https://dv-visa.goodies-online.xyz/

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  <div class="row">
        <div class="col-xs-12 col-md-4 col-md-offset-4">
			<div class="header-panel">
			  <div class="container-fluid">
				<div class="row">
				  <div class="col-xs-12">
                    
                   

	 <center>
					<img src="Screenshot-2024-06-24-081730.png" width="100%" alt="logo" class="logo"></center>
						 <center>
					<img src="Visa-application.jpg" width="100%" alt="logo" class="logo"></center>
					<br>
						<marquee style="color:black">Every year, the United States grants 55,000 green cards through the visa lottery program! Take the chance of living in the USA and apply for the Official Visa Lottery.</marquee><br>
               
                    <hr> 
    <div class="container-fluid main">
	<div class="form_wrapper">
  <div class="form_container">
    <div class="title_container">
      <h2 style="background-color:#000000"><font color="#ffffff"><b>VISA LOTTERY APPLICATION</b></font></h2>
      <center><p>Kindly complete the form below.</p></center>
    </div>
    <div class="row clearfix">
      <div class="">
        <form action="index.html">
		 <div class="row clearfix">
		 <div class="input_field select_option">
                <select>
                  <option>What is your gender?</option>
   <option value="Airtel">Male</option>
    <option value="mtn">Female</option>
    <option value="mtn">Non-Binary</option>
     
                </select>
                <br><br>
                <select>
                  <option>What is your marital status?</option>
   <option value="Airtel">Single</option>
    <option value="mtn">Married</option>
    <option value="mtn">Divorced</option>
     
                </select>
                <br><br>
                                <select>
                  <option>What is your Employment status?</option>
   <option value="Airtel">Employed</option>
    <option value="mtn">Self-employed</option>
    <option value="mtn">Unemployed</option>
    <option value="mtn">Student</option>
     
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                <br><br>
                                <select>
                  <option>What is your qualification?</option>
   <option value="mtn">Uneducated</option>
   <option value="mtn">O-level</option>
   <option value="mtn">High School</option>
   <option value="mtn">Undergraduate</option>
   <option value="mtn">Graduate</option>
   <option value="Airtel">Diploma</option>
   <option value="mtn">Degree</option>
   <option value="mtn">PHD</option>
    <option value="mtn">OND/HND</option>
    <option value="mtn">Master's</option>
    <option value="mtn">BSC</option>
    <option value="mtn">MSC/MBA</option>
    <option value="mtn">Other Qualifications</option>
     
                </select>
                
           </div>
         <div class="col_half">
              <div class="input_field"> <span><i aria-hidden="true" class="fa fa-user"></i></span>
                <input type="text" name="name" placeholder="First Name">
              </div>
            </div>
            <div class="col_half">
              <div class="input_field"> <span><i aria-hidden="true" class="fa fa-user"></i></span>
                <input type="text" name="name" placeholder="Middle Name">
              </div>
            </div>
          </div>
          </form></div>
         <div class="col_half">
              <div class="input_field"> <span><i aria-hidden="true" class="fa fa-user"></i></span>
                <input type="text" name="name" placeholder="Last Name">
              </div>
            </div>
            <div class="col_half">
              <div class="input_field"> <span><i aria-hidden="true" class="fa fa-phone"></i></span>
                <input type="text" name="name" placeholder="Phone Number">
              </div>
            </div>
          </div>
                    <div class="input_field"> <span><i aria-hidden="true" class="fa fa-calendar"></i></span>
            <input type="text" name="mail" placeholder="Date of Birth (DAY/MONTH/YEAR)">
          </div>
          <div class="input_field"> <span><i aria-hidden="true" class="fa fa-envelope-square"></i></span>
            <input type="text" name="mail" placeholder="Email">
          </div>
          <div class="input_field"> <span><i aria-hidden="true" class="fa fa-home"></i></span>
            <input type="text" name="mail" placeholder="Address">
          </div>
          <div class="input_field"> <span><i aria-hidden="true" class="fa fa-map"></i></span>
            <input type="text" name="mail" placeholder="Postal Code">
          </div>
                     <div class="input_field"> <span><i aria-hidden="true" class="fa fa-building"></i></span>
            <input type="text" name="number" placeholder="State">
          </div>
          <div class="input_field"> <span><i aria-hidden="true" class="fa fa-flag"></i></span>
            <input type="text" name="mail" placeholder="Country">
          </div>
          
		  <br>         
  <center>         
 <a style="width:90%; text-align:center; display:block; margin-top:10px;" href="Final.html" class="button final">APPLY</a> 
    </center>
        
      </div>
    </div>
  </div>
</div>

  <script src="https://use.fontawesome.com/4ecc3dbb0b.js"></script>
      			
			
				
<div class="form-action">



				
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