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Enquiry Form

Title *

First name *

Last name *

Contact phone number *

Email address *

Subject

Staff group you are applying for *

<div class="form-group  helpdesk_ticket_custom_field_specialty_606619">
    <label for="helpdesk_ticket_custom_field_specialty_606619" class=" form-label">
    	Specialty
	  	
	  		<span class="fw-asterisk">*</span>
	  	
      
    </label>

<option value>Choose...</option>

<option  data-custom-properties='{"id": "{"data-id"=>7000200381}"}'value="Acute Care Common Stem (ACCS)">
            Acute Care Common Stem (ACCS)
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000062129}"}'value="Acute Care Common Stem - Acute Medicine">
            Acute Care Common Stem - Acute Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000062130}"}'value="Acute Care Common Stem - Anaesthetics">
            Acute Care Common Stem - Anaesthetics
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000062131}"}'value="Acute Care Common Stem - Emergency Medicine">
            Acute Care Common Stem - Emergency Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000070297}"}'value="Acute Care Common Stem - General">
            Acute Care Common Stem - General
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000062132}"}'value="Acute Care Common Stem - Intensive Care Medicine">
            Acute Care Common Stem - Intensive Care Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000062133}"}'value="Acute Internal Medicine">
            Acute Internal Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000062134}"}'value="Allergy">
            Allergy
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000062135}"}'value="Anaesthetics">
            Anaesthetics
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000062136}"}'value="Audio Vestibular Medicine">
            Audio Vestibular Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000062137}"}'value="Basic Neurosciences">
            Basic Neurosciences
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000070298}"}'value="Blood Transfusion">
            Blood Transfusion
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072543}"}'value="Broad Based Training">
            Broad Based Training
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000062139}"}'value="Cardiology">
            Cardiology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000062138}"}'value="Cardiothoracic Surgery">
            Cardiothoracic Surgery
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000062140}"}'value="Chemical Pathology">
            Chemical Pathology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000062141}"}'value="Child &amp; Adolescent Psychiatry">
            Child &amp; Adolescent Psychiatry
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072544}"}'value="Child Mental Health">
            Child Mental Health
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000062142}"}'value="Clinical Cytogenetics And Molecular Genetics">
            Clinical Cytogenetics And Molecular Genetics
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000062143}"}'value="Clinical Genetics">
            Clinical Genetics
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000062144}"}'value="Clinical Neurophysiology">
            Clinical Neurophysiology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000062145}"}'value="Clinical Oncology">
            Clinical Oncology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000062146}"}'value="Clinical Pharmacology &amp; Therapeutics">
            Clinical Pharmacology &amp; Therapeutics
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072545}"}'value="Clinical Physiology">
            Clinical Physiology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000062147}"}'value="Clinical Radiology">
            Clinical Radiology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000062148}"}'value="Combined Infection Training">
            Combined Infection Training
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072546}"}'value="Community Child Health">
            Community Child Health
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000062149}"}'value="Community Sexual &amp; Reproductive Health">
            Community Sexual &amp; Reproductive Health
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072547}"}'value="Congenital Cardiac Surgery">
            Congenital Cardiac Surgery
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000062150}"}'value="Core Anaesthetics Training">
            Core Anaesthetics Training
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000062151}"}'value="Core Medical Training">
            Core Medical Training
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000062152}"}'value="Core Psychiatry Training">
            Core Psychiatry Training
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000062153}"}'value="Core Surgical Training">
            Core Surgical Training
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072548}"}'value="Cytopathology">
            Cytopathology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000200382}"}'value="Dental">
            Dental
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000130930}"}'value="Dental and Maxillofacial Radiology">
            Dental and Maxillofacial Radiology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000145964}"}'value="Dental Core Training">
            Dental Core Training
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000145965}"}'value="Dental Foundation Training">
            Dental Foundation Training
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000062154}"}'value="Dermatology">
            Dermatology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000062155}"}'value="Diagnostic Neuropathology">
            Diagnostic Neuropathology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000062156}"}'value="Emergency Medicine">
            Emergency Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000062157}"}'value="Endocrinology And Diabetes Mellitus">
            Endocrinology And Diabetes Mellitus
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000130929}"}'value="Endodontics">
            Endodontics
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000071890}"}'value="Foundation">
            Foundation
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072550}"}'value="Forensic Histopathology">
            Forensic Histopathology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072551}"}'value="Forensic Psychiatry">
            Forensic Psychiatry
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072552}"}'value="Gastro-Enterology">
            Gastro-Enterology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072553}"}'value="General (Internal) Medicine">
            General (Internal) Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072554}"}'value="General Practice">
            General Practice
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072555}"}'value="General Psychiatry">
            General Psychiatry
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072556}"}'value="General Surgery">
            General Surgery
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072557}"}'value="Genito-Urinary Medicine">
            Genito-Urinary Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072558}"}'value="Geriatric Medicine">
            Geriatric Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072559}"}'value="Gynaecological Oncology">
            Gynaecological Oncology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072560}"}'value="Haematology">
            Haematology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072561}"}'value="Hepatology">
            Hepatology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072562}"}'value="Histopathology">
            Histopathology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072563}"}'value="Immunology">
            Immunology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072564}"}'value="Infectious Diseases">
            Infectious Diseases
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072712}"}'value="Intensive Care Medicine">
            Intensive Care Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000162551}"}'value="Internal Medicine Training">
            Internal Medicine Training
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072713}"}'value="Interventional Radiology">
            Interventional Radiology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072714}"}'value="Liaison Psychiatry">
            Liaison Psychiatry
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072715}"}'value="Maternal And Fetal Medicine">
            Maternal And Fetal Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072716}"}'value="Medical Microbiology">
            Medical Microbiology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072717}"}'value="Medical Oncology">
            Medical Oncology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072718}"}'value="Medical Ophthalmology">
            Medical Ophthalmology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072719}"}'value="Medical Psychotherapy">
            Medical Psychotherapy
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072720}"}'value="Medical Virology">
            Medical Virology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072721}"}'value="Metabolic Medicine">
            Metabolic Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072722}"}'value="Neonatal Medicine">
            Neonatal Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072723}"}'value="Neurology">
            Neurology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072724}"}'value="Neurosurgery">
            Neurosurgery
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072725}"}'value="Nuclear Medicine">
            Nuclear Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072726}"}'value="Obstetrics and Gynaecology">
            Obstetrics and Gynaecology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072727}"}'value="Occupational Medicine">
            Occupational Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072728}"}'value="Old Age Psychiatry">
            Old Age Psychiatry
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000130931}"}'value="OMFS- Dental">
            OMFS- Dental
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072729}"}'value="Ophthalmology">
            Ophthalmology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072730}"}'value="Oral And Maxillofacial Pathology">
            Oral And Maxillofacial Pathology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072731}"}'value="Oral And Maxillofacial Surgery">
            Oral And Maxillofacial Surgery
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000130932}"}'value="Oral Maxillofacial Histopathology">
            Oral Maxillofacial Histopathology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000130933}"}'value="Oral Medicine">
            Oral Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000130934}"}'value="Oral Microbiology">
            Oral Microbiology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000130935}"}'value="Oral Surgery">
            Oral Surgery
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000130936}"}'value="Orthodontics">
            Orthodontics
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072732}"}'value="Otolaryngology">
            Otolaryngology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072733}"}'value="Paediatric Allergy, Immunology And Infectious Diseases">
            Paediatric Allergy, Immunology And Infectious Diseases
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072734}"}'value="Paediatric And Perinatal Pathology">
            Paediatric And Perinatal Pathology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072735}"}'value="Paediatric Cardiology">
            Paediatric Cardiology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072736}"}'value="Paediatric Clinical Pharmacology And Therapeutics">
            Paediatric Clinical Pharmacology And Therapeutics
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072737}"}'value="Paediatric Dentistry">
            Paediatric Dentistry
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072738}"}'value="Paediatric Diabetes And Endocrinology">
            Paediatric Diabetes And Endocrinology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072739}"}'value="Paediatric Emergency Medicine">
            Paediatric Emergency Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072740}"}'value="Paediatric Gastroenterology, Hepatology And Nutrition">
            Paediatric Gastroenterology, Hepatology And Nutrition
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072741}"}'value="Paediatric Inherited Metabolic Medicine">
            Paediatric Inherited Metabolic Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072742}"}'value="Paediatric Intensive Care Medicine">
            Paediatric Intensive Care Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072743}"}'value="Paediatric Nephrology">
            Paediatric Nephrology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072744}"}'value="Paediatric Neurodisability">
            Paediatric Neurodisability
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072745}"}'value="Paediatric Neurology">
            Paediatric Neurology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072746}"}'value="Paediatric Oncology">
            Paediatric Oncology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072747}"}'value="Paediatric Palliative Medicine">
            Paediatric Palliative Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072748}"}'value="Paediatric Respiratory Medicine">
            Paediatric Respiratory Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072749}"}'value="Paediatric Rheumatology">
            Paediatric Rheumatology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072750}"}'value="Paediatric Surgery">
            Paediatric Surgery
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072751}"}'value="Paediatrics">
            Paediatrics
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072752}"}'value="Palliative Medicine">
            Palliative Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072753}"}'value="Periodontics">
            Periodontics
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072754}"}'value="Pharmaceutical Medicine">
            Pharmaceutical Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072755}"}'value="Plastic Surgery">
            Plastic Surgery
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072756}"}'value="Prosthodontics">
            Prosthodontics
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072757}"}'value="Psychiatry Of Learning Disability">
            Psychiatry Of Learning Disability
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072758}"}'value="Public Health Dental">
            Public Health Dental
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072759}"}'value="Public Health Medicine">
            Public Health Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072760}"}'value="Rehabilitation Medicine">
            Rehabilitation Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072761}"}'value="Rehabilitation Psychiatry">
            Rehabilitation Psychiatry
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072762}"}'value="Renal Medicine">
            Renal Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072763}"}'value="Reproductive Medicine">
            Reproductive Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072764}"}'value="Respiratory Medicine">
            Respiratory Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072765}"}'value="Restorative Dentistry">
            Restorative Dentistry
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072766}"}'value="Rheumatology">
            Rheumatology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072767}"}'value="Special Care Dentistry">
            Special Care Dentistry
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072768}"}'value="Sport And Exercise Medicine">
            Sport And Exercise Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072769}"}'value="Stroke Medicine">
            Stroke Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072770}"}'value="Substance Misuse Psychiatry">
            Substance Misuse Psychiatry
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072771}"}'value="Trauma And Orthopaedic Surgery">
            Trauma And Orthopaedic Surgery
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072772}"}'value="Tropical Medicine">
            Tropical Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072773}"}'value="Urogynaecology">
            Urogynaecology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072774}"}'value="Urology">
            Urology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072775}"}'value="Vascular Surgery">
            Vascular Surgery
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000072776}"}'value="Transplant Surgery">
            Transplant Surgery
          </option>

</select>

<div class="form-group  helpdesk_ticket_custom_field_grade_of_training_606619">
    <label for="helpdesk_ticket_custom_field_grade_of_training_606619" class=" form-label">
    	Grade
	  	
	  		<span class="fw-asterisk">*</span>
	  	
      
    </label>

<option value>Choose...</option>

<option  data-custom-properties='{"id": "{"data-id"=>7000069311}"}'value="Core Training Year 1">
            Core Training Year 1
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069312}"}'value="Core Training Year 2">
            Core Training Year 2
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069313}"}'value="Core Training Year 3">
            Core Training Year 3
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069314}"}'value="Dental Foundation Training">
            Dental Foundation Training
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069315}"}'value="Foundation Year 1">
            Foundation Year 1
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069316}"}'value="Foundation Year 2">
            Foundation Year 2
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069317}"}'value="Specialty Training Year 1">
            Specialty Training Year 1
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069318}"}'value="Specialty Training Year 2">
            Specialty Training Year 2
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069319}"}'value="Specialty Training Year 3">
            Specialty Training Year 3
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069320}"}'value="Specialty Training Year 4">
            Specialty Training Year 4
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069321}"}'value="Specialty Training Year 5">
            Specialty Training Year 5
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000070294}"}'value="Specialty Training Year 6">
            Specialty Training Year 6
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000070295}"}'value="Specialty Training Year 7">
            Specialty Training Year 7
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000070296}"}'value="Specialty Training Year 8">
            Specialty Training Year 8
          </option>

</select>

<div class="form-group ">
	
		<label for="helpdesk_ticket_custom_field_cf_professional_registration_number_gmcgdcgphc_etc_if_applicable_606619" class=" form-label">
			Professional registration number (GMC/GDC/GPhC etc) if applicable
			
				<span class="fw-asterisk">*</span>
			
			
		</label>

<div class="form-group ">
	
		<label for="helpdesk_ticket_custom_field_cf_name_of_the_event_606619" class=" form-label">
			Name of the event
			
				<span class="fw-asterisk">*</span>
			
			
		</label>

<option value>Choose...</option>

</select>

<div class="form-group ">
	
		<label for="helpdesk_ticket_custom_field_cf_oriel_id_if_applicable_606619" class=" form-label">
			Oriel ID (if applicable)
			
			
		</label>

<div class="form-group  helpdesk_ticket_custom_field_levels_606619">
    <label for="helpdesk_ticket_custom_field_levels_606619" class=" form-label">
    	School of Pharmacy
	  	
	  		<span class="fw-asterisk">*</span>
	  	
      
    </label>

<option value>Choose...</option>

<option  data-custom-properties='{"id": "{"data-id"=>7000050451}"}'value="Aston University">
            Aston University
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000050452}"}'value="Cardiff University">
            Cardiff University
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000057541}"}'value="De Montfort University">
            De Montfort University
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000057542}"}'value="Durham University">
            Durham University
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000057543}"}'value="Keele University">
            Keele University
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000057544}"}'value="King&#39;s College, University of London">
            King&#39;s College, University of London
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000057545}"}'value="Kingston University London">
            Kingston University London
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000057546}"}'value="Liverpool John Moores University">
            Liverpool John Moores University
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000057547}"}'value="Medway School of Pharmacy">
            Medway School of Pharmacy
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000057548}"}'value="Queen’s University Belfast">
            Queen’s University Belfast
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000057549}"}'value="Robert Gordon University">
            Robert Gordon University
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000057550}"}'value="University College London">
            University College London
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000057551}"}'value="University of Bath">
            University of Bath
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000057552}"}'value="University of Birmingham">
            University of Birmingham
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000057553}"}'value="University of Bradford">
            University of Bradford
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000057554}"}'value="University of Brighton">
            University of Brighton
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000057555}"}'value="University of Central Lancashire">
            University of Central Lancashire
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000057556}"}'value="University of East Anglia">
            University of East Anglia
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000057557}"}'value="University of Hertfordshire">
            University of Hertfordshire
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000057558}"}'value="University of Huddersfield">
            University of Huddersfield
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000057559}"}'value="University of Lincoln">
            University of Lincoln
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000057560}"}'value="University of Manchester">
            University of Manchester
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000057561}"}'value="University of Nottingham">
            University of Nottingham
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000057562}"}'value="University of Portsmouth">
            University of Portsmouth
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000057563}"}'value="University of Reading">
            University of Reading
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000057564}"}'value="University of Strathclyde">
            University of Strathclyde
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000057565}"}'value="University of Sunderland">
            University of Sunderland
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000057566}"}'value="University of Ulster">
            University of Ulster
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000057567}"}'value="University of Wolverhampton">
            University of Wolverhampton
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000057568}"}'value="Other">
            Other
          </option>

</select>

<div class="form-group ">
	
		<label for="helpdesk_ticket_custom_field_cf_specify_school_of_pharmacy_606619" class=" form-label">
			Please specify other
			
			
		</label>

<div class="form-group ">
	
		<label for="helpdesk_ticket_custom_field_cf_oriel_id_if_applicable_606619" class=" form-label">
			Oriel ID (if applicable)
			
			
		</label>

<div class="form-group  helpdesk_ticket_custom_field_dental_school_606619">
    <label for="helpdesk_ticket_custom_field_dental_school_606619" class=" form-label">
    	Dental school
	  	
	  		<span class="fw-asterisk">*</span>
	  	
      
    </label>

<option value>Choose...</option>

<option  data-custom-properties='{"id": "{"data-id"=>7000050933}"}'value="Aberdeen, (University of), School of Medicine and Dentistry">
            Aberdeen, (University of), School of Medicine and Dentistry
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000050934}"}'value="Barts and the London, Queen Mary School of Medicine and Dentistry, Institute of Dentistry">
            Barts and the London, Queen Mary School of Medicine and Dentistry, Institute of Dentistry
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060456}"}'value="Bristol (University of), School of Oral and Dental Sciences">
            Bristol (University of), School of Oral and Dental Sciences
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060457}"}'value="Cardiff (University), School of Dentistry">
            Cardiff (University), School of Dentistry
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060458}"}'value="Central Lancashire (University of), School of Dentistry">
            Central Lancashire (University of), School of Dentistry
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060459}"}'value="Dundee (University of), School of Dentistry">
            Dundee (University of), School of Dentistry
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060460}"}'value="Edinburgh (University of), Edinburgh Postgraduate Dental Institute">
            Edinburgh (University of), Edinburgh Postgraduate Dental Institute
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060461}"}'value="Glasgow (University of), Dental School">
            Glasgow (University of), Dental School
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060462}"}'value="King&#39;s College London, Dental Institute">
            King&#39;s College London, Dental Institute
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060463}"}'value="Leeds (University of), Leeds Dental Institute">
            Leeds (University of), Leeds Dental Institute
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060464}"}'value="Liverpool (University of), School of Dental Sciences">
            Liverpool (University of), School of Dental Sciences
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060465}"}'value="Manchester (University of), School of Dentistry">
            Manchester (University of), School of Dentistry
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060466}"}'value="Newcastle University, School of Dental Sciences">
            Newcastle University, School of Dental Sciences
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060467}"}'value="Plymouth University Peninsula Schools of Medicine and Dentistry">
            Plymouth University Peninsula Schools of Medicine and Dentistry
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060468}"}'value="Queens University Belfast, Centre for Dental Education">
            Queens University Belfast, Centre for Dental Education
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060469}"}'value="Sheffield (University of), The School of Clinical Dentistry">
            Sheffield (University of), The School of Clinical Dentistry
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060470}"}'value="University College London Eastman Dental Institute">
            University College London Eastman Dental Institute
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060471}"}'value="University of Birmingham School of Dentistry">
            University of Birmingham School of Dentistry
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060472}"}'value="Other">
            Other
          </option>

</select>

<div class="form-group ">
	
		<label for="helpdesk_ticket_custom_field_cf_specify_dental_school_606619" class=" form-label">
			Please specify other
			
			
		</label>

<div class="form-group  helpdesk_ticket_custom_field_dental_specialty_606619">
    <label for="helpdesk_ticket_custom_field_dental_specialty_606619" class=" form-label">
    	Dental specialty
	  	
	  		<span class="fw-asterisk">*</span>
	  	
      
    </label>

<option value>Choose...</option>

<option  data-custom-properties='{"id": "{"data-id"=>7000060425}"}'value="Dental and Maxillofacial Radiology">
            Dental and Maxillofacial Radiology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060426}"}'value="Dental Core Training CT1">
            Dental Core Training CT1
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060473}"}'value="Dental Core Training CT2">
            Dental Core Training CT2
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060474}"}'value="Dental Foundation">
            Dental Foundation
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060475}"}'value="Dental Public Health">
            Dental Public Health
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060476}"}'value="Endodontics">
            Endodontics
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060477}"}'value="General Dental Practitioner">
            General Dental Practitioner
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000095727}"}'value="Oral and Maxillofacial pathology">
            Oral and Maxillofacial pathology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000093793}"}'value="Oral and Maxillofacial surgery">
            Oral and Maxillofacial surgery
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060478}"}'value="Oral Medicine">
            Oral Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060479}"}'value="Oral Microbiology">
            Oral Microbiology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060480}"}'value="Oral Surgery">
            Oral Surgery
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060481}"}'value="Orthodontics">
            Orthodontics
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060482}"}'value="Paediatric Dentistry">
            Paediatric Dentistry
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060483}"}'value="Periodontics">
            Periodontics
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060484}"}'value="Prosthodontics">
            Prosthodontics
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060485}"}'value="Restorative Dentistry">
            Restorative Dentistry
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060486}"}'value="Special Care Dentistry">
            Special Care Dentistry
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060487}"}'value="Surgical Dentistry">
            Surgical Dentistry
          </option>

</select>

<div class="form-group ">
	
		<label for="helpdesk_ticket_custom_field_cf_oriel_id_if_applicable_606619" class=" form-label">
			Oriel ID (if applicable)
			
			
		</label>

<option value>Choose...</option>

</select>

<div class="form-group ">
	
		<label for="helpdesk_ticket_custom_field_cf_specify_dental_school_606619" class=" form-label">
			Please specify other
			
			
		</label>

<div class="form-group ">
	
		<label for="helpdesk_ticket_custom_field_cf_oriel_id_if_applicable_606619" class=" form-label">
			Oriel ID (if applicable)
			
			
		</label>

<div class="form-group  helpdesk_ticket_custom_field_some_606619">
    <label for="helpdesk_ticket_custom_field_some_606619" class=" form-label">
    	Medical School
	  	
	  		<span class="fw-asterisk">*</span>
	  	
      
    </label>

<option value>Choose...</option>

<option  data-custom-properties='{"id": "{"data-id"=>7000050465}"}'value="Aberdeen (University of), School of Medicine">
            Aberdeen (University of), School of Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000050466}"}'value="Barts and The London School of Medicine and Dentistry, Queen Mary, University of London">
            Barts and The London School of Medicine and Dentistry, Queen Mary, University of London
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060389}"}'value="Birmingham (University of), School of Medicine">
            Birmingham (University of), School of Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060390}"}'value="Brighton and Sussex Medical School">
            Brighton and Sussex Medical School
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060391}"}'value="Bristol (University of), Faculty of Medicine">
            Bristol (University of), Faculty of Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060392}"}'value="Cambridge (University of), School of Clinical Medicine">
            Cambridge (University of), School of Clinical Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060393}"}'value="Cardiff University, School of Medicine">
            Cardiff University, School of Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060394}"}'value="Dundee (University of), Faculty of Medicine, Dentistry and Nursing">
            Dundee (University of), Faculty of Medicine, Dentistry and Nursing
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060395}"}'value="Edinburgh (The University of), College of Medicine and Veterinary Medicine">
            Edinburgh (The University of), College of Medicine and Veterinary Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060396}"}'value="Exeter (University of), Medical School">
            Exeter (University of), Medical School
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060397}"}'value="Glasgow (University of), College of Medical, Veterinary and Life Sciences">
            Glasgow (University of), College of Medical, Veterinary and Life Sciences
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060398}"}'value="Hull York Medical School">
            Hull York Medical School
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060399}"}'value="Imperial College School of Medicine, London">
            Imperial College School of Medicine, London
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060400}"}'value="Keele University, School of Medicine">
            Keele University, School of Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060401}"}'value="King&#39;s College London School of Medicine (at Guy&#39;s, King&#39;s College and St Thomas&#39; Hospital)">
            King&#39;s College London School of Medicine (at Guy&#39;s, King&#39;s College and St Thomas&#39; Hospital)
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060402}"}'value="Lancaster University, Faculty of Health &amp; Medicine">
            Lancaster University, Faculty of Health &amp; Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060403}"}'value="Leeds (University of), School of Medicine">
            Leeds (University of), School of Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060404}"}'value="Leicester (University of), Leicester Medical School">
            Leicester (University of), Leicester Medical School
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060405}"}'value="Liverpool (University of), Faculty of Health and Life Sciences">
            Liverpool (University of), Faculty of Health and Life Sciences
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060406}"}'value="London School of Hygiene and Tropical Medicine (Postgraduate Medical School)&nbsp;">
            London School of Hygiene and Tropical Medicine (Postgraduate Medical School)&nbsp;
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060407}"}'value="Manchester (University of), Faculty of Medical and Human Sciences">
            Manchester (University of), Faculty of Medical and Human Sciences
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060408}"}'value="Newcastle University Medical School">
            Newcastle University Medical School
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060409}"}'value="Norwich Medical School, University of East Anglia&nbsp;">
            Norwich Medical School, University of East Anglia&nbsp;
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060410}"}'value="Nottingham (The University of), Faculty of Medicine and Health Sciences">
            Nottingham (The University of), Faculty of Medicine and Health Sciences
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060411}"}'value="Oxford (University of), Medical Sciences Divison">
            Oxford (University of), Medical Sciences Divison
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060412}"}'value="Plymouth University Peninsula Schools of Medicine and Dentistry">
            Plymouth University Peninsula Schools of Medicine and Dentistry
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060413}"}'value="Queen&#39;s University Belfast, Faculty of Medicine and Health Sciences">
            Queen&#39;s University Belfast, Faculty of Medicine and Health Sciences
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060414}"}'value="Sheffield (The University of), School of Medicine">
            Sheffield (The University of), School of Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060415}"}'value="Southampton (University of), School of Medicine">
            Southampton (University of), School of Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060416}"}'value="St Andrews (University of), Faculty of Medical Sciences">
            St Andrews (University of), Faculty of Medical Sciences
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060417}"}'value="St George&#39;s, University of London">
            St George&#39;s, University of London
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060418}"}'value="Swansea University, School&nbsp;of Medicine">
            Swansea University, School&nbsp;of Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060419}"}'value="University College London, University College Medical School ">
            University College London, University College Medical School 
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060420}"}'value="Warwick (The University of), Warwick Medical School">
            Warwick (The University of), Warwick Medical School
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060421}"}'value="Other">
            Other
          </option>

</select>

<div class="form-group ">
	
		<label for="helpdesk_ticket_custom_field_cf_other_606619" class=" form-label">
			Please specify other
			
			
		</label>

<div class="form-group  helpdesk_ticket_custom_field_foundation_vacancy_606619">
    <label for="helpdesk_ticket_custom_field_foundation_vacancy_606619" class=" form-label">
    	Foundation vacancy
	  	
	  		<span class="fw-asterisk">*</span>
	  	
      
    </label>

<option value>Choose...</option>

<option  data-custom-properties='{"id": "{"data-id"=>7000060423}"}'value="Specialised Foundation Programme">
            Specialised Foundation Programme
          </option>

</select>

<div class="form-group ">
	
		<label for="helpdesk_ticket_custom_field_cf_oriel_id_if_applicable_606619" class=" form-label">
			Oriel ID (if applicable)
			
			
		</label>

<div class="form-group  helpdesk_ticket_custom_field_foundation_school_606619">
    <label for="helpdesk_ticket_custom_field_foundation_school_606619" class=" form-label">
    	Foundation School
	  	
	  		<span class="fw-asterisk">*</span>
	  	
      
    </label>

<option value>Choose...</option>

<option  data-custom-properties='{"id": "{"data-id"=>7000060428}"}'value="Birmingham Foundation School">
            Birmingham Foundation School
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060429}"}'value="Black Country/Shropshire Foundation School">
            Black Country/Shropshire Foundation School
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060488}"}'value="Coventry and Warwickshire Foundation School">
            Coventry and Warwickshire Foundation School
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060489}"}'value="East Anglian Foundation School">
            East Anglian Foundation School
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060490}"}'value="Hereford &amp; Worcestershire Foundation School">
            Hereford &amp; Worcestershire Foundation School
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060491}"}'value="Leicestershire, Northamptonshire and Rutland &nbsp;Foundation School">
            Leicestershire, Northamptonshire and Rutland &nbsp;Foundation School
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060492}"}'value="Malta Foundation School">
            Malta Foundation School
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060493}"}'value="Mersey Foundation School">
            Mersey Foundation School
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060494}"}'value="North Central and East London Foundation School">
            North Central and East London Foundation School
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060495}"}'value="North West London Foundation School">
            North West London Foundation School
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060496}"}'value="North Western Foundation School">
            North Western Foundation School
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060497}"}'value="North Yorkshire East Coast Foundation School">
            North Yorkshire East Coast Foundation School
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060498}"}'value="Northern Foundation School">
            Northern Foundation School
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060499}"}'value="Northern Ireland Foundation School">
            Northern Ireland Foundation School
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060500}"}'value="Oxford Foundation School">
            Oxford Foundation School
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060501}"}'value="Peninsula Foundation School">
            Peninsula Foundation School
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060502}"}'value="Scotland - East Region Foundation School">
            Scotland - East Region Foundation School
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060503}"}'value="Scotland - North Region Foundation School">
            Scotland - North Region Foundation School
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060504}"}'value="Scotland - South East Region Foundation School">
            Scotland - South East Region Foundation School
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060505}"}'value="Scotland - West Region Foundation School">
            Scotland - West Region Foundation School
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060506}"}'value="Severn Foundation School">
            Severn Foundation School
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060507}"}'value="South Thames Foundation School">
            South Thames Foundation School
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060508}"}'value="South Yorkshire Foundation School">
            South Yorkshire Foundation School
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060509}"}'value="Staffordshire Foundation School">
            Staffordshire Foundation School
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060510}"}'value="Trent Foundation School">
            Trent Foundation School
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060511}"}'value="Wales Foundation School">
            Wales Foundation School
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060512}"}'value="Wessex Foundation School">
            Wessex Foundation School
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060513}"}'value="West Midlands Central Foundation School">
            West Midlands Central Foundation School
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060514}"}'value="West Midlands North Foundation School">
            West Midlands North Foundation School
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060515}"}'value="West Midlands South Foundation School">
            West Midlands South Foundation School
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060516}"}'value="West Yorkshire Foundation School">
            West Yorkshire Foundation School
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060517}"}'value="Other">
            Other
          </option>

</select>

<div class="form-group ">
	
		<label for="helpdesk_ticket_custom_field_cf_foundation_school_other_606619" class=" form-label">
			Please specify other
			
			
		</label>

<option value>Choose...</option>

</select>

<div class="form-group  helpdesk_ticket_custom_field_level_specialty_606619">
    <label for="helpdesk_ticket_custom_field_level_specialty_606619" class=" form-label">
    	Level
	  	
	  		<span class="fw-asterisk">*</span>
	  	
      
    </label>

<option value>Choose...</option>

<option  data-custom-properties='{"id": "{"data-id"=>7000060432}"}'value="Academic Clinical Fellowship (ACF)">
            Academic Clinical Fellowship (ACF)
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060433}"}'value="Academic Clinical Lectureship (ACL)">
            Academic Clinical Lectureship (ACL)
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060592}"}'value="CT1">
            CT1
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060593}"}'value="CT2">
            CT2
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060594}"}'value="CT3">
            CT3
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060595}"}'value="LAT">
            LAT
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060596}"}'value="NA">
            NA
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060597}"}'value="SpR">
            SpR
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060598}"}'value="ST1">
            ST1
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060599}"}'value="ST2">
            ST2
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060600}"}'value="ST3">
            ST3
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060601}"}'value="ST4">
            ST4
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060602}"}'value="ST5">
            ST5
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060603}"}'value="ST6">
            ST6
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060604}"}'value="ST7">
            ST7
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060605}"}'value="Sub-spec - unspecified">
            Sub-spec - unspecified
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000060606}"}'value="Unspecified">
            Unspecified
          </option>

</select>

<div class="form-group  helpdesk_ticket_custom_field_region_606619">
    <label for="helpdesk_ticket_custom_field_region_606619" class=" form-label">
    	Current Training Region/Deanery
	  	
	  		<span class="fw-asterisk">*</span>
	  	
      
    </label>

<option value>Choose...</option>

<option  data-custom-properties='{"id": "{"data-id"=>7000057603}"}'value="Northen Ireland">
            Northen Ireland
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000057604}"}'value="Scotland">
            Scotland
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000057605}"}'value="Wales">
            Wales
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000057606}"}'value="East Midlands">
            East Midlands
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000057607}"}'value="East of England">
            East of England
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000057608}"}'value="Kent, Surrey and Sussex">
            Kent, Surrey and Sussex
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000057609}"}'value="London">
            London
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000057610}"}'value="North East">
            North East
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000057611}"}'value="North West">
            North West
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000057612}"}'value="South West">
            South West
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000057613}"}'value="Thames Valley">
            Thames Valley
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000057614}"}'value="Wessex">
            Wessex
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000057615}"}'value="West Midlands">
            West Midlands
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000057616}"}'value="Yorkshire and the Humber">
            Yorkshire and the Humber
          </option>

</select>

<div class="form-group  helpdesk_ticket_custom_field_trust_606619">
    <label for="helpdesk_ticket_custom_field_trust_606619" class=" form-label">
    	Trust
	  	
	  		<span class="fw-asterisk">*</span>
	  	
      
    </label>

<option value>Choose...</option>

<option  data-custom-properties='{"id": "{"data-id"=>7000069397}"}'value="Abertawe Bro Morgannwg University LHB">
            Abertawe Bro Morgannwg University LHB
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069398}"}'value="AINTREE UNIVERSITY HOSPITAL NHS FOUNDATION TRUST">
            AINTREE UNIVERSITY HOSPITAL NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069400}"}'value="ALDER HEY CHILDREN&#39;S NHS FOUNDATION TRUST">
            ALDER HEY CHILDREN&#39;S NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069401}"}'value="ANEURIN BEVAN UNIVERSITY LHB">
            ANEURIN BEVAN UNIVERSITY LHB
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069402}"}'value="ASHFORD AND ST PETER&#39;S HOSPITALS NHS FOUNDATION TRUST">
            ASHFORD AND ST PETER&#39;S HOSPITALS NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069403}"}'value="AXA PPP Healthcare">
            AXA PPP Healthcare
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069404}"}'value="BARKING, HAVERING AND REDBRIDGE UNIVERSITY HOSPITALS NHS TRUST">
            BARKING, HAVERING AND REDBRIDGE UNIVERSITY HOSPITALS NHS TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069405}"}'value="BARNET, ENFIELD AND HARINGEY MENTAL HEALTH NHS TRUST">
            BARNET, ENFIELD AND HARINGEY MENTAL HEALTH NHS TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069406}"}'value="BARTS HEALTH NHS TRUST">
            BARTS HEALTH NHS TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069407}"}'value="BASILDON AND THURROCK UNIVERSITY HOSPITALS NHS FOUNDATION TRUST">
            BASILDON AND THURROCK UNIVERSITY HOSPITALS NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069408}"}'value="BEDFORD HOSPITAL NHS TRUST">
            BEDFORD HOSPITAL NHS TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069409}"}'value="BIRMINGHAM AND SOLIHULL MENTAL HEALTH NHS FOUNDATION TRUST">
            BIRMINGHAM AND SOLIHULL MENTAL HEALTH NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069410}"}'value="BIRMINGHAM CHILDREN&#39;S HOSPITAL NHS FOUNDATION TRUST">
            BIRMINGHAM CHILDREN&#39;S HOSPITAL NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069411}"}'value="BIRMINGHAM WOMEN&#39;S NHS FOUNDATION TRUST">
            BIRMINGHAM WOMEN&#39;S NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069412}"}'value="BLACKPOOL TEACHING HOSPITALS NHS FOUNDATION TRUST">
            BLACKPOOL TEACHING HOSPITALS NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069413}"}'value="BMI Health Services">
            BMI Health Services
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069414}"}'value="BRADFORD TEACHING HOSPITALS NHS FOUNDATION TRUST">
            BRADFORD TEACHING HOSPITALS NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069415}"}'value="Brighton &amp; Hove City Council">
            Brighton &amp; Hove City Council
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069416}"}'value="BRIGHTON AND SUSSEX UNIVERSITY HOSPITALS NHS TRUST">
            BRIGHTON AND SUSSEX UNIVERSITY HOSPITALS NHS TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069417}"}'value="British Airways Health Services">
            British Airways Health Services
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069418}"}'value="BUCKINGHAMSHIRE HEALTHCARE NHS TRUST">
            BUCKINGHAMSHIRE HEALTHCARE NHS TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069419}"}'value="BUPA Occupational Health">
            BUPA Occupational Health
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069420}"}'value="CALDERDALE AND HUDDERSFIELD NHS FOUNDATION TRUST">
            CALDERDALE AND HUDDERSFIELD NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069421}"}'value="CAMBRIDGE UNIVERSITY HOSPITALS NHS FOUNDATION TRUST">
            CAMBRIDGE UNIVERSITY HOSPITALS NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069422}"}'value="CAMBRIDGESHIRE AND PETERBOROUGH NHS FOUNDATION TRUST">
            CAMBRIDGESHIRE AND PETERBOROUGH NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069423}"}'value="Camden and Islington NHS Foundation Trust">
            Camden and Islington NHS Foundation Trust
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069424}"}'value="Capita Health Solutions">
            Capita Health Solutions
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069425}"}'value="CARDIFF &amp; VALE UNIVERSITY LHB">
            CARDIFF &amp; VALE UNIVERSITY LHB
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069426}"}'value="CENTRAL AND NORTH WEST LONDON NHS FOUNDATION TRUST">
            CENTRAL AND NORTH WEST LONDON NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069427}"}'value="CENTRAL LONDON COMMUNITY HEALTHCARE NHS TRUST">
            CENTRAL LONDON COMMUNITY HEALTHCARE NHS TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069428}"}'value="CENTRAL MANCHESTER UNIVERSITY HOSPITALS NHS FOUNDATION TRUST">
            CENTRAL MANCHESTER UNIVERSITY HOSPITALS NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069429}"}'value="CHELSEA AND WESTMINSTER HOSPITAL NHS FOUNDATION TRUST">
            CHELSEA AND WESTMINSTER HOSPITAL NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069430}"}'value="Civil Aviation Authority">
            Civil Aviation Authority
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069431}"}'value="COLCHESTER HOSPITAL UNIVERSITY NHS FOUNDATION TRUST">
            COLCHESTER HOSPITAL UNIVERSITY NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069432}"}'value="CORNWALL PARTNERSHIP NHS FOUNDATION TRUST">
            CORNWALL PARTNERSHIP NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069433}"}'value="CROYDON HEALTH SERVICES NHS TRUST">
            CROYDON HEALTH SERVICES NHS TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069434}"}'value="Croydon PCT">
            Croydon PCT
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069435}"}'value="DARTFORD AND GRAVESHAM NHS TRUST">
            DARTFORD AND GRAVESHAM NHS TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069436}"}'value="Defence Military Deanery">
            Defence Military Deanery
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069437}"}'value="Dental - Self Funded">
            Dental - Self Funded
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069438}"}'value="Department for International Development">
            Department for International Development
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069439}"}'value="Department of Health">
            Department of Health
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069440}"}'value="DERBY TEACHING HOSPITALS NHS FOUNDATION TRUST">
            DERBY TEACHING HOSPITALS NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069441}"}'value="Duradiamond Healthcare">
            Duradiamond Healthcare
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069442}"}'value="Ealing PCT">
            Ealing PCT
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069443}"}'value="EAST AND NORTH HERTFORDSHIRE NHS TRUST">
            EAST AND NORTH HERTFORDSHIRE NHS TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069444}"}'value="EAST KENT HOSPITALS UNIVERSITY NHS FOUNDATION TRUST">
            EAST KENT HOSPITALS UNIVERSITY NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069445}"}'value="EAST LONDON NHS FOUNDATION TRUST">
            EAST LONDON NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069446}"}'value="EAST OF ENGLAND AMBULANCE SERVICE NHS TRUST">
            EAST OF ENGLAND AMBULANCE SERVICE NHS TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069447}"}'value="East Sussex County Council">
            East Sussex County Council
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069448}"}'value="EAST SUSSEX HEALTHCARE NHS TRUST">
            EAST SUSSEX HEALTHCARE NHS TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069449}"}'value="EASTERN AND COASTAL KENT PCT">
            EASTERN AND COASTAL KENT PCT
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069450}"}'value="EPSOM AND ST HELIER UNIVERSITY HOSPITALS NHS TRUST">
            EPSOM AND ST HELIER UNIVERSITY HOSPITALS NHS TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069451}"}'value="Esso">
            Esso
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069452}"}'value="FRIMLEY HEALTH NHS FOUNDATION TRUST">
            FRIMLEY HEALTH NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069453}"}'value="GATESHEAD HEALTH NHS FOUNDATION TRUST">
            GATESHEAD HEALTH NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069454}"}'value="GlaxoSmithKline">
            GlaxoSmithKline
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069455}"}'value="GLOUCESTERSHIRE HOSPITALS NHS FOUNDATION TRUST">
            GLOUCESTERSHIRE HOSPITALS NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069457}"}'value="GREAT ORMOND STREET HOSPITAL FOR CHILDREN NHS FOUNDATION TRUST">
            GREAT ORMOND STREET HOSPITAL FOR CHILDREN NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069458}"}'value="GREAT WESTERN HOSPITALS NHS FOUNDATION TRUST">
            GREAT WESTERN HOSPITALS NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069459}"}'value="Greater London Authority">
            Greater London Authority
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069460}"}'value="GUY&#39;S AND ST THOMAS&#39; NHS FOUNDATION TRUST">
            GUY&#39;S AND ST THOMAS&#39; NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069461}"}'value="HAMPSHIRE HOSPITALS NHS FOUNDATION TRUST">
            HAMPSHIRE HOSPITALS NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069462}"}'value="Harlow Occupational Health">
            Harlow Occupational Health
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069463}"}'value="HARROGATE AND DISTRICT NHS FOUNDATION TRUST">
            HARROGATE AND DISTRICT NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069464}"}'value="Health Management Ltd">
            Health Management Ltd
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069465}"}'value="HEART OF ENGLAND NHS FOUNDATION TRUST">
            HEART OF ENGLAND NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069468}"}'value="HERTFORDSHIRE COMMUNITY NHS TRUST">
            HERTFORDSHIRE COMMUNITY NHS TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069469}"}'value="HERTFORDSHIRE PARTNERSHIP UNIVERSITY NHS FOUNDATION TRUST">
            HERTFORDSHIRE PARTNERSHIP UNIVERSITY NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069470}"}'value="Hertfordshire PCT">
            Hertfordshire PCT
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069471}"}'value="HOMERTON UNIVERSITY HOSPITAL NHS FOUNDATION TRUST">
            HOMERTON UNIVERSITY HOSPITAL NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069472}"}'value="Hospices (8A6)">
            Hospices (8A6)
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069473}"}'value="Hospices (8A8)">
            Hospices (8A8)
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069474}"}'value="Hospital of St John and St Elizabeth">
            Hospital of St John and St Elizabeth
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069475}"}'value="HOUNSLOW AND RICHMOND COMMUNITY HEALTHCARE NHS TRUST">
            HOUNSLOW AND RICHMOND COMMUNITY HEALTHCARE NHS TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069476}"}'value="HULL AND EAST YORKSHIRE HOSPITALS NHS TRUST">
            HULL AND EAST YORKSHIRE HOSPITALS NHS TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069477}"}'value="IMPERIAL COLLEGE">
            IMPERIAL COLLEGE
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069478}"}'value="IMPERIAL COLLEGE HEALTHCARE NHS TRUST">
            IMPERIAL COLLEGE HEALTHCARE NHS TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069479}"}'value="IPSWICH HOSPITAL NHS TRUST">
            IPSWICH HOSPITAL NHS TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069480}"}'value="ISLE OF WIGHT NHS TRUST">
            ISLE OF WIGHT NHS TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069481}"}'value="KENT AND MEDWAY NHS AND SOCIAL CARE PARTNERSHIP TRUST">
            KENT AND MEDWAY NHS AND SOCIAL CARE PARTNERSHIP TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069482}"}'value="KENT COMMUNITY HEALTH NHS FOUNDATION TRUST">
            KENT COMMUNITY HEALTH NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069483}"}'value="Kent County Council">
            Kent County Council
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069484}"}'value="KING&#39;S COLLEGE HOSPITAL NHS FOUNDATION TRUST">
            KING&#39;S COLLEGE HOSPITAL NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069485}"}'value="King&#39;s College London">
            King&#39;s College London
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069486}"}'value="King&#39;s College London (GKT Dental Institute)">
            King&#39;s College London (GKT Dental Institute)
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069487}"}'value="KINGSTON HOSPITAL NHS FOUNDATION TRUST">
            KINGSTON HOSPITAL NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069488}"}'value="LANCASHIRE CARE NHS FOUNDATION TRUST">
            LANCASHIRE CARE NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069489}"}'value="LEEDS TEACHING HOSPITALS NHS TRUST">
            LEEDS TEACHING HOSPITALS NHS TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069490}"}'value="LEWISHAM AND GREENWICH NHS TRUST">
            LEWISHAM AND GREENWICH NHS TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069491}"}'value="LIVERPOOL HEART AND CHEST HOSPITAL NHS FOUNDATION TRUST">
            LIVERPOOL HEART AND CHEST HOSPITAL NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069492}"}'value="LIVERPOOL WOMEN&#39;S NHS FOUNDATION TRUST">
            LIVERPOOL WOMEN&#39;S NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069494}"}'value="LONDON AMBULANCE SERVICE NHS TRUST">
            LONDON AMBULANCE SERVICE NHS TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069495}"}'value="London Borough Of Barking And Dagenham">
            London Borough Of Barking And Dagenham
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069496}"}'value="London Borough Of Barnet">
            London Borough Of Barnet
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069497}"}'value="London Borough Of Bromley">
            London Borough Of Bromley
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069498}"}'value="London Borough of Camden">
            London Borough of Camden
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069499}"}'value="London Borough Of Croydon">
            London Borough Of Croydon
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069500}"}'value="London Borough Of Ealing">
            London Borough Of Ealing
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069501}"}'value="London Borough Of Enfield">
            London Borough Of Enfield
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069502}"}'value="London Borough Of Greenwich">
            London Borough Of Greenwich
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069503}"}'value="London Borough Of Hackney">
            London Borough Of Hackney
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069504}"}'value="London Borough Of Hammersmith And Fulham">
            London Borough Of Hammersmith And Fulham
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069505}"}'value="London Borough Of Haringey">
            London Borough Of Haringey
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069506}"}'value="London Borough Of Harrow">
            London Borough Of Harrow
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069507}"}'value="LONDON BOROUGH OF HILLINGDON">
            LONDON BOROUGH OF HILLINGDON
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069508}"}'value="London Borough Of Islington">
            London Borough Of Islington
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069509}"}'value="London Borough Of Lambeth Council">
            London Borough Of Lambeth Council
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069510}"}'value="London Borough Of Lewisham Council">
            London Borough Of Lewisham Council
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069511}"}'value="London Borough Of Merton Council">
            London Borough Of Merton Council
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069512}"}'value="London Borough Of Newham Council">
            London Borough Of Newham Council
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069513}"}'value="London Borough Of Redbridge Council">
            London Borough Of Redbridge Council
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069514}"}'value="London Borough Of Richmond Upon Thames Council">
            London Borough Of Richmond Upon Thames Council
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069515}"}'value="London Borough Of Southwark Council">
            London Borough Of Southwark Council
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069516}"}'value="London Borough Of Sutton Council">
            London Borough Of Sutton Council
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069517}"}'value="London Borough Of Tower Hamlets Council">
            London Borough Of Tower Hamlets Council
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069518}"}'value="London Borough Of Waltham Forest Council">
            London Borough Of Waltham Forest Council
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069519}"}'value="London Borough Of Wandsworth">
            London Borough Of Wandsworth
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069521}"}'value="LONDON NORTH WEST HEALTHCARE NHS TRUST">
            LONDON NORTH WEST HEALTHCARE NHS TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069522}"}'value="London School Of Hygiene &amp; Trop. Med.">
            London School Of Hygiene &amp; Trop. Med.
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069523}"}'value="London Transport">
            London Transport
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069528}"}'value="London Underground">
            London Underground
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069529}"}'value="LUTON AND DUNSTABLE UNIVERSITY HOSPITAL NHS FOUNDATION TRUST">
            LUTON AND DUNSTABLE UNIVERSITY HOSPITAL NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069530}"}'value="MAIDSTONE AND TUNBRIDGE WELLS NHS TRUST">
            MAIDSTONE AND TUNBRIDGE WELLS NHS TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069531}"}'value="Medicins Sans Frontieres">
            Medicins Sans Frontieres
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069532}"}'value="Medicins Sans Frontieres Medigold Health Consultancy Ltd">
            Medicins Sans Frontieres Medigold Health Consultancy Ltd
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069533}"}'value="Medway Council">
            Medway Council
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069534}"}'value="MEDWAY NHS FOUNDATION TRUST">
            MEDWAY NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069535}"}'value="MEDWAY PCT">
            MEDWAY PCT
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069536}"}'value="MID ESSEX HOSPITAL SERVICES NHS TRUST">
            MID ESSEX HOSPITAL SERVICES NHS TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069537}"}'value="Mid Essex PCT">
            Mid Essex PCT
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069538}"}'value="MILDMAY UK">
            MILDMAY UK
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069539}"}'value="MILTON KEYNES UNIVERSITY HOSPITAL NHS FOUNDATION TRUST">
            MILTON KEYNES UNIVERSITY HOSPITAL NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069540}"}'value="MOORFIELDS EYE HOSPITAL NHS FOUNDATION TRUST">
            MOORFIELDS EYE HOSPITAL NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069541}"}'value="National Air Traffic Services Ltd">
            National Air Traffic Services Ltd
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069542}"}'value="National Institute Of Clinical Excellence">
            National Institute Of Clinical Excellence
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069543}"}'value="Nexus Healthcare Ltd">
            Nexus Healthcare Ltd
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069544}"}'value="NHS ASHFORD CCG">
            NHS ASHFORD CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069545}"}'value="NHS BARKING AND DAGENHAM CCG">
            NHS BARKING AND DAGENHAM CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069546}"}'value="NHS BARNET CCG">
            NHS BARNET CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069547}"}'value="NHS BEXLEY CCG">
            NHS BEXLEY CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069548}"}'value="NHS BRACKNELL AND ASCOT CCG">
            NHS BRACKNELL AND ASCOT CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069549}"}'value="NHS BRENT CCG">
            NHS BRENT CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069550}"}'value="NHS BRIGHTON AND HOVE CCG">
            NHS BRIGHTON AND HOVE CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069551}"}'value="NHS BROMLEY CCG">
            NHS BROMLEY CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069552}"}'value="NHS CAMDEN CCG">
            NHS CAMDEN CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069553}"}'value="NHS CANTERBURY AND COASTAL CCG">
            NHS CANTERBURY AND COASTAL CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069554}"}'value="NHS CENTRAL LONDON (WESTMINSTER) CCG">
            NHS CENTRAL LONDON (WESTMINSTER) CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069555}"}'value="NHS CITY AND HACKNEY CCG">
            NHS CITY AND HACKNEY CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069556}"}'value="NHS COASTAL WEST SUSSEX CCG">
            NHS COASTAL WEST SUSSEX CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069557}"}'value="NHS CRAWLEY CCG">
            NHS CRAWLEY CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069558}"}'value="NHS CROYDON CCG">
            NHS CROYDON CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069559}"}'value="NHS DARTFORD, GRAVESHAM AND SWANLEY CCG">
            NHS DARTFORD, GRAVESHAM AND SWANLEY CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069560}"}'value="NHS EALING CCG">
            NHS EALING CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069561}"}'value="NHS EAST AND NORTH HERTFORDSHIRE CCG">
            NHS EAST AND NORTH HERTFORDSHIRE CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069562}"}'value="NHS EAST SURREY CCG">
            NHS EAST SURREY CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069563}"}'value="NHS EASTBOURNE, HAILSHAM AND SEAFORD CCG">
            NHS EASTBOURNE, HAILSHAM AND SEAFORD CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069564}"}'value="NHS ENFIELD CCG">
            NHS ENFIELD CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069565}"}'value="NHS GREENWICH CCG">
            NHS GREENWICH CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069566}"}'value="NHS GUILDFORD AND WAVERLEY CCG">
            NHS GUILDFORD AND WAVERLEY CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069567}"}'value="NHS HAMMERSMITH AND FULHAM CCG">
            NHS HAMMERSMITH AND FULHAM CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069568}"}'value="NHS HARINGEY CCG">
            NHS HARINGEY CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069569}"}'value="NHS HARROW CCG">
            NHS HARROW CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069570}"}'value="NHS HASTINGS AND ROTHER CCG">
            NHS HASTINGS AND ROTHER CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069571}"}'value="NHS HAVERING CCG">
            NHS HAVERING CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069572}"}'value="NHS HERTS VALLEYS CCG">
            NHS HERTS VALLEYS CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069573}"}'value="NHS HIGH WEALD LEWES HAVENS CCG">
            NHS HIGH WEALD LEWES HAVENS CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069574}"}'value="NHS HILLINGDON CCG">
            NHS HILLINGDON CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069575}"}'value="NHS HORSHAM AND MID SUSSEX CCG">
            NHS HORSHAM AND MID SUSSEX CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069576}"}'value="NHS HOUNSLOW CCG">
            NHS HOUNSLOW CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069577}"}'value="NHS ISLINGTON CCG">
            NHS ISLINGTON CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069578}"}'value="NHS KINGSTON CCG">
            NHS KINGSTON CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069579}"}'value="NHS LAMBETH CCG">
            NHS LAMBETH CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069580}"}'value="NHS LEWISHAM CCG">
            NHS LEWISHAM CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069581}"}'value="NHS MEDWAY CCG">
            NHS MEDWAY CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069582}"}'value="NHS MERTON CCG">
            NHS MERTON CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069583}"}'value="NHS NEWHAM CCG">
            NHS NEWHAM CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069584}"}'value="NHS NORTH EAST ESSEX CCG">
            NHS NORTH EAST ESSEX CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069585}"}'value="NHS NORTH EAST HAMPSHIRE AND FARNHAM CCG">
            NHS NORTH EAST HAMPSHIRE AND FARNHAM CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069586}"}'value="NHS NORTH WEST SURREY CCG">
            NHS NORTH WEST SURREY CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069587}"}'value="NHS REDBRIDGE CCG">
            NHS REDBRIDGE CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069588}"}'value="NHS RICHMOND CCG">
            NHS RICHMOND CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069589}"}'value="NHS SOUTH KENT COAST CCG">
            NHS SOUTH KENT COAST CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069590}"}'value="NHS SOUTHWARK CCG">
            NHS SOUTHWARK CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069591}"}'value="NHS SURREY DOWNS CCG">
            NHS SURREY DOWNS CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069592}"}'value="NHS SURREY HEATH CCG">
            NHS SURREY HEATH CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069593}"}'value="NHS SUTTON CCG">
            NHS SUTTON CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069594}"}'value="NHS SWALE CCG">
            NHS SWALE CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069595}"}'value="NHS THANET CCG">
            NHS THANET CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069596}"}'value="NHS TOWER HAMLETS CCG">
            NHS TOWER HAMLETS CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069597}"}'value="NHS WALTHAM FOREST CCG">
            NHS WALTHAM FOREST CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069598}"}'value="NHS WANDSWORTH CCG">
            NHS WANDSWORTH CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069599}"}'value="NHS WEST ESSEX CCG">
            NHS WEST ESSEX CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069600}"}'value="NHS WEST KENT CCG">
            NHS WEST KENT CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069601}"}'value="NHS WEST LONDON CCG">
            NHS WEST LONDON CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069602}"}'value="NHS WINDSOR, ASCOT AND MAIDENHEAD CCG">
            NHS WINDSOR, ASCOT AND MAIDENHEAD CCG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069603}"}'value="NIHR">
            NIHR
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069604}"}'value="Non NHS Authority (8FN)">
            Non NHS Authority (8FN)
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069605}"}'value="NORFOLK AND NORWICH UNIVERSITY HOSPITALS NHS FOUNDATION TRUST">
            NORFOLK AND NORWICH UNIVERSITY HOSPITALS NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069606}"}'value="NORTH BRISTOL NHS TRUST">
            NORTH BRISTOL NHS TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069607}"}'value="NORTH EAST LONDON NHS FOUNDATION TRUST">
            NORTH EAST LONDON NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069608}"}'value="NORTH ESSEX PARTNERSHIP UNIVERSITY NHS FOUNDATION TRUST">
            NORTH ESSEX PARTNERSHIP UNIVERSITY NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069609}"}'value="NORTH MIDDLESEX UNIVERSITY HOSPITAL NHS TRUST">
            NORTH MIDDLESEX UNIVERSITY HOSPITAL NHS TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069610}"}'value="NORTH TEES AND HARTLEPOOL NHS FOUNDATION TRUST">
            NORTH TEES AND HARTLEPOOL NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069611}"}'value="NORTHERN LINCOLNSHIRE AND GOOLE NHS FOUNDATION TRUST">
            NORTHERN LINCOLNSHIRE AND GOOLE NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069612}"}'value="NOTTINGHAM UNIVERSITY HOSPITALS NHS TRUST">
            NOTTINGHAM UNIVERSITY HOSPITALS NHS TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069613}"}'value="NOTTINGHAMSHIRE HEALTHCARE NHS FOUNDATION TRUST">
            NOTTINGHAMSHIRE HEALTHCARE NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069614}"}'value="Nuffield Trust">
            Nuffield Trust
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069615}"}'value="OXFORD UNIVERSITY HOSPITALS NHS FOUNDATION TRUST">
            OXFORD UNIVERSITY HOSPITALS NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069616}"}'value="OXLEAS NHS FOUNDATION TRUST">
            OXLEAS NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069617}"}'value="PAPWORTH HOSPITAL NHS FOUNDATION TRUST">
            PAPWORTH HOSPITAL NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069618}"}'value="Peace Hospice">
            Peace Hospice
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069619}"}'value="PENNINE ACUTE HOSPITALS NHS TRUST">
            PENNINE ACUTE HOSPITALS NHS TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069620}"}'value="PETERBOROUGH AND STAMFORD HOSPITALS NHS FOUNDATION TRUST">
            PETERBOROUGH AND STAMFORD HOSPITALS NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069621}"}'value="Pfizer Ltd.">
            Pfizer Ltd.
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069622}"}'value="PLYMOUTH HOSPITALS NHS TRUST">
            PLYMOUTH HOSPITALS NHS TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069623}"}'value="PORTSMOUTH HOSPITALS NHS TRUST">
            PORTSMOUTH HOSPITALS NHS TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069624}"}'value="Premier Occupational Healthcare">
            Premier Occupational Healthcare
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069625}"}'value="Preventative Healthcare Co">
            Preventative Healthcare Co
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069626}"}'value="Public Health England">
            Public Health England
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069627}"}'value="Public Health Laboratory Service">
            Public Health Laboratory Service
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069628}"}'value="Queen Mary College, University of London">
            Queen Mary College, University of London
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069629}"}'value="Queen Mary&#39;s School of Dentistry">
            Queen Mary&#39;s School of Dentistry
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069630}"}'value="Queen Mary&#39;s School of Medicine">
            Queen Mary&#39;s School of Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069631}"}'value="QUEEN VICTORIA HOSPITAL NHS FOUNDATION TRUST">
            QUEEN VICTORIA HOSPITAL NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069632}"}'value="ROYAL BERKSHIRE NHS FOUNDATION TRUST">
            ROYAL BERKSHIRE NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069633}"}'value="Royal Borough Of Kensington And Chelsea">
            Royal Borough Of Kensington And Chelsea
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069634}"}'value="Royal Borough Of Kingston-Upon-Thames Council">
            Royal Borough Of Kingston-Upon-Thames Council
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069635}"}'value="ROYAL BROMPTON &amp; HAREFIELD NHS FOUNDATION TRUST">
            ROYAL BROMPTON &amp; HAREFIELD NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069636}"}'value="ROYAL CORNWALL HOSPITALS NHS TRUST">
            ROYAL CORNWALL HOSPITALS NHS TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069637}"}'value="ROYAL DEVON AND EXETER NHS FOUNDATION TRUST">
            ROYAL DEVON AND EXETER NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069638}"}'value="ROYAL FREE LONDON NHS FOUNDATION TRUST">
            ROYAL FREE LONDON NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069639}"}'value="ROYAL LIVERPOOL AND BROADGREEN UNIVERSITY HOSPITALS NHS TRUST">
            ROYAL LIVERPOOL AND BROADGREEN UNIVERSITY HOSPITALS NHS TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069640}"}'value="ROYAL NATIONAL ORTHOPAEDIC HOSPITAL NHS TRUST">
            ROYAL NATIONAL ORTHOPAEDIC HOSPITAL NHS TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069641}"}'value="ROYAL SURREY COUNTY HOSPITAL NHS FOUNDATION TRUST">
            ROYAL SURREY COUNTY HOSPITAL NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069642}"}'value="ROYAL UNITED HOSPITALS BATH NHS FOUNDATION TRUST">
            ROYAL UNITED HOSPITALS BATH NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069643}"}'value="SALFORD ROYAL NHS FOUNDATION TRUST">
            SALFORD ROYAL NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069644}"}'value="SALISBURY NHS FOUNDATION TRUST">
            SALISBURY NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069645}"}'value="SANDWELL AND WEST BIRMINGHAM HOSPITALS NHS TRUST">
            SANDWELL AND WEST BIRMINGHAM HOSPITALS NHS TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069646}"}'value="SHEFFIELD TEACHING HOSPITALS NHS FOUNDATION TRUST">
            SHEFFIELD TEACHING HOSPITALS NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069647}"}'value="SOLENT NHS TRUST">
            SOLENT NHS TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069648}"}'value="SOUTH EAST COAST AMBULANCE SERVICE NHS FOUNDATION TRUST">
            SOUTH EAST COAST AMBULANCE SERVICE NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069649}"}'value="SOUTH ESSEX PARTNERSHIP UNIVERSITY NHS FOUNDATION TRUST">
            SOUTH ESSEX PARTNERSHIP UNIVERSITY NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069650}"}'value="SOUTH LONDON AND MAUDSLEY NHS FOUNDATION TRUST">
            SOUTH LONDON AND MAUDSLEY NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069651}"}'value="SOUTH LONDON HEALTHCARE NHS TRUST">
            SOUTH LONDON HEALTHCARE NHS TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069652}"}'value="SOUTH TEES HOSPITALS NHS FOUNDATION TRUST">
            SOUTH TEES HOSPITALS NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069653}"}'value="SOUTH WARWICKSHIRE NHS FOUNDATION TRUST">
            SOUTH WARWICKSHIRE NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069654}"}'value="SOUTH WEST LONDON AND ST GEORGE&#39;S MENTAL HEALTH NHS TRUST">
            SOUTH WEST LONDON AND ST GEORGE&#39;S MENTAL HEALTH NHS TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069655}"}'value="SOUTHEND UNIVERSITY HOSPITAL NHS FOUNDATION TRUST">
            SOUTHEND UNIVERSITY HOSPITAL NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069656}"}'value="SOUTHERN HEALTH NHS FOUNDATION TRUST">
            SOUTHERN HEALTH NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069657}"}'value="St Christopher&#39;s Hospice">
            St Christopher&#39;s Hospice
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069658}"}'value="ST GEORGE&#39;S UNIVERSITY HOSPITALS NHS FOUNDATION TRUST">
            ST GEORGE&#39;S UNIVERSITY HOSPITALS NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069659}"}'value="St Georges University of London">
            St Georges University of London
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069660}"}'value="ST HELENS AND KNOWSLEY HOSPITAL SERVICES NHS TRUST">
            ST HELENS AND KNOWSLEY HOSPITAL SERVICES NHS TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069661}"}'value="St Raphaels Hospice">
            St Raphaels Hospice
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069662}"}'value="STAFFORDSHIRE AND STOKE ON TRENT PARTNERSHIP NHS TRUST">
            STAFFORDSHIRE AND STOKE ON TRENT PARTNERSHIP NHS TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069663}"}'value="STOCKPORT NHS FOUNDATION TRUST">
            STOCKPORT NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069664}"}'value="SURREY AND BORDERS PARTNERSHIP NHS FOUNDATION TRUST">
            SURREY AND BORDERS PARTNERSHIP NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069665}"}'value="SURREY AND SUSSEX HEALTHCARE NHS TRUST">
            SURREY AND SUSSEX HEALTHCARE NHS TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069666}"}'value="Surrey County Council">
            Surrey County Council
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069667}"}'value="SURREY PCT">
            SURREY PCT
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069668}"}'value="SUSSEX COMMUNITY NHS FOUNDATION TRUST">
            SUSSEX COMMUNITY NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069669}"}'value="SUSSEX PARTNERSHIP NHS FOUNDATION TRUST">
            SUSSEX PARTNERSHIP NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069670}"}'value="TAUNTON AND SOMERSET NHS FOUNDATION TRUST">
            TAUNTON AND SOMERSET NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069671}"}'value="TAVISTOCK AND PORTMAN NHS FOUNDATION TRUST">
            TAVISTOCK AND PORTMAN NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069672}"}'value="TEES, ESK AND WEAR VALLEYS NHS FOUNDATION TRUST">
            TEES, ESK AND WEAR VALLEYS NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069673}"}'value="THE CHRISTIE NHS FOUNDATION TRUST">
            THE CHRISTIE NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069674}"}'value="THE DUDLEY GROUP NHS FOUNDATION TRUST">
            THE DUDLEY GROUP NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069675}"}'value="THE HILLINGDON HOSPITALS NHS FOUNDATION TRUST">
            THE HILLINGDON HOSPITALS NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069676}"}'value="THE INSTITUTE OF CANCER RESEARCH">
            THE INSTITUTE OF CANCER RESEARCH
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069677}"}'value="THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST">
            THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069678}"}'value="THE PRINCESS ALEXANDRA HOSPITAL NHS TRUST">
            THE PRINCESS ALEXANDRA HOSPITAL NHS TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069679}"}'value="THE ROYAL BOURNEMOUTH AND CHRISTCHURCH HOSPITALS NHS FOUNDATION TRUST">
            THE ROYAL BOURNEMOUTH AND CHRISTCHURCH HOSPITALS NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069680}"}'value="THE ROYAL MARSDEN NHS FOUNDATION TRUST">
            THE ROYAL MARSDEN NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069681}"}'value="THE ROYAL ORTHOPAEDIC HOSPITAL NHS FOUNDATION TRUST">
            THE ROYAL ORTHOPAEDIC HOSPITAL NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069682}"}'value="The University of Brighton and Sussex">
            The University of Brighton and Sussex
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069683}"}'value="THE WALTON CENTRE NHS FOUNDATION TRUST">
            THE WALTON CENTRE NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069684}"}'value="THE WHITTINGTON HOSPITAL NHS TRUST">
            THE WHITTINGTON HOSPITAL NHS TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069685}"}'value="Tower Hamlets PCT">
            Tower Hamlets PCT
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069686}"}'value="Trinity Hospice">
            Trinity Hospice
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069687}"}'value="UCL Partners">
            UCL Partners
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069688}"}'value="University College London">
            University College London
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069689}"}'value="University College London (Eastman Dental Institute)">
            University College London (Eastman Dental Institute)
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069690}"}'value="UNIVERSITY COLLEGE LONDON HOSPITALS NHS FOUNDATION TRUST">
            UNIVERSITY COLLEGE LONDON HOSPITALS NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069691}"}'value="UNIVERSITY HOSPITAL OF SOUTH MANCHESTER NHS FOUNDATION TRUST">
            UNIVERSITY HOSPITAL OF SOUTH MANCHESTER NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069692}"}'value="UNIVERSITY HOSPITAL SOUTHAMPTON NHS FOUNDATION TRUST">
            UNIVERSITY HOSPITAL SOUTHAMPTON NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069693}"}'value="UNIVERSITY HOSPITALS BIRMINGHAM NHS FOUNDATION TRUST">
            UNIVERSITY HOSPITALS BIRMINGHAM NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069694}"}'value="UNIVERSITY HOSPITALS BRISTOL NHS FOUNDATION TRUST">
            UNIVERSITY HOSPITALS BRISTOL NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069695}"}'value="UNIVERSITY HOSPITALS COVENTRY AND WARWICKSHIRE NHS TRUST">
            UNIVERSITY HOSPITALS COVENTRY AND WARWICKSHIRE NHS TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069696}"}'value="UNIVERSITY HOSPITALS OF LEICESTER NHS TRUST">
            UNIVERSITY HOSPITALS OF LEICESTER NHS TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069697}"}'value="WEST HERTFORDSHIRE HOSPITALS NHS TRUST">
            WEST HERTFORDSHIRE HOSPITALS NHS TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069698}"}'value="WEST LONDON MENTAL HEALTH NHS TRUST">
            WEST LONDON MENTAL HEALTH NHS TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069699}"}'value="WEST MIDDLESEX UNIVERSITY HOSPITAL NHS TRUST">
            WEST MIDDLESEX UNIVERSITY HOSPITAL NHS TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069700}"}'value="West Sussex County Council">
            West Sussex County Council
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069701}"}'value="West Sussex County Council, Occupational Health Dept.">
            West Sussex County Council, Occupational Health Dept.
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069702}"}'value="WESTERN SUSSEX HOSPITALS NHS FOUNDATION TRUST">
            WESTERN SUSSEX HOSPITALS NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069703}"}'value="Westminster City Council">
            Westminster City Council
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069704}"}'value="WIRRAL UNIVERSITY TEACHING HOSPITAL NHS FOUNDATION TRUST">
            WIRRAL UNIVERSITY TEACHING HOSPITAL NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069705}"}'value="WORCESTERSHIRE ACUTE HOSPITALS NHS TRUST">
            WORCESTERSHIRE ACUTE HOSPITALS NHS TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069706}"}'value="WRIGHTINGTON, WIGAN AND LEIGH NHS FOUNDATION TRUST">
            WRIGHTINGTON, WIGAN AND LEIGH NHS FOUNDATION TRUST
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069707}"}'value="Your Healthcare">
            Your Healthcare
          </option>

</select>

<option value>Choose...</option>

</select>

<option value>Choose...</option>

</select>

<div class="form-group  helpdesk_ticket_custom_field_training_programme_606619">
    <label for="helpdesk_ticket_custom_field_training_programme_606619" class=" form-label">
    	Training programme
	  	
	  		<span class="fw-asterisk">*</span>
	  	
      
    </label>

<option value>Choose...</option>

<option  data-custom-properties='{"id": "{"data-id"=>7000069309}"}'value="Acute Care Common Stem KSS">
            Acute Care Common Stem KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069310}"}'value="Acute Care Common Stem North East LDN">
            Acute Care Common Stem North East LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069709}"}'value="Acute Care Common Stem North West LDN">
            Acute Care Common Stem North West LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069710}"}'value="Acute Care Common Stem South LDN">
            Acute Care Common Stem South LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069711}"}'value="Acute Internal Medicine KSS">
            Acute Internal Medicine KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069712}"}'value="Acute Internal Medicine North East LDN">
            Acute Internal Medicine North East LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069713}"}'value="Acute Internal Medicine North West LDN">
            Acute Internal Medicine North West LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069714}"}'value="Acute Internal Medicine South LDN">
            Acute Internal Medicine South LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069715}"}'value="Additional Dental Specialties Dental and Maxillofacial Radiology Pan LDN">
            Additional Dental Specialties Dental and Maxillofacial Radiology Pan LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069716}"}'value="Additional Dental Specialties Oral and Maxillofacial Pathology Pan LDN">
            Additional Dental Specialties Oral and Maxillofacial Pathology Pan LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069717}"}'value="Additional Dental Specialties Oral Medicine Pan LDN">
            Additional Dental Specialties Oral Medicine Pan LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069718}"}'value="Additional Dental Specialties Oral Microbiology Pan LDN">
            Additional Dental Specialties Oral Microbiology Pan LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069719}"}'value="Allergy Pan LDN">
            Allergy Pan LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192608}"}'value="Anaesthetics Higher North LDN">
            Anaesthetics Higher North LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069720}"}'value="Anaesthetics Higher North East &amp; Central LDN">
            Anaesthetics Higher North East &amp; Central LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069721}"}'value="Anaesthetics Higher North West LDN">
            Anaesthetics Higher North West LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192609}"}'value="Anaesthetics Higher South LDN">
            Anaesthetics Higher South LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069722}"}'value="Anaesthetics Higher South East LDN">
            Anaesthetics Higher South East LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069723}"}'value="Anaesthetics Higher South West LDN">
            Anaesthetics Higher South West LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069724}"}'value="Anaesthetics KSS">
            Anaesthetics KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069725}"}'value="Audio vestibular medicine Pan LDN">
            Audio vestibular medicine Pan LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069726}"}'value="Broad Based Training KSS">
            Broad Based Training KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069727}"}'value="Cardiology KSS">
            Cardiology KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069728}"}'value="Cardiology North East LDN">
            Cardiology North East LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069729}"}'value="Cardiology North West LDN">
            Cardiology North West LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069730}"}'value="Cardiology South LDN">
            Cardiology South LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069731}"}'value="Cardiology Wessex KSS">
            Cardiology Wessex KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069732}"}'value="Cardiothoracic surgery Pan LDN">
            Cardiothoracic surgery Pan LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069733}"}'value="Chemical Pathology North East LDN">
            Chemical Pathology North East LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069734}"}'value="Chemical Pathology North West LDN">
            Chemical Pathology North West LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069735}"}'value="Chemical Pathology South LDN">
            Chemical Pathology South LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192610}"}'value="Child &amp; Adolescent Psychiatry KSS">
            Child &amp; Adolescent Psychiatry KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069736}"}'value="Child and Adolescent Psychiatry North LDN">
            Child and Adolescent Psychiatry North LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069737}"}'value="Child and Adolescent Psychiatry South LDN">
            Child and Adolescent Psychiatry South LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069738}"}'value="Clinical Genetics Pan LDN">
            Clinical Genetics Pan LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069739}"}'value="Clinical Neurophysiology North LDN">
            Clinical Neurophysiology North LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069740}"}'value="Clinical Neurophysiology South LDN">
            Clinical Neurophysiology South LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069741}"}'value="Clinical Oncology North East LDN">
            Clinical Oncology North East LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069742}"}'value="Clinical Oncology North West &amp; South LDN">
            Clinical Oncology North West &amp; South LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069743}"}'value="Clinical Pharmacology and Therapeutics Pan LDN">
            Clinical Pharmacology and Therapeutics Pan LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069744}"}'value="Clinical Radiology KSS">
            Clinical Radiology KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069745}"}'value="Clinical Radiology North East LDN">
            Clinical Radiology North East LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069746}"}'value="Clinical Radiology North West LDN">
            Clinical Radiology North West LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069747}"}'value="Clinical Radiology South East LDN">
            Clinical Radiology South East LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069748}"}'value="Clinical Radiology South West LDN">
            Clinical Radiology South West LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069749}"}'value="Community Sexual and Reproductive Health Pan LDN">
            Community Sexual and Reproductive Health Pan LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069750}"}'value="Core Anaesthetics Training KSS">
            Core Anaesthetics Training KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069751}"}'value="Core Anaesthetics Training North East &amp; Central LDN">
            Core Anaesthetics Training North East &amp; Central LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069752}"}'value="Core Anaesthetics Training North West LDN">
            Core Anaesthetics Training North West LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069753}"}'value="Core Anaesthetics Training South LDN">
            Core Anaesthetics Training South LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069754}"}'value="Core Medical Training KSS">
            Core Medical Training KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069755}"}'value="Core Medical Training North East &amp; Central LDN">
            Core Medical Training North East &amp; Central LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069756}"}'value="Core Medical Training North West LDN">
            Core Medical Training North West LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069757}"}'value="Core Medical Training South East LDN">
            Core Medical Training South East LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069758}"}'value="Core Medical Training South West LDN">
            Core Medical Training South West LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069759}"}'value="Core Psychiatry Training KSS">
            Core Psychiatry Training KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000159093}"}'value="Core Psychiatry Training North Central LDN">
            Core Psychiatry Training North Central LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069760}"}'value="Core Psychiatry Training North East LDN">
            Core Psychiatry Training North East LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069761}"}'value="Core Psychiatry Training North West LDN">
            Core Psychiatry Training North West LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069762}"}'value="Core Psychiatry Training South East LDN">
            Core Psychiatry Training South East LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069763}"}'value="Core Psychiatry Training South West LDN">
            Core Psychiatry Training South West LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069764}"}'value="Core Surgical Training KSS">
            Core Surgical Training KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069765}"}'value="Core Surgical Training North East LDN">
            Core Surgical Training North East LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069766}"}'value="Core Surgical Training North West LDN">
            Core Surgical Training North West LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069767}"}'value="Core Surgical Training South LDN">
            Core Surgical Training South LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069768}"}'value="Dental Core Training KSS">
            Dental Core Training KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069769}"}'value="Dental Core Training North LDN">
            Dental Core Training North LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069770}"}'value="Dental Core Training South LDN">
            Dental Core Training South LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192611}"}'value="Dental Foundation North LDN">
            Dental Foundation North LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069771}"}'value="Dental Foundation Training Central KSS">
            Dental Foundation Training Central KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192612}"}'value="Dental Foundation Training Central LDN">
            Dental Foundation Training Central LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069772}"}'value="Dental Foundation Training Coastal KSS">
            Dental Foundation Training Coastal KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192613}"}'value="Dental Foundation Training East Kent &amp; Medway">
            Dental Foundation Training East Kent &amp; Medway
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069773}"}'value="Dental Foundation Training East KSS">
            Dental Foundation Training East KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069774}"}'value="Dental Foundation Training North Central LDN">
            Dental Foundation Training North Central LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069775}"}'value="Dental Foundation Training North East LDN">
            Dental Foundation Training North East LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192615}"}'value="Dental Foundation Training North LDN">
            Dental Foundation Training North LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192614}"}'value="Dental Foundation Training North Kent">
            Dental Foundation Training North Kent
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069776}"}'value="Dental Foundation Training North West LDN">
            Dental Foundation Training North West LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192616}"}'value="Dental Foundation Training South Central LDN">
            Dental Foundation Training South Central LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069777}"}'value="Dental Foundation Training South East LDN">
            Dental Foundation Training South East LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069778}"}'value="Dental Foundation Training South KSS">
            Dental Foundation Training South KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069779}"}'value="Dental Foundation Training South West LDN">
            Dental Foundation Training South West LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192617}"}'value="Dental Foundation Training Surrey">
            Dental Foundation Training Surrey
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192618}"}'value="Dental Foundation Training Sussex">
            Dental Foundation Training Sussex
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069780}"}'value="Dental Foundation Training West KSS">
            Dental Foundation Training West KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192619}"}'value="Dental Foundation Training West LDN">
            Dental Foundation Training West LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069781}"}'value="Dermatology KSS">
            Dermatology KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069782}"}'value="Dermatology North LDN">
            Dermatology North LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069783}"}'value="Dermatology South LDN">
            Dermatology South LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069784}"}'value="Diagnostic Neuropathology Pan LDN">
            Diagnostic Neuropathology Pan LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069785}"}'value="Emergency medicine - Pre-hospital emergency medicine KSS">
            Emergency medicine - Pre-hospital emergency medicine KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069786}"}'value="Emergency Medicine (run through) KSS">
            Emergency Medicine (run through) KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069787}"}'value="Emergency Medicine KSS">
            Emergency Medicine KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069788}"}'value="Emergency Medicine North East LDN">
            Emergency Medicine North East LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069789}"}'value="Emergency Medicine North West LDN">
            Emergency Medicine North West LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069790}"}'value="Emergency Medicine South LDN">
            Emergency Medicine South LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069791}"}'value="Endocrinology and Diabetes Mellitus KSS">
            Endocrinology and Diabetes Mellitus KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069792}"}'value="Endocrinology and Diabetes Mellitus North East LDN">
            Endocrinology and Diabetes Mellitus North East LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069793}"}'value="Endocrinology and Diabetes Mellitus North West LDN">
            Endocrinology and Diabetes Mellitus North West LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069794}"}'value="Endocrinology and Diabetes Mellitus South LDN">
            Endocrinology and Diabetes Mellitus South LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069806}"}'value="Endodontics Pan LDN">
            Endodontics Pan LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192620}"}'value="Forensic Psychiatry &amp; Medical Psychotherapy North LDN">
            Forensic Psychiatry &amp; Medical Psychotherapy North LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192621}"}'value="Forensic Psychiatry &amp; Medical Psychotherapy South LDN">
            Forensic Psychiatry &amp; Medical Psychotherapy South LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069807}"}'value="Forensic Psychiatry KSS">
            Forensic Psychiatry KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192622}"}'value="Forensic Psychiatry North LDN">
            Forensic Psychiatry North LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069808}"}'value="Forensic Psychiatry North East LDN">
            Forensic Psychiatry North East LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069809}"}'value="Forensic Psychiatry North West LDN">
            Forensic Psychiatry North West LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069810}"}'value="Forensic Psychiatry South LDN">
            Forensic Psychiatry South LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192623}"}'value="Foundation North LDN">
            Foundation North LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069811}"}'value="Foundation North Central and East LDN">
            Foundation North Central and East LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069813}"}'value="Foundation North West LDN">
            Foundation North West LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000145962}"}'value="Foundation Programme KSS">
            Foundation Programme KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000145963}"}'value="Foundation Programme South LDN">
            Foundation Programme South LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069815}"}'value="Gastro-enterology KSS">
            Gastro-enterology KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069816}"}'value="Gastro-enterology North East LDN">
            Gastro-enterology North East LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069817}"}'value="Gastro-enterology North West LDN">
            Gastro-enterology North West LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069818}"}'value="Gastro-enterology South LDN">
            Gastro-enterology South LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069819}"}'value="Gastro-enterology Wessex KSS">
            Gastro-enterology Wessex KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192624}"}'value="General (Internal) Medicine KSS">
            General (Internal) Medicine KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192625}"}'value="General Practice - Barking &amp; Dagenham TERS LDN">
            General Practice - Barking &amp; Dagenham TERS LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192626}"}'value="General Practice - Barking, Dagenham and Havering LDN">
            General Practice - Barking, Dagenham and Havering LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192627}"}'value="General Practice - Barking, Dagenham and Havering TERS LDN">
            General Practice - Barking, Dagenham and Havering TERS LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069820}"}'value="General Practice - Barnet LDN">
            General Practice - Barnet LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192628}"}'value="General Practice - Bexley LDN">
            General Practice - Bexley LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069821}"}'value="General Practice - Bexley &amp; Sidcup LDN">
            General Practice - Bexley &amp; Sidcup LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192629}"}'value="General Practice - Bexley TERS LDN">
            General Practice - Bexley TERS LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192630}"}'value="General Practice - Brent TERS LDN">
            General Practice - Brent TERS LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069822}"}'value="General Practice - Brighton and Mid Sussex KSS">
            General Practice - Brighton and Mid Sussex KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069823}"}'value="General Practice - Bromley LDN">
            General Practice - Bromley LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069824}"}'value="General Practice - Central Middlesex LDN">
            General Practice - Central Middlesex LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069825}"}'value="General Practice - Chertsey KSS">
            General Practice - Chertsey KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069826}"}'value="General Practice - Crawley and East Surrey KSS">
            General Practice - Crawley and East Surrey KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069827}"}'value="General Practice - Croydon LDN">
            General Practice - Croydon LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192631}"}'value="General Practice - Croydon TERS LDN">
            General Practice - Croydon TERS LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069828}"}'value="General Practice - Dartford KSS">
            General Practice - Dartford KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192632}"}'value="General Practice - Dartford (Dartford) TERS KSS">
            General Practice - Dartford (Dartford) TERS KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192633}"}'value="General Practice - Dartford (Gravesend) TERS KSS">
            General Practice - Dartford (Gravesend) TERS KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069829}"}'value="General Practice - Ealing LDN">
            General Practice - Ealing LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192634}"}'value="General Practice - Ealing TERS LDN">
            General Practice - Ealing TERS LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069830}"}'value="General Practice - East Kent KSS">
            General Practice - East Kent KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069831}"}'value="General Practice - East Sussex KSS">
            General Practice - East Sussex KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192635}"}'value="General Practice - East Sussex (Hailsham) TERS KSS">
            General Practice - East Sussex (Hailsham) TERS KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192636}"}'value="General Practice - East Sussex (Hastings) TERS KSS">
            General Practice - East Sussex (Hastings) TERS KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192638}"}'value="General Practice - Enfield (Haringey) TERS LDN">
            General Practice - Enfield (Haringey) TERS LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069832}"}'value="General Practice - Enfield &amp; Haringey LDN">
            General Practice - Enfield &amp; Haringey LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192637}"}'value="General Practice - Enfield (Enfield) TERS LDN">
            General Practice - Enfield (Enfield) TERS LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069833}"}'value="General Practice - Epsom KSS">
            General Practice - Epsom KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069834}"}'value="General Practice - Frimley KSS">
            General Practice - Frimley KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069835}"}'value="General Practice - Greenwich LDN">
            General Practice - Greenwich LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192639}"}'value="General Practice - Greenwich TERS LDN">
            General Practice - Greenwich TERS LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069836}"}'value="General Practice - Guildford KSS">
            General Practice - Guildford KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069837}"}'value="General Practice - Guys &amp; St. Thomas&#39; LDN">
            General Practice - Guys &amp; St. Thomas&#39; LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069838}"}'value="General Practice - Hackney LDN">
            General Practice - Hackney LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192640}"}'value="General Practice - Havering TERS LDN">
            General Practice - Havering TERS LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069839}"}'value="General Practice - Hillingdon LDN">
            General Practice - Hillingdon LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192641}"}'value="General Practice - Hillingdon TERS LDN">
            General Practice - Hillingdon TERS LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192642}"}'value="General Practice - Hounslow TERS LDN">
            General Practice - Hounslow TERS LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069840}"}'value="General Practice - Ilford LDN">
            General Practice - Ilford LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192643}"}'value="General Practice - Ilford TERS LDN">
            General Practice - Ilford TERS LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069841}"}'value="General Practice - Imperial LDN">
            General Practice - Imperial LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069842}"}'value="General Practice - Kings LDN">
            General Practice - Kings LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069843}"}'value="General Practice - Kingston &amp; Roehampton LDN">
            General Practice - Kingston &amp; Roehampton LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069844}"}'value="General Practice - Lewisham LDN">
            General Practice - Lewisham LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192644}"}'value="General Practice - Lewisham TERS LDN">
            General Practice - Lewisham TERS LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069845}"}'value="General Practice - Maidstone and Tunbridge Wells KSS">
            General Practice - Maidstone and Tunbridge Wells KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069846}"}'value="General Practice - Medway KSS">
            General Practice - Medway KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192645}"}'value="General Practice - Medway (Chatham) TERS KSS">
            General Practice - Medway (Chatham) TERS KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192646}"}'value="General Practice - Medway (Gillingham) TERS KSS">
            General Practice - Medway (Gillingham) TERS KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069847}"}'value="General Practice - Newham LDN">
            General Practice - Newham LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192647}"}'value="General Practice - Newham TERS LDN">
            General Practice - Newham TERS LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069848}"}'value="General Practice - Northwick Park LDN">
            General Practice - Northwick Park LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192648}"}'value="General Practice - Redbridge TERS LDN">
            General Practice - Redbridge TERS LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069849}"}'value="General Practice - Riverside LDN">
            General Practice - Riverside LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069850}"}'value="General Practice - Romford LDN">
            General Practice - Romford LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069851}"}'value="General Practice - Royal Free LDN">
            General Practice - Royal Free LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069852}"}'value="General Practice - St Georges LDN">
            General Practice - St Georges LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069853}"}'value="General Practice - St Helier LDN">
            General Practice - St Helier LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069854}"}'value="General Practice - St Mary&#39;s LDN">
            General Practice - St Mary&#39;s LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192649}"}'value="General Practice - Swale TERS - Medway KSS">
            General Practice - Swale TERS - Medway KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192650}"}'value="General Practice - Thanet TERS - East Kent KSS">
            General Practice - Thanet TERS - East Kent KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069855}"}'value="General Practice - Tower Hamlets LDN">
            General Practice - Tower Hamlets LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069856}"}'value="General Practice - UCLH LDN">
            General Practice - UCLH LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192651}"}'value="General Practice - Waltham Forest NELFT LDN">
            General Practice - Waltham Forest NELFT LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192652}"}'value="General Practice - Waltham Forest TERS LDN">
            General Practice - Waltham Forest TERS LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192653}"}'value="General Practice - Waltham Forest Whipps LDN">
            General Practice - Waltham Forest Whipps LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069857}"}'value="General Practice - West Middlesex LDN">
            General Practice - West Middlesex LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069858}"}'value="General Practice - Western Sussex KSS">
            General Practice - Western Sussex KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069859}"}'value="General Practice - Whipps Cross LDN">
            General Practice - Whipps Cross LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069860}"}'value="General Practice - Whittington LDN">
            General Practice - Whittington LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192656}"}'value="General Psychiatry KSS">
            General Psychiatry KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192654}"}'value="General Psychiatry &amp; Medical Psychotherapy North LDN">
            General Psychiatry &amp; Medical Psychotherapy North LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192655}"}'value="General Psychiatry &amp; Medical Psychotherapy South LDN">
            General Psychiatry &amp; Medical Psychotherapy South LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192657}"}'value="General Psychiatry North Central LDN">
            General Psychiatry North Central LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192658}"}'value="General Psychiatry North East LDN">
            General Psychiatry North East LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192659}"}'value="General Psychiatry North West LDN">
            General Psychiatry North West LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192660}"}'value="General Psychiatry South East LDN">
            General Psychiatry South East LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069861}"}'value="General Psychiatry &amp; Old Age Psychiatry KSS">
            General Psychiatry &amp; Old Age Psychiatry KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000159094}"}'value="General Psychiatry &amp; Old Age Psychiatry North Central LDN">
            General Psychiatry &amp; Old Age Psychiatry North Central LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069862}"}'value="General Psychiatry &amp; Old Age Psychiatry North East LDN">
            General Psychiatry &amp; Old Age Psychiatry North East LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069863}"}'value="General Psychiatry &amp; Old Age Psychiatry North West LDN">
            General Psychiatry &amp; Old Age Psychiatry North West LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069864}"}'value="General Psychiatry &amp; Old Age Psychiatry South East LDN">
            General Psychiatry &amp; Old Age Psychiatry South East LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069865}"}'value="General Psychiatry &amp; Old Age Psychiatry South West LDN">
            General Psychiatry &amp; Old Age Psychiatry South West LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069866}"}'value="General Surgery KSS">
            General Surgery KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069867}"}'value="General Surgery North East LDN">
            General Surgery North East LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069868}"}'value="General Surgery North West LDN">
            General Surgery North West LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069869}"}'value="General Surgery South East LDN">
            General Surgery South East LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069870}"}'value="General Surgery South West LDN">
            General Surgery South West LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069871}"}'value="Genito-urinary Medicine KSS">
            Genito-urinary Medicine KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069872}"}'value="Genito-Urinary Medicine North East LDN">
            Genito-Urinary Medicine North East LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069873}"}'value="Genito-Urinary Medicine North West LDN">
            Genito-Urinary Medicine North West LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069874}"}'value="Genito-Urinary Medicine South LDN">
            Genito-Urinary Medicine South LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069875}"}'value="Geriatric Medicine KSS">
            Geriatric Medicine KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069876}"}'value="Geriatric Medicine North East LDN">
            Geriatric Medicine North East LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069877}"}'value="Geriatric Medicine North West LDN">
            Geriatric Medicine North West LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069878}"}'value="Geriatric Medicine South East LDN">
            Geriatric Medicine South East LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069879}"}'value="Geriatric Medicine South West LDN">
            Geriatric Medicine South West LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069880}"}'value="Haematology North East LDN">
            Haematology North East LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069881}"}'value="Haematology North West LDN">
            Haematology North West LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069882}"}'value="Haematology South LDN">
            Haematology South LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069883}"}'value="Histopathology North East LDN">
            Histopathology North East LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069884}"}'value="Histopathology North West LDN">
            Histopathology North West LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069885}"}'value="Histopathology South LDN">
            Histopathology South LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069886}"}'value="Histopathology ST1 Pan LDN">
            Histopathology ST1 Pan LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069887}"}'value="Histopathology Wessex KSS">
            Histopathology Wessex KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069888}"}'value="Immunology Pan LDN">
            Immunology Pan LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069889}"}'value="Infectious Diseases KSS">
            Infectious Diseases KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069890}"}'value="Infectious Diseases Pan LDN">
            Infectious Diseases Pan LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069891}"}'value="Intensive Care Medicine Pan LDN">
            Intensive Care Medicine Pan LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069892}"}'value="Intensive Care Medicine Single KSS">
            Intensive Care Medicine Single KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000183761}"}'value="Internal Medicine Training">
            Internal Medicine Training
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000175881}"}'value="Internal Medicine Training KSS">
            Internal Medicine Training KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000175882}"}'value="Internal Medicine Training North East and Central LDN">
            Internal Medicine Training North East and Central LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000175883}"}'value="Internal Medicine Training North West LDN">
            Internal Medicine Training North West LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000175884}"}'value="Internal Medicine Training South East LDN">
            Internal Medicine Training South East LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000183762}"}'value="Internal Medicine Training South West LDN">
            Internal Medicine Training South West LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192661}"}'value="Internal Medicine Training Stage 1 KSS">
            Internal Medicine Training Stage 1 KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192662}"}'value="Internal Medicine Training Stage 1 North East &amp; Central LDN">
            Internal Medicine Training Stage 1 North East &amp; Central LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192663}"}'value="Internal Medicine Training Stage 1 North West LDN">
            Internal Medicine Training Stage 1 North West LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192664}"}'value="Internal Medicine Training Stage 1 South East LDN">
            Internal Medicine Training Stage 1 South East LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192665}"}'value="Internal Medicine Training Stage 1 South West LDN">
            Internal Medicine Training Stage 1 South West LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192666}"}'value="Joint Dental Foundation Core Training">
            Joint Dental Foundation Core Training
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069893}"}'value="Medical Microbiology KSS">
            Medical Microbiology KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069894}"}'value="Medical Microbiology Pan LDN">
            Medical Microbiology Pan LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192667}"}'value="Medical Oncology">
            Medical Oncology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069895}"}'value="Medical Oncology North East LDN">
            Medical Oncology North East LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069896}"}'value="Medical Oncology North West &amp; South LDN">
            Medical Oncology North West &amp; South LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069897}"}'value="Medical Ophthalmology Pan LDN">
            Medical Ophthalmology Pan LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192668}"}'value="Medical Psychotherapy North LDN">
            Medical Psychotherapy North LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069898}"}'value="Medical Psychotherapy North East LDN">
            Medical Psychotherapy North East LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069899}"}'value="Medical Psychotherapy North West LDN">
            Medical Psychotherapy North West LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069900}"}'value="Medical Psychotherapy South LDN">
            Medical Psychotherapy South LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069901}"}'value="Medical Virology Pan LDN">
            Medical Virology Pan LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069902}"}'value="Neurology KSS">
            Neurology KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069903}"}'value="Neurology North LDN">
            Neurology North LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069904}"}'value="Neurology South LDN">
            Neurology South LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069905}"}'value="Neurosurgery North LDN">
            Neurosurgery North LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069906}"}'value="Neurosurgery South LDN">
            Neurosurgery South LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069907}"}'value="Nuclear Medicine KSS">
            Nuclear Medicine KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069908}"}'value="Nuclear Medicine Pan LDN">
            Nuclear Medicine Pan LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069909}"}'value="Obstetrics and Gynaecology KSS">
            Obstetrics and Gynaecology KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069910}"}'value="Obstetrics and Gynaecology North East LDN">
            Obstetrics and Gynaecology North East LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069911}"}'value="Obstetrics and Gynaecology North West LDN">
            Obstetrics and Gynaecology North West LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069912}"}'value="Obstetrics and Gynaecology South LDN">
            Obstetrics and Gynaecology South LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069913}"}'value="Occupational Medicine Pan LDN">
            Occupational Medicine Pan LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192669}"}'value="Old Age Psychiatry North Central LDN">
            Old Age Psychiatry North Central LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192670}"}'value="Old Age Psychiatry North East LDN">
            Old Age Psychiatry North East LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192671}"}'value="Old Age Psychiatry North West LDN">
            Old Age Psychiatry North West LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192672}"}'value="Old Age Psychiatry South East LDN">
            Old Age Psychiatry South East LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069914}"}'value="Ophthalmology KSS">
            Ophthalmology KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069915}"}'value="Ophthalmology North LDN">
            Ophthalmology North LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069916}"}'value="Ophthalmology South LDN">
            Ophthalmology South LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069917}"}'value="Oral and Maxillo-facial Surgery KSS">
            Oral and Maxillo-facial Surgery KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069918}"}'value="Oral and maxillofacial surgery Pan LDN">
            Oral and maxillofacial surgery Pan LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069919}"}'value="Oral and Maxillo-facial Surgery Wessex KSS">
            Oral and Maxillo-facial Surgery Wessex KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069920}"}'value="Oral Surgery Pan LDN">
            Oral Surgery Pan LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069921}"}'value="Orthodontics Pan LDN">
            Orthodontics Pan LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069922}"}'value="Otolaryngology KSS">
            Otolaryngology KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069923}"}'value="Otolaryngology North LDN">
            Otolaryngology North LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069924}"}'value="Otolaryngology South LDN">
            Otolaryngology South LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069925}"}'value="Paediatric and Perinatal Pathology Pan LDN">
            Paediatric and Perinatal Pathology Pan LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069926}"}'value="Paediatric Cardiology Pan LDN">
            Paediatric Cardiology Pan LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069927}"}'value="Paediatric Dentistry Pan LDN">
            Paediatric Dentistry Pan LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069928}"}'value="Paediatric Surgery Pan LDN">
            Paediatric Surgery Pan LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069929}"}'value="Paediatrics KSS">
            Paediatrics KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192673}"}'value="Paediatrics ST1-4 North East LDN">
            Paediatrics ST1-4 North East LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192674}"}'value="Paediatrics ST1-4 North West LDN">
            Paediatrics ST1-4 North West LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192675}"}'value="Paediatrics ST1-4 South LDN">
            Paediatrics ST1-4 South LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069930}"}'value="Paediatrics ST1-5 North East LDN">
            Paediatrics ST1-5 North East LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069931}"}'value="Paediatrics ST1-5 North LDN - Historic">
            Paediatrics ST1-5 North LDN - Historic
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069932}"}'value="Paediatrics ST1-5 North West LDN">
            Paediatrics ST1-5 North West LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069933}"}'value="Paediatrics ST1-5 South LDN">
            Paediatrics ST1-5 South LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069934}"}'value="Paediatrics ST6-8 Pan LDN">
            Paediatrics ST6-8 Pan LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069935}"}'value="Palliative Medicine North East LDN">
            Palliative Medicine North East LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069936}"}'value="Palliative Medicine North West &amp; South LDN">
            Palliative Medicine North West &amp; South LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192676}"}'value="Periodontics Pan LDN">
            Periodontics Pan LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069937}"}'value="Periodontics&nbsp;Pan LDN">
            Periodontics&nbsp;Pan LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069938}"}'value="Plastic Surgery Pan LDN">
            Plastic Surgery Pan LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069939}"}'value="Prosthodontics Pan LDN">
            Prosthodontics Pan LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192677}"}'value="Psychiatry of Learning Disability KSS">
            Psychiatry of Learning Disability KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069940}"}'value="Psychiatry of Learning Disability North LDN">
            Psychiatry of Learning Disability North LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069941}"}'value="Psychiatry of Learning Disability South LDN">
            Psychiatry of Learning Disability South LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069942}"}'value="Public health dental Pan LDN">
            Public health dental Pan LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192678}"}'value="Public Health Medicine London and KSS">
            Public Health Medicine London and KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069943}"}'value="Public Health Medicine North LDN">
            Public Health Medicine North LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192679}"}'value="Public Health Medicine Pan London">
            Public Health Medicine Pan London
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069944}"}'value="Public Health Medicine South East LDN">
            Public Health Medicine South East LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069945}"}'value="Public Health Medicine South West LDN">
            Public Health Medicine South West LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069946}"}'value="Rehabilitation Medicine Pan LDN">
            Rehabilitation Medicine Pan LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069947}"}'value="Renal Medicine KSS">
            Renal Medicine KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069948}"}'value="Renal Medicine North East LDN">
            Renal Medicine North East LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069949}"}'value="Renal Medicine North LDN - Historic">
            Renal Medicine North LDN - Historic
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069950}"}'value="Renal Medicine North West LDN">
            Renal Medicine North West LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000192680}"}'value="Renal Medicine North LDN">
            Renal Medicine North LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069951}"}'value="Renal Medicine South LDN">
            Renal Medicine South LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069952}"}'value="Respiratory Medicine KSS">
            Respiratory Medicine KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069953}"}'value="Respiratory Medicine North East LDN">
            Respiratory Medicine North East LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069954}"}'value="Respiratory Medicine North West LDN">
            Respiratory Medicine North West LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069955}"}'value="Respiratory Medicine South LDN">
            Respiratory Medicine South LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069956}"}'value="Restorative Dentistry Pan LDN">
            Restorative Dentistry Pan LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069957}"}'value="Rheumatology KSS">
            Rheumatology KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069958}"}'value="Rheumatology North East LDN">
            Rheumatology North East LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069959}"}'value="Rheumatology North West LDN">
            Rheumatology North West LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069960}"}'value="Rheumatology South LDN">
            Rheumatology South LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069961}"}'value="Special Care Dentistry Pan LDN">
            Special Care Dentistry Pan LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069962}"}'value="Sport and Exercise Medicine Pan LDN">
            Sport and Exercise Medicine Pan LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069963}"}'value="Stroke Medicine KSS">
            Stroke Medicine KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069964}"}'value="Trauma and Orthopaedic Surgery North East LDN">
            Trauma and Orthopaedic Surgery North East LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069965}"}'value="Trauma and Orthopaedic Surgery North West LDN">
            Trauma and Orthopaedic Surgery North West LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069966}"}'value="Trauma and Orthopaedic Surgery South East LDN">
            Trauma and Orthopaedic Surgery South East LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069967}"}'value="Trauma and Orthopaedic Surgery South West LDN">
            Trauma and Orthopaedic Surgery South West LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069968}"}'value="Trauma and Orthopaedics KSS">
            Trauma and Orthopaedics KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069969}"}'value="Urology KSS">
            Urology KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069970}"}'value="Urology North LDN">
            Urology North LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069971}"}'value="Urology South LDN">
            Urology South LDN
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069972}"}'value="Urology Wessex KSS">
            Urology Wessex KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069973}"}'value="Vascular Surgery KSS">
            Vascular Surgery KSS
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000069974}"}'value="Vascular Surgery Pan LDN">
            Vascular Surgery Pan LDN
          </option>

</select>

<option value>Choose...</option>

</select>

<option value>Choose...</option>

</select>

<option value>Choose...</option>

</select>

<option value>Choose...</option>

</select>

<option value>Choose...</option>

</select>

<option value>Choose...</option>

</select>

<option value>Choose...</option>

</select>

<div class="form-group  helpdesk_ticket_custom_field_cf_subspecialty_606619">
    <label for="helpdesk_ticket_custom_field_cf_subspecialty_606619" class=" form-label">
    	Sub-specialty
	  	
      
    </label>

<option value>Choose...</option>

<option  data-custom-properties='{"id": "{"data-id"=>7000200181}"}'value="Acute Care Common Stem - Anaesthetics">
            Acute Care Common Stem - Anaesthetics
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000200182}"}'value="Acute Care Common Stem - Emergency Medicine">
            Acute Care Common Stem - Emergency Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000200183}"}'value="Acute Care Common Stem - General">
            Acute Care Common Stem - General
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000200184}"}'value="Acute Care Common Stem - Intensive Care Medicine">
            Acute Care Common Stem - Intensive Care Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000200185}"}'value="Acute Care Common Stem - Internal Medicine">
            Acute Care Common Stem - Internal Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000200186}"}'value="Community Child Health">
            Community Child Health
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000200187}"}'value="Congenital Cardiac Surgery">
            Congenital Cardiac Surgery
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000200188}"}'value="Cytopathology">
            Cytopathology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000200189}"}'value="Dental and Maxillofacial Radiology">
            Dental and Maxillofacial Radiology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000200190}"}'value="Dental Core Training">
            Dental Core Training
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000200191}"}'value="Dental Foundation Training">
            Dental Foundation Training
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000200192}"}'value="Endodontics">
            Endodontics
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000200193}"}'value="Gynaecological Oncology">
            Gynaecological Oncology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000200194}"}'value="Hepatology">
            Hepatology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000200195}"}'value="Interventional Radiology">
            Interventional Radiology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000200196}"}'value="Liaison Psychiatry">
            Liaison Psychiatry
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000200197}"}'value="Maternal And Fetal Medicine">
            Maternal And Fetal Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000200198}"}'value="Metabolic Medicine">
            Metabolic Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000200199}"}'value="Neonatal Medicine">
            Neonatal Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000200200}"}'value="OMFS- Dental">
            OMFS- Dental
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000200201}"}'value="Oral And Maxillofacial Pathology">
            Oral And Maxillofacial Pathology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000200202}"}'value="Oral Maxillofacial Histopathology">
            Oral Maxillofacial Histopathology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000200203}"}'value="Oral Medicine">
            Oral Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000200204}"}'value="Oral Microbiology">
            Oral Microbiology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000200205}"}'value="Oral Surgery">
            Oral Surgery
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000200206}"}'value="Orthodontics">
            Orthodontics
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000200207}"}'value="Paediatric Allergy, Immunology And Infectious Diseases">
            Paediatric Allergy, Immunology And Infectious Diseases
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000200208}"}'value="Paediatric Clinical Pharmacology And Therapeutics">
            Paediatric Clinical Pharmacology And Therapeutics
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000200209}"}'value="Paediatric Dentistry">
            Paediatric Dentistry
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000200210}"}'value="Paediatric Diabetes And Endocrinology">
            Paediatric Diabetes And Endocrinology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000200211}"}'value="Paediatric Emergency Medicine">
            Paediatric Emergency Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000200212}"}'value="Paediatric Gastroenterology, Hepatology And Nutrition">
            Paediatric Gastroenterology, Hepatology And Nutrition
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000200213}"}'value="Paediatric Inherited Metabolic Medicine">
            Paediatric Inherited Metabolic Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000200214}"}'value="Paediatric Intensive Care Medicine">
            Paediatric Intensive Care Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000200215}"}'value="Paediatric Nephrology">
            Paediatric Nephrology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000200216}"}'value="Paediatric Neurodisability">
            Paediatric Neurodisability
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000200217}"}'value="Paediatric Neurology">
            Paediatric Neurology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000200218}"}'value="Paediatric Oncology">
            Paediatric Oncology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000200219}"}'value="Paediatric Palliative Medicine">
            Paediatric Palliative Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000200220}"}'value="Paediatric Respiratory Medicine">
            Paediatric Respiratory Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000200221}"}'value="Paediatric Rheumatology">
            Paediatric Rheumatology
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000200222}"}'value="Periodontics">
            Periodontics
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000200223}"}'value="Prosthodontics">
            Prosthodontics
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000200224}"}'value="Public Health Dental">
            Public Health Dental
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000200225}"}'value="Rehabilitation Psychiatry">
            Rehabilitation Psychiatry
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000200226}"}'value="Reproductive Medicine">
            Reproductive Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000200227}"}'value="Restorative Dentistry">
            Restorative Dentistry
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000200228}"}'value="Special Care Dentistry">
            Special Care Dentistry
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000200229}"}'value="Stroke Medicine">
            Stroke Medicine
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000200230}"}'value="Urogynaecology">
            Urogynaecology
          </option>

</select>

<option value>Choose...</option>

</select>

<option value>Choose...</option>

</select>

<option value>Choose...</option>

</select>

<option value>Choose...</option>

</select>

<option value>Choose...</option>

</select>

<option value>Choose...</option>

</select>

<option value>Choose...</option>

</select>

<option value>Choose...</option>

</select>

<option value>Choose...</option>

</select>

<option value>Choose...</option>

</select>

<option value>Choose...</option>

</select>

<option value>Choose...</option>

</select>

<option value>Choose...</option>

</select>

<option value>Choose...</option>

</select>

<option value>Choose...</option>

<option  data-custom-properties='{"id": "{"data-id"=>7000108032}"}'value="Medical Education Manager">
            Medical Education Manager
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000108033}"}'value="Medical School Manager">
            Medical School Manager
          </option>

</select>

<option value>Choose...</option>

</select>

<option value>Choose...</option>

</select>

<option value>Choose...</option>

</select>

<option value>Choose...</option>

</select>

<option value>Choose...</option>

</select>

<option value>Choose...</option>

</select>

<option value>Choose...</option>

</select>

<option value>Choose...</option>

</select>

<option value>Choose...</option>

</select>

<option value>Choose...</option>

</select>

<option value>Choose...</option>

</select>

<option value>Choose...</option>

</select>

<div class="form-group  helpdesk_ticket_custom_field_cf_letb_606619">
    <label for="helpdesk_ticket_custom_field_cf_letb_606619" class=" form-label">
    	LETB (Deanery)
	  	
	  		<span class="fw-asterisk">*</span>
	  	
      
    </label>

<option value>Choose...</option>

<option  data-custom-properties='{"id": "{"data-id"=>7000183335}"}'value="NWL">
            NWL
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000183336}"}'value="NCEL">
            NCEL
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000183337}"}'value="SL">
            SL
          </option>

</select>

<div class="form-group  helpdesk_ticket_custom_field_cf_place_of_primary_qualification_606619">
    <label for="helpdesk_ticket_custom_field_cf_place_of_primary_qualification_606619" class=" form-label">
    	Place of Primary Qualification
	  	
	  		<span class="fw-asterisk">*</span>
	  	
      
    </label>

<option value>Choose...</option>

<option  data-custom-properties='{"id": "{"data-id"=>7000183339}"}'value="UK">
            UK
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000183340}"}'value="EU">
            EU
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000183341}"}'value="IMG">
            IMG
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000183342}"}'value="Prefer not to say">
            Prefer not to say
          </option>

</select>

<div class="form-group  helpdesk_ticket_custom_field_cf_how_did_you_hear_about_this_scheme_606619">
    <label for="helpdesk_ticket_custom_field_cf_how_did_you_hear_about_this_scheme_606619" class=" form-label">
    	How did you hear about this scheme?
	  	
      
    </label>

<option value>Choose...</option>

<option  data-custom-properties='{"id": "{"data-id"=>7000183343}"}'value="Word of Mouth">
            Word of Mouth
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000183344}"}'value="Doctors.net">
            Doctors.net
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000183345}"}'value="Social Media">
            Social Media
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000183346}"}'value="Colleague">
            Colleague
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000183347}"}'value="Google">
            Google
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000183348}"}'value="Employer">
            Employer
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000183349}"}'value="HEE">
            HEE
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000183350}"}'value="PSU (please specify which service)">
            PSU (please specify which service)
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000183351}"}'value="Other">
            Other
          </option>

</select>

<div class="form-group ">
	
		<label for="helpdesk_ticket_custom_field_cf_please_specify_606619" class=" form-label">
			Please specify
			
				<span class="fw-asterisk">*</span>
			
			
		</label>

<option value>Choose...</option>

</select>

<option value>Choose...</option>

</select>

<div class="form-group ">
	
		<label for="helpdesk_ticket_custom_field_cf_oriel_pin_606619" class=" form-label">
			Oriel Pin
			
			
		</label>

<div class="form-group ">
  
		<label for="helpdesk_ticket_custom_field_cf_address_606619" class="form-label">
			Address
			
			
		</label>

<textarea
  	class="form-control section-field"
  	id="helpdesk_ticket_custom_field_cf_address_606619"
  	name="helpdesk_ticket[custom_field][cf_address_606619]"
    rows="6"
    cols=""
  	
  	
		placeholder=""
    
  >&lt/textarea&gt

<div class="form-group ">
	
		<label for="helpdesk_ticket_custom_field_cf_original_programme_start_date_606619" class=" form-label">
			Original Programme Start Date
			
			
		</label>

<div class="form-group ">
	
		<label for="helpdesk_ticket_custom_field_cf_anticipated_return_date_606619" class=" form-label">
			Anticipated return date
			
			
		</label>

<div class="form-group  helpdesk_ticket_custom_field_cf_reason_for_deferral_606619">
    <label for="helpdesk_ticket_custom_field_cf_reason_for_deferral_606619" class=" form-label">
    	Reason for deferral
	  	
      
    </label>

<option value>Choose...</option>

<option  data-custom-properties='{"id": "{"data-id"=>7000201660}"}'value="Ill Health (my own)">
            Ill Health (my own)
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000201661}"}'value="Other">
            Other
          </option>
       
          <option  data-custom-properties='{"id": "{"data-id"=>7000205986}"}'value="Parental Leave">
            Parental Leave
          </option>

</select>

<div class="form-group ">
  
		<label for="helpdesk_ticket_custom_field_cf_further_details_to_support_my_deferral_application_606619" class="form-label">
			Further details to support my deferral application
			
			
		</label>

<textarea
  	class="form-control section-field"
  	id="helpdesk_ticket_custom_field_cf_further_details_to_support_my_deferral_application_606619"
  	name="helpdesk_ticket[custom_field][cf_further_details_to_support_my_deferral_application_606619]"
    rows="6"
    cols=""
  	
  	
		placeholder=""
    
  >&lt/textarea&gt

<label for="helpdesk_ticket_custom_field_cf_i_confirm_that_i_have_accepted_an_offer_of_a_place_on_a_nhse_education_london_or_kent_surrey_sussex_training_programme_606619" class="form-check-label ">
			I confirm that I have accepted an offer of a place on a NHSE Education, London or Kent, Surrey & Sussex training programme.
			
			
		</label>

<label for="helpdesk_ticket_custom_field_cf_i_understand_that_i_am_required_to_confirm_a_date_for_the_start_of_the_deferred_606619" class="form-check-label ">
			I understand that I am required to confirm a date for the start of the deferred programme at least six months before the planned start date; or a minimum of three months’ notice where the duration of the period out of the programme is less than six months
			
			
		</label>

<label for="helpdesk_ticket_custom_field_cf_i_confirm_that_the_information_given_in_this_application_is_accurate_to_the_best_of_my_knowledge_and_belief_606619" class="form-check-label ">
			I confirm that the information given in this application is accurate to the best of my knowledge and belief.
			
			
		</label>

<label for="helpdesk_ticket_custom_field_cf_i_understand_that_my_placement_may_depend_on_availability_at_that_time_606619" class="form-check-label ">
			I understand that my placement may depend on availability at that time.
			
			
		</label>

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