<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Comoros"> Comoros<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Congo"> Congo<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Congo"> Congo, the Democratic Republic of the<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Cook Islands"> Cook Islands<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Costa Rica"> Costa Rica<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Cota D'Ivoire"> Cote d'Ivoire<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Croatia"> Croatia (Hrvatska)<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Cuba"> Cuba<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Cyprus"> Cyprus<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Czech Republic"> Czech Republic<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Denmark"> Denmark<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Djibouti"> Djibouti<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Dominica"> Dominica<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Dominican Republic"> Dominican Republic<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="East Timor"> East Timor<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Ecuador"> Ecuador<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Egypt"> Egypt<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="El Salvador"> El Salvador<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Equatorial Guinea"> Equatorial Guinea<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Eritrea"> Eritrea<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Estonia"> Estonia<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Ethiopia"> Ethiopia<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Falkland Islands"> Falkland Islands (Malvinas)<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Faroe Islands"> Faroe Islands<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Fiji"> Fiji<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Finland"> Finland<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="France"> France<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="France Metropolitan"> France, Metropolitan<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="French Guiana"> French Guiana<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="French Polynesia"> French Polynesia<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="French Southern Territories"> French Southern Territories<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Gabon"> Gabon<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Gambia"> Gambia<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Georgia"> Georgia<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Germany"> Germany<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Ghana"> Ghana<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Gibraltar"> Gibraltar<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Greece"> Greece<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Greenland"> Greenland<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Grenada"> Grenada<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Guadeloupe"> Guadeloupe<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Guam"> Guam<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Guatemala"> Guatemala<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Guinea"> Guinea<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Guinea-Bissau"> Guinea-Bissau<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Guyana"> Guyana<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Haiti"> Haiti<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Heard and McDonald Islands"> Heard and Mc Donald Islands<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Holy See"> Holy See (Vatican City State)<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Honduras"> Honduras<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Hong Kong"> Hong Kong<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Hungary"> Hungary<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Iceland"> Iceland<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="India"> India<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Indonesia"> Indonesia<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Iran"> Iran (Islamic Republic of)<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Iraq"> Iraq<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Ireland"> Ireland<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Israel"> Israel<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Italy"> Italy<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Jamaica"> Jamaica<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Japan"> Japan<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Jordan"> Jordan<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Kazakhstan"> Kazakhstan<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Kenya"> Kenya<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Kiribati"> Kiribati<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Democratic People's Republic of Korea"> Korea, Democratic People's Republic of<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Korea"> Korea, Republic of<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Kuwait"> Kuwait<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Kyrgyzstan"> Kyrgyzstan<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Lao"> Lao People's Democratic Republic<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Latvia"> Latvia<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Lebanon"> Lebanon<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Lesotho"> Lesotho<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Liberia"> Liberia<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Libyan Arab Jamahiriya"> Libyan Arab Jamahiriya<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Liechtenstein"> Liechtenstein<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Lithuania"> Lithuania<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Luxembourg"> Luxembourg<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Macau"> Macau<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Macedonia"> Macedonia, The Former Yugoslav Republic of<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Madagascar"> Madagascar<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Malawi"> Malawi<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Malaysia"> Malaysia<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Maldives"> Maldives<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Mali"> Mali<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Malta"> Malta<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Marshall Islands"> Marshall Islands<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Martinique"> Martinique<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Mauritania"> Mauritania<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Mauritius"> Mauritius<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Mayotte"> Mayotte<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Mexico"> Mexico<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Micronesia"> Micronesia, Federated States of<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Moldova"> Moldova, Republic of<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Monaco"> Monaco<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Mongolia"> Mongolia<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Montserrat"> Montserrat<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Morocco"> Morocco<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Mozambique"> Mozambique<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Myanmar"> Myanmar<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Namibia"> Namibia<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Nauru"> Nauru<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Nepal"> Nepal<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Netherlands"> Netherlands<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Netherlands Antilles"> Netherlands Antilles<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="New Caledonia"> New Caledonia<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="New Zealand"> New Zealand<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Nicaragua"> Nicaragua<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Niger"> Niger<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Nigeria"> Nigeria<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Niue"> Niue<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Norfolk Island"> Norfolk Island<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Northern Mariana Islands"> Northern Mariana Islands<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Norway"> Norway<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Oman"> Oman<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Pakistan"> Pakistan<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Palau"> Palau<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Panama"> Panama<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Papua New Guinea"> Papua New Guinea<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Paraguay"> Paraguay<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Peru"> Peru<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Philippines"> Philippines<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Pitcairn"> Pitcairn<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Poland"> Poland<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Portugal"> Portugal<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Puerto Rico"> Puerto Rico<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Qatar"> Qatar<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Reunion"> Reunion<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Romania"> Romania<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Russia"> Russian Federation<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Rwanda"> Rwanda<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Saint Kitts and Nevis"> Saint Kitts and Nevis<br/> 
    <input type="checkbox"  class="country-check"  name="country[]" value="Saint LUCIA"> Saint LUCIA<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Saint Vincent"> Saint Vincent and the Grenadines<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Samoa"> Samoa<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="San Marino"> San Marino<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Sao Tome and Principe"> Sao Tome and Principe<br/> 
    <input type="checkbox"  class="country-check"  name="country[]" value="Saudi Arabia"> Saudi Arabia<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Senegal"> Senegal<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Seychelles"> Seychelles<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Sierra"> Sierra Leone<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Singapore"> Singapore<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Slovakia"> Slovakia (Slovak Republic)<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Slovenia"> Slovenia<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Solomon Islands"> Solomon Islands<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Somalia"> Somalia<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="South Africa"> South Africa<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="South Georgia"> South Georgia and the South Sandwich Islands<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Span"> Spain<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="SriLanka"> Sri Lanka<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="St. Helena"> St. Helena<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="St. Pierre and Miguelon"> St. Pierre and Miquelon<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Sudan"> Sudan<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Suriname"> Suriname<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Svalbard"> Svalbard and Jan Mayen Islands<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Swaziland"> Swaziland<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Sweden"> Sweden<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Switzerland"> Switzerland<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Syria"> Syrian Arab Republic<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Taiwan"> Taiwan, Province of China<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Tajikistan"> Tajikistan<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Tanzania"> Tanzania, United Republic of<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Thailand"> Thailand<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Togo"> Togo<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Tokelau"> Tokelau<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Tonga"> Tonga<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Trinidad and Tobago"> Trinidad and Tobago<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Tunisia"> Tunisia<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Turkey"> Turkey<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Turkmenistan"> Turkmenistan<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Turks and Caicos"> Turks and Caicos Islands<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Tuvalu"> Tuvalu<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Uganda"> Uganda<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Ukraine"> Ukraine<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="United Arab Emirates"> United Arab Emirates<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="United Kingdom"> United Kingdom<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="United States"> United States<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="United States Minor Outlying Islands"> United States Minor Outlying Islands<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Uruguay"> Uruguay<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Uzbekistan"> Uzbekistan<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Vanuatu"> Vanuatu<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Venezuela"> Venezuela<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Vietnam"> Viet Nam<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Virgin Islands (British)"> Virgin Islands (British)<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Virgin Islands (U.S)"> Virgin Islands (U.S.)<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Wallis and Futana Islands"> Wallis and Futuna Islands<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Western Sahara"> Western Sahara<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Yemen"> Yemen<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Yugoslavia"> Yugoslavia<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Zambia"> Zambia<br/>
    <input type="checkbox"  class="country-check"  name="country[]" value="Zimbabwe"> Zimbabwe<br/>

