https://bcrinstance.my.salesforce-sites.com/FormularioSalidaDelPais

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    <div style="margin-bottom:0px;"><img src="/FormularioSalidaDelPais/resource/1534827286000/LogoProspectoTC/imagens/bcrlogopequeno.jpg"></div>
    <div style="margin-left:30%;margin-bottom:3%;top:5%;"><img src="/FormularioSalidaDelPais/resource/1534827286000/LogoProspectoTC/imagens/SalidaPais.jpg"></div><span id="j_id0:j_id7" style="margin-left:34%;"><h1 class="titulo">Reporte su Salida del País</h1></span><br><br><span id="j_id0:j_id10" style="margin-left:34%;"><h3 class="titulo2">Request to report your departure</h3></span><br><br><span id="j_id0:j_id13" style="margin-left:36%;"><h3>Los campos identificados con un asterisco (*) son obligatorios.</h3></span><br><span id="j_id0:j_id16" style="margin-left:36%;"><h3>The fields identified with an asterix (*) are obligated.</h3></span><br><span id="j_id0:j_id19" style="margin-left:36%;"><h3>No debe digitar en ningún lado el número de tarjeta.</h3></span><br><span id="j_id0:j_id22" style="margin-left:36%;"><h3>You should not typing your card number in any field.</h3></span><br><span id="j_id0:j_id25" style="margin-left:36%;"><h3>Todas las transacciones realizadas en el extranjero, se cargarán en moneda local (colones).</h3></span><br><span id="j_id0:j_id28" style="margin-left:36%;"><h3>All transactions in the coin of the exterior will be charged in to the local coin.</h3></span><br><br><br>
                
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                        <li class="form-field"><label>
Nombre y apellidos
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Tipo Identificación
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Identificación
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                        <li class="form-field"><label>
Teléfono celular
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                        <li class="form-field"><label>
Teléfono de residencia
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                        <li class="form-field"><label>
Teléfono pariente cercano
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                        <li class="form-field"><label>
Correo electrónico (e-mail)
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                        <li class="form-field"><label>
Correo adicional
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                        <li class="form-field"><label>
País destino 1 (Destination Country 1)
                                <span class="required" style="color:red;">*</span></label>
                            <div><select id="j_id0:j_id58:j_id98" name="j_id0:j_id58:j_id98" style="width:33%;"><option value="">--Ninguno--</option><option value="Acrotiri - Akrotiri">Acrotiri - Akrotiri</option>
<option value="Afganistán - Afghanistan">Afganistán - Afghanistan</option>
<option value="Albania - Albania">Albania - Albania</option>
<option value="Alemania - Germany">Alemania - Germany</option>
<option value="Andorra - Angola">Andorra - Angola</option>
<option value="Anguila - Anguilla">Anguila - Anguilla</option>
<option value="Antártida - Antarctica">Antártida - Antarctica</option>
<option value="Antigua y Barbuda - Antigua and Barbuda">Antigua y Barbuda - Antigua and Barbuda</option>
<option value="Antillas Neerlandesas - Netherlands Antilles">Antillas Neerlandesas - Netherlands Antilles</option>
<option value="Arabia Saudita o Arabia Saudí - Saudi Arabia">Arabia Saudita o Arabia Saudí - Saudi Arabia</option>
<option value="Argelia - Algeria">Argelia - Algeria</option>
<option value="Argentina - Argentina">Argentina - Argentina</option>
<option value="Armenia - Armenia">Armenia - Armenia</option>
<option value="Aruba - Aruba">Aruba - Aruba</option>
<option value="Australia - Australia">Australia - Australia</option>
<option value="Austria - Austria">Austria - Austria</option>
<option value="Azerbaiyán - Azerbaijan">Azerbaiyán - Azerbaijan</option>
<option value="Bailiazgo de Guernsey - Guernsey">Bailiazgo de Guernsey - Guernsey</option>
<option value="Bailiazgo de Jersey - Jersey">Bailiazgo de Jersey - Jersey</option>
<option value="Banglasdés - Banglasdesh">Banglasdés - Banglasdesh</option>
<option value="Barbados - Barbados">Barbados - Barbados</option>
<option value="Baréin - Bahrain">Baréin - Bahrain</option>
<option value="Bassas da India - Bassas da India">Bassas da India - Bassas da India</option>
<option value="Bélgica - Belgium">Bélgica - Belgium</option>
<option value="Belice - Belize">Belice - Belize</option>
<option value="Benín - Benin">Benín - Benin</option>
<option value="Bielorrusia - Belarus">Bielorrusia - Belarus</option>
<option value="Birmania - Burma">Birmania - Burma</option>
<option value="Bolivia - Bolivia">Bolivia - Bolivia</option>
<option value="Bosnia y Herzegovina - Bosina and Herzegovina">Bosnia y Herzegovina - Bosina and Herzegovina</option>
<option value="Botsuana - Botswana">Botsuana - Botswana</option>
<option value="Brasil - Brazil">Brasil - Brazil</option>
<option value="Brunéi - Brunei">Brunéi - Brunei</option>
<option value="Bulgaria - Bulgaria">Bulgaria - Bulgaria</option>
<option value="Burkina Faso - Burkina Faso">Burkina Faso - Burkina Faso</option>
<option value="Burundi - Burundi">Burundi - Burundi</option>
<option value="Bután - Bhutan">Bután - Bhutan</option>
<option value="Cabo Verde - Cape Verde">Cabo Verde - Cape Verde</option>
<option value="Camboya - Cambodia">Camboya - Cambodia</option>
<option value="Camerún - Cameoon">Camerún - Cameoon</option>
<option value="Canadá - Canada">Canadá - Canada</option>
<option value="Catra - Qatar">Catra - Qatar</option>
<option value="Chad - Chad">Chad - Chad</option>
<option value="Chile - Chile">Chile - Chile</option>
<option value="China - China">China - China</option>
<option value="Chipre - Cyprus">Chipre - Cyprus</option>
<option value="Cisjordania - West Bank">Cisjordania - West Bank</option>
<option value="Colombia - Colombia">Colombia - Colombia</option>
<option value="Cormoras - Comoros">Cormoras - Comoros</option>
<option value="Corea del Norte - Korea North">Corea del Norte - Korea North</option>
<option value="Corea del Sur - Korea South">Corea del Sur - Korea South</option>
<option value="Costa de Marfil - Cote d'lvoire">Costa de Marfil - Cote d'lvoire</option>
<option value="Costa Rica - Costa Rica">Costa Rica - Costa Rica</option>
<option value="Croacia - Croacia">Croacia - Croacia</option>
<option value="Cuba - Cuba">Cuba - Cuba</option>
<option value="Curazao - Curacao">Curazao - Curacao</option>
<option value="Dhekelia - Dhekelia">Dhekelia - Dhekelia</option>
<option value="Dinamarca - Denmark">Dinamarca - Denmark</option>
<option value="Dominica - Dominica">Dominica - Dominica</option>
<option value="Ecuador - Ecuador">Ecuador - Ecuador</option>
<option value="Egipto - Egypt">Egipto - Egypt</option>
<option value="El archipiélago Svalbard - Svalbard">El archipiélago Svalbard - Svalbard</option>
<option value="El Salvador - El Salvador">El Salvador - El Salvador</option>
<option value="Emiratos Árabes Unidos - United Arab Emirates">Emiratos Árabes Unidos - United Arab Emirates</option>
<option value="Eritrea - Eritrea">Eritrea - Eritrea</option>
<option value="Eslovaquia - Slovaquia">Eslovaquia - Slovaquia</option>
<option value="Eslovenia - Slovenia">Eslovenia - Slovenia</option>
<option value="España - Spain">España - Spain</option>
<option value="Estados Federados de Micronesia - Micronesia Federated States of">Estados Federados de Micronesia - Micronesia Federated States of</option>
<option value="Estados Unidos - United States">Estados Unidos - United States</option>
<option value="Estonia - Estonia">Estonia - Estonia</option>
<option value="Etiopía - Ethiopia">Etiopía - Ethiopia</option>
<option value="Filipinas - Philippines">Filipinas - Philippines</option>
<option value="Finlandia - Finland">Finlandia - Finland</option>
<option value="Fiyi - Fiji">Fiyi - Fiji</option>
<option value="Francia - France">Francia - France</option>
<option value="Franja de Gaza - Gaza Strip">Franja de Gaza - Gaza Strip</option>
<option value="Gabón - Gbaon">Gabón - Gbaon</option>
<option value="Gambia - Gambia">Gambia - Gambia</option>
<option value="Georgia - Georgia">Georgia - Georgia</option>
<option value="Ghana - Ghana">Ghana - Ghana</option>
<option value="Gibraltar - Gibraltar">Gibraltar - Gibraltar</option>
<option value="Granada - Grenada">Granada - Grenada</option>
<option value="Grecia - Greece">Grecia - Greece</option>
<option value="Groenlandia - Greenland">Groenlandia - Greenland</option>
<option value="Guadalupe - Guadeloupe">Guadalupe - Guadeloupe</option>
<option value="Guam - Guam">Guam - Guam</option>
<option value="Guatemala - Guatemala">Guatemala - Guatemala</option>
<option value="Guinea - Guinea">Guinea - Guinea</option>
<option value="Guinea Bisaú - Guinea Bissau">Guinea Bisaú - Guinea Bissau</option>
<option value="Guinea Ecuatorial - Equatorial Guinea">Guinea Ecuatorial - Equatorial Guinea</option>
<option value="Guinea FRancesa - French Guiana">Guinea FRancesa - French Guiana</option>
<option value="Guyana - Guyana">Guyana - Guyana</option>
<option value="Haití - Haiti">Haití - Haiti</option>
<option value="Honduras - Honduras">Honduras - Honduras</option>
<option value="Hong Kong - Hong Kong">Hong Kong - Hong Kong</option>
<option value="Hungría - Hungary">Hungría - Hungary</option>
<option value="India - India">India - India</option>
<option value="Indonesia - Indonesia">Indonesia - Indonesia</option>
<option value="Irak - Iraq">Irak - Iraq</option>
<option value="Irán - Iran">Irán - Iran</option>
<option value="Irlanda - Ireland">Irlanda - Ireland</option>
<option value="Isla Clipperton o Isla de la Pasión - Clipperton Island">Isla Clipperton o Isla de la Pasión - Clipperton Island</option>
<option value="Isla de la Reunión - Reunión">Isla de la Reunión - Reunión</option>
<option value="Isla de Man - Isle of Man">Isla de Man - Isle of Man</option>
<option value="Isla de Montserrat - Montserrat">Isla de Montserrat - Montserrat</option>
<option value="Isla de Navaza - Navassa Island">Isla de Navaza - Navassa Island</option>
<option value="Isla Europa - Europa Island">Isla Europa - Europa Island</option>
<option value="Isla Juan de Nova - Juan de Nova Island">Isla Juan de Nova - Juan de Nova Island</option>
<option value="Isla Navidad - Christmas Island">Isla Navidad - Christmas Island</option>
<option value="Isla Norfolk - Norfolk Island">Isla Norfolk - Norfolk Island</option>
<option value="Isla Tromelin - Tromelin Island">Isla Tromelin - Tromelin Island</option>
<option value="Isla Wake - Wake Island">Isla Wake - Wake Island</option>
<option value="Islandia - Iceland">Islandia - Iceland</option>
<option value="Islas Ashmore y Cartier - Ashmore and Cartier Islands">Islas Ashmore y Cartier - Ashmore and Cartier Islands</option>
<option value="Islas Caimán - Cayman Islands">Islas Caimán - Cayman Islands</option>
<option value="Islas Cocos o Islas Keeling - Cocos (Keeling Islands)">Islas Cocos o Islas Keeling - Cocos (Keeling Islands)</option>
<option value="Islas Cook - Cook Islands">Islas Cook - Cook Islands</option>
<option value="Islas del Mar del Coral - Coral Sea Islands">Islas del Mar del Coral - Coral Sea Islands</option>
<option value="Islas Feroe - Faroe Islands">Islas Feroe - Faroe Islands</option>
<option value="Islas Georgias del Sur y Sandwich del Sur - South Georgia and the South Sandwich Islands">Islas Georgias del Sur y Sandwich del Sur - South Georgia and the South Sandwich Islands</option>
<option value="Islas Gloriosas o Glorioso - Glorioso Islands">Islas Gloriosas o Glorioso - Glorioso Islands</option>
<option value="Islas Heard y McDonald - Heard Island and McDonald Islands">Islas Heard y McDonald - Heard Island and McDonald Islands</option>
<option value="Islas Malvinas - Falkland Islands (Islas Malvinas">Islas Malvinas - Falkland Islands (Islas Malvinas</option>
<option value="Islas Marianas del Norte - Northern Mariana Islands">Islas Marianas del Norte - Northern Mariana Islands</option>
<option value="Islas Marshall - Marshall Islands">Islas Marshall - Marshall Islands</option>
<option value="Islas Paracelso - Paracel Islands">Islas Paracelso - Paracel Islands</option>
<option value="Islas Pitcairn - Pitcairn Islands">Islas Pitcairn - Pitcairn Islands</option>
<option value="Islas Salomón - Solomon Islands">Islas Salomón - Solomon Islands</option>
<option value="Islas Spratly - Spratly Islands">Islas Spratly - Spratly Islands</option>
<option value="Islas Turcas y Caicos - Turks and Caicos Islands">Islas Turcas y Caicos - Turks and Caicos Islands</option>
<option value="Islas Vírgenes - Virgin Islands">Islas Vírgenes - Virgin Islands</option>
<option value="Islas Vírgenes Británicas - British Virgin Islands">Islas Vírgenes Británicas - British Virgin Islands</option>
<option value="Israel - Israel">Israel - Israel</option>
<option value="Italia - Italy">Italia - Italy</option>
<option value="Jamaica - Jamaica">Jamaica - Jamaica</option>
<option value="Jan Mayen - Jan Mayen">Jan Mayen - Jan Mayen</option>
<option value="Japón - Japan">Japón - Japan</option>
<option value="Jordania - Jordan">Jordania - Jordan</option>
<option value="Kazajistán - Kazakhstan">Kazajistán - Kazakhstan</option>
<option value="Kenia - Kenya">Kenia - Kenya</option>
<option value="Kirguistán - Kyrgyzstan">Kirguistán - Kyrgyzstan</option>
<option value="Kiribati - Kiribati">Kiribati - Kiribati</option>
<option value="Kuwait - Kuwait">Kuwait - Kuwait</option>
<option value="La Colectividad de Wallis y Futuna - Wallis and Futuna">La Colectividad de Wallis y Futuna - Wallis and Futuna</option>
<option value="La isla Bouvet - Bouvet Island">La isla Bouvet - Bouvet Island</option>
<option value="Laos - Laos">Laos - Laos</option>
<option value="Las Bahamas - The Bahamas">Las Bahamas - The Bahamas</option>
<option value="Las islas Bermudas - Bermuda">Las islas Bermudas - Bermuda</option>
<option value="Lesoto - Lesotho">Lesoto - Lesotho</option>
<option value="Letonia - Latvia">Letonia - Latvia</option>
<option value="Líbano - Lebanon">Líbano - Lebanon</option>
<option value="Liberia - Liberia">Liberia - Liberia</option>
<option value="Libia - Libya">Libia - Libya</option>
<option value="Liechtenstein - Liechtenstein">Liechtenstein - Liechtenstein</option>
<option value="Lituania - Lithuania">Lituania - Lithuania</option>
<option value="Luxemburgo - Luxembourg">Luxemburgo - Luxembourg</option>
<option value="Macao - Macau">Macao - Macau</option>
<option value="Macedonia - Macedonia">Macedonia - Macedonia</option>
<option value="Madagascar - Madagascar">Madagascar - Madagascar</option>
<option value="Malasia - Malaysia">Malasia - Malaysia</option>
<option value="Malaui o Malawi - Malawi">Malaui o Malawi - Malawi</option>
<option value="Maldivas - Maldives">Maldivas - Maldives</option>
<option value="Malí o Mali - Mali">Malí o Mali - Mali</option>
<option value="Malta - Malta">Malta - Malta</option>
<option value="Marruecos - Morocco">Marruecos - Morocco</option>
<option value="Martinica - Martinique">Martinica - Martinique</option>
<option value="Mauricio - Mauritius">Mauricio - Mauritius</option>
<option value="Mauritania - Mauritania">Mauritania - Mauritania</option>
<option value="Mayotte - Mayotte">Mayotte - Mayotte</option>
<option value="México - Mexico">México - Mexico</option>
<option value="Moldavia - Moldova">Moldavia - Moldova</option>
<option value="Mónaco - Monaco">Mónaco - Monaco</option>
<option value="Mongolia - Mongolia">Mongolia - Mongolia</option>
<option value="Mozambique - Mozambique">Mozambique - Mozambique</option>
<option value="Namibia - Namibia">Namibia - Namibia</option>
<option value="Nepal - Nepal">Nepal - Nepal</option>
<option value="Nicaragua - Nicaragua">Nicaragua - Nicaragua</option>
<option value="Niger - Niger">Niger - Niger</option>
<option value="Nigeria - Nigeria">Nigeria - Nigeria</option>
<option value="Niue - Niue">Niue - Niue</option>
<option value="Noruega - Norway">Noruega - Norway</option>
<option value="Nueva Caledonia - New Caledonia">Nueva Caledonia - New Caledonia</option>
<option value="Nueva Zelanda - New Zealand">Nueva Zelanda - New Zealand</option>
<option value="Omán - Oman">Omán - Oman</option>
<option value="Países Bajos (Holanda) - Netherlands (Holland)">Países Bajos (Holanda) - Netherlands (Holland)</option>
<option value="Pakistán o Paquistán - Pakistan">Pakistán o Paquistán - Pakistan</option>
<option value="Palau - Palau">Palau - Palau</option>
<option value="Panamá - Panama">Panamá - Panama</option>
<option value="Papúa Nueva Guinea - Papua New Guinea">Papúa Nueva Guinea - Papua New Guinea</option>
<option value="Paraguay - Paraguay">Paraguay - Paraguay</option>
<option value="Perú - Peru">Perú - Peru</option>
<option value="Polinesia Francesa - French Polynesia">Polinesia Francesa - French Polynesia</option>
<option value="Polonia - Poland">Polonia - Poland</option>
<option value="Portugal - Portugal">Portugal - Portugal</option>
<option value="Puerto Rico - Puerto Rico">Puerto Rico - Puerto Rico</option>
<option value="Reino Unido - United Kingdom">Reino Unido - United Kingdom</option>
<option value="República Centroafricana - Central African Republic">República Centroafricana - Central African Republic</option>
<option value="República Checa - Czech Republic">República Checa - Czech Republic</option>
<option value="República de Nauru - Nauru">República de Nauru - Nauru</option>
<option value="República del Congo - Congo Republic of the">República del Congo - Congo Republic of the</option>
<option value="República Democrática del Congo - Congo Democratic Republic of the">República Democrática del Congo - Congo Democratic Republic of the</option>
<option value="República Dominicana - Dominican Republic">República Dominicana - Dominican Republic</option>
<option value="Ruanda - Rwanda">Ruanda - Rwanda</option>
<option value="Rumania o Rumanía - Romania">Rumania o Rumanía - Romania</option>
<option value="Rusia - Russia">Rusia - Russia</option>
<option value="Sahara Occidental - Western Sahara">Sahara Occidental - Western Sahara</option>
<option value="Samoa - Samoa">Samoa - Samoa</option>
<option value="Samoa Americana - American Samoa">Samoa Americana - American Samoa</option>
<option value="San Cristóbal y Nieves - Saint Kitts and Nevis">San Cristóbal y Nieves - Saint Kitts and Nevis</option>
<option value="San Marino - San Marino">San Marino - San Marino</option>
<option value="San Pedro y Miquelón - Saint Pierre and Miquelon">San Pedro y Miquelón - Saint Pierre and Miquelon</option>
<option value="San Vicente y las Granadinas - Saint Vincent and the Grenadines">San Vicente y las Granadinas - Saint Vincent and the Grenadines</option>
<option value="Santa Elena Ascensión y Tristán de Acuña - Saint Helena">Santa Elena Ascensión y Tristán de Acuña - Saint Helena</option>
<option value="Santa Lucía - Saint Lucia">Santa Lucía - Saint Lucia</option>
<option value="Santa Sede (Ciudad del Vaticano) - Holy See (Vatican City)">Santa Sede (Ciudad del Vaticano) - Holy See (Vatican City)</option>
<option value="Santo Tomé y Príncipe - Sao Tome and Principe">Santo Tomé y Príncipe - Sao Tome and Principe</option>
<option value="Senegal - Senegal">Senegal - Senegal</option>
<option value="Serbia y Montenegro - Serbia and Montenegro">Serbia y Montenegro - Serbia and Montenegro</option>
<option value="Seychelles - Seychelles">Seychelles - Seychelles</option>
<option value="Sierra Leona - Sierra Leone">Sierra Leona - Sierra Leone</option>
<option value="Singapur - Singapore">Singapur - Singapore</option>
<option value="Siria - Syria">Siria - Syria</option>
<option value="Somalia - Somalia">Somalia - Somalia</option>
<option value="Sri Lanka - Sri Lanka">Sri Lanka - Sri Lanka</option>
<option value="Suazilandia - Swaziland">Suazilandia - Swaziland</option>
<option value="Sudáfrica - South Africa">Sudáfrica - South Africa</option>
<option value="Sudán - Sudan">Sudán - Sudan</option>
<option value="Suecia - Sweden">Suecia - Sweden</option>
<option value="Suiza - Switzerland">Suiza - Switzerland</option>
<option value="Surinam - Suriname">Surinam - Suriname</option>
<option value="Tailandia - Thailand">Tailandia - Thailand</option>
<option value="Taiwán - Taiwan">Taiwán - Taiwan</option>
<option value="Tanzania - Tanzania">Tanzania - Tanzania</option>
<option value="Tayikistán - Tajikistan">Tayikistán - Tajikistan</option>
<option value="Territorio británico del océano Índico - British Indian Ocean Territory">Territorio británico del océano Índico - British Indian Ocean Territory</option>
<option value="Tierras Australes y Antárticas Francesas - French Southern and Antarctic Lands">Tierras Australes y Antárticas Francesas - French Southern and Antarctic Lands</option>
<option value="Timor Oriental - Timor Leste">Timor Oriental - Timor Leste</option>
<option value="Togo - Togo">Togo - Togo</option>
<option value="Tokelau - Tokelau">Tokelau - Tokelau</option>
<option value="Tonga - Tonga">Tonga - Tonga</option>
<option value="Trinidad y Tobago - Trinidad and Tobago">Trinidad y Tobago - Trinidad and Tobago</option>
<option value="Túnez - Tunisia">Túnez - Tunisia</option>
<option value="Turkmenistán - Turkmenistan">Turkmenistán - Turkmenistan</option>
<option value="Turquía - Turkey">Turquía - Turkey</option>
<option value="Tuvalu - Tuvalu">Tuvalu - Tuvalu</option>
<option value="Ucrania - Ukraine">Ucrania - Ukraine</option>
<option value="Uganda - Uganda">Uganda - Uganda</option>
<option value="Uruguay - Uruguay">Uruguay - Uruguay</option>
<option value="Uzbekistán - Uzbekistan">Uzbekistán - Uzbekistan</option>
<option value="Vanuatu - Vanuatu">Vanuatu - Vanuatu</option>
<option value="Venezuela - Venezuela">Venezuela - Venezuela</option>
<option value="Vietnam - Vietnam">Vietnam - Vietnam</option>
<option value="Yemen - Yemen">Yemen - Yemen</option>
<option value="Yibuti - Djibouti">Yibuti - Djibouti</option>
<option value="Zambia - Zambia">Zambia - Zambia</option>
<option value="Zimbabue - Zimbabwe">Zimbabue - Zimbabwe</option>
</select>&nbsp;
                                
                            </div>
                        </li>
                        <li class="form-field"><label>
Fecha salida/Fecha llegada(Departure date/Arrival date)
                                <span class="required" style="color:red;">*</span></label><span class="dateInput dateOnlyInput"><input autocomplete="off" id="j_id0:j_id58:j_id102" name="j_id0:j_id58:j_id102" onfocus="DatePicker.pickDate(true, 'j_id0:j_id58:j_id102', false);" size="12" style="width:10%;" type="text"><span class="dateFormat">[&nbsp;<a href="javascript:DatePicker.insertDate('03/12/2024', 'j_id0:j_id58:j_id102', true);">03/12/2024</a>&nbsp;]</span></span> &nbsp;<span class="dateInput dateOnlyInput"><input autocomplete="off" id="j_id0:j_id58:j_id104" name="j_id0:j_id58:j_id104" onfocus="DatePicker.pickDate(true, 'j_id0:j_id58:j_id104', false);" size="12" style="width:10%;" type="text"><span class="dateFormat">[&nbsp;<a href="javascript:DatePicker.insertDate('03/12/2024', 'j_id0:j_id58:j_id104', true);">03/12/2024</a>&nbsp;]</span></span>                          
                        </li>
                        <li class="form-field"><input type="submit" name="j_id0:j_id58:j_id215" value="Otro Destino" style="margin-left:48%;height:40px;width:105px;background:#e21c24;color:#ffffff;font-weight:bold; right:30%;" class="btn">                   
                        </li><span id="j_id0:j_id58:j_id217">
                            <li class="form-field"><label>
Algún teléfono en el exterior donde localizarlo (Telephone number in order to contact you on your trip)
                                    <span class="required" style="color:red;">&nbsp;</span></label><input id="j_id0:j_id58:j_id221" maxlength="40" name="j_id0:j_id58:j_id221" size="20" style="width:33%;" type="text">
                            </li>
                            <li class="form-field"><label>
Nombre y teléfono  de persona en Costa Rica en caso de necesitar comunicarse directamente (Telephone number                                                         and name of person in Costa Rica in case we need to comunícate with you directly)
                                    <span class="required" style="color:red;">&nbsp;</span></label><input id="j_id0:j_id58:j_id225" maxlength="40" name="j_id0:j_id58:j_id225" size="20" style="width:33%;" type="text">
                            </li></span>                 
                        <li class="form-field"><label>
Ingrese el captcha
                                <span class="required" style="color:red;">*</span></label>     
                            <div id="captcha">
                                <div id="grecaptcha"><div style="width: 304px; height: 78px;"><div><iframe title="reCAPTCHA" width="304" height="78" role="presentation" name="a-v07sn4w3suo8" frameborder="0" scrolling="no" sandbox="allow-forms allow-popups allow-same-origin allow-scripts allow-top-navigation allow-modals allow-popups-to-escape-sandbox allow-storage-access-by-user-activation" src="https://www.google.com/recaptcha/api2/anchor?ar=1&amp;k=6Let4pMUAAAAAOQEdaysDp9Juq02ZU_yiBQDi2tc&amp;co=aHR0cHM6Ly9iY3JpbnN0YW5jZS5teS5zYWxlc2ZvcmNlLXNpdGVzLmNvbTo0NDM.&amp;hl=es&amp;v=pPK749sccDmVW_9DSeTMVvh2&amp;size=normal&amp;cb=d524ck39dv1j"></iframe></div><textarea id="g-recaptcha-response" name="g-recaptcha-response" class="g-recaptcha-response" style="width: 250px; height: 40px; border: 1px solid rgb(193, 193, 193); margin: 10px 25px; padding: 0px; resize: none; display: none;"></textarea></div><iframe style="display: none;"></iframe></div>
                            </div>
                        <br>
                        </li>                       
                            <li class="form-field"><input type="submit" name="j_id0:j_id58:j_id231" value="Enviar" style="margin-left:48%;height:40px;width:105px;background:#e21c24;color:#ffffff;font-weight:bold; right:30%;" class="btn">
                            </li>                                                                               
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<script type="text/javascript">Sfdc.onReady(function(){
	SfdcApp && SfdcApp.Visualforce && SfdcApp.Visualforce.VSManager && SfdcApp.Visualforce.VSManager.vfPrepareForms(["j_id0:j_id58"]);

});</script><div class="datePicker" id="datePicker"><div class="dateBar"><img src="/FormularioSalidaDelPais/img/s.gif" alt="Mes anterior" class="calLeft" onblur="this.className = 'calLeft';" onclick="DatePicker.datePicker.prevMonth();" onfocus="this.className = 'calLeftOn';" onmouseout="this.className = 'calLeft';" onmouseover="this.className = 'calLeftOn';" title="Mes anterior"><select id="calMonthPicker" name="calMonthPicker" title="Mes"><option value="0">enero</option>
<option value="1">febrero</option>
<option value="2">marzo</option>
<option value="3">abril</option>
<option value="4">mayo</option>
<option value="5">junio</option>
<option value="6">julio</option>
<option value="7">agosto</option>
<option value="8">septiembre</option>
<option value="9">octubre</option>
<option value="10">noviembre</option>
<option value="11">diciembre</option>
</select><img src="/FormularioSalidaDelPais/img/s.gif" alt="Mes siguiente" class="calRight" onblur="this.className = 'calRight';" onclick="DatePicker.datePicker.nextMonth();" onfocus="this.className = 'calRightOn';" onmouseout="this.className = 'calRight';" onmouseover="this.className = 'calRightOn';" title="Mes siguiente"><select id="calYearPicker" name="calYearPicker" title="Año"><option value="2023">2023</option>
<option value="2024">2024</option>
<option value="2025">2025</option>
<option value="2026">2026</option>
<option value="2027">2027</option>
<option value="2028">2028</option>
<option value="2029">2029</option>
</select></div><div class="calBody"><table class="calDays" border="0" cellpadding="0" cellspacing="0" id="datePickerCalendar"><tbody><tr><th class="dayOfWeek" scope="col">lun</th><th class="dayOfWeek" scope="col">mar</th><th class="dayOfWeek" scope="col">mié</th><th class="dayOfWeek" scope="col">jue</th><th class="dayOfWeek" scope="col">vie</th><th class="dayOfWeek" scope="col">sáb</th><th class="dayOfWeek" scope="col">dom</th></tr>
<tr class="calRow" id="calRow1"><td onblur="hiOff(this);" onclick="DatePicker.datePicker.selectDate(this);" onfocus="hiOn(this);" onmouseout="hiOff(this);" onmouseover="hiOn(this);">&nbsp;</td><td onblur="hiOff(this);" onclick="DatePicker.datePicker.selectDate(this);" onfocus="hiOn(this);" onmouseout="hiOff(this);" onmouseover="hiOn(this);">&nbsp;</td><td onblur="hiOff(this);" onclick="DatePicker.datePicker.selectDate(this);" onfocus="hiOn(this);" onmouseout="hiOff(this);" onmouseover="hiOn(this);">&nbsp;</td><td onblur="hiOff(this);" onclick="DatePicker.datePicker.selectDate(this);" onfocus="hiOn(this);" onmouseout="hiOff(this);" onmouseover="hiOn(this);">&nbsp;</td><td onblur="hiOff(this);" onclick="DatePicker.datePicker.selectDate(this);" onfocus="hiOn(this);" onmouseout="hiOff(this);" onmouseover="hiOn(this);">&nbsp;</td><td onblur="hiOff(this);" onclick="DatePicker.datePicker.selectDate(this);" onfocus="hiOn(this);" onmouseout="hiOff(this);" onmouseover="hiOn(this);">&nbsp;</td><td onblur="hiOff(this);" onclick="DatePicker.datePicker.selectDate(this);" onfocus="hiOn(this);" onmouseout="hiOff(this);" onmouseover="hiOn(this);">&nbsp;</td></tr>
<tr class="calRow" id="calRow2"><td onblur="hiOff(this);" onclick="DatePicker.datePicker.selectDate(this);" onfocus="hiOn(this);" onmouseout="hiOff(this);" onmouseover="hiOn(this);">&nbsp;</td><td onblur="hiOff(this);" onclick="DatePicker.datePicker.selectDate(this);" onfocus="hiOn(this);" onmouseout="hiOff(this);" onmouseover="hiOn(this);">&nbsp;</td><td onblur="hiOff(this);" onclick="DatePicker.datePicker.selectDate(this);" onfocus="hiOn(this);" onmouseout="hiOff(this);" onmouseover="hiOn(this);">&nbsp;</td><td onblur="hiOff(this);" onclick="DatePicker.datePicker.selectDate(this);" onfocus="hiOn(this);" onmouseout="hiOff(this);" onmouseover="hiOn(this);">&nbsp;</td><td onblur="hiOff(this);" onclick="DatePicker.datePicker.selectDate(this);" onfocus="hiOn(this);" onmouseout="hiOff(this);" onmouseover="hiOn(this);">&nbsp;</td><td onblur="hiOff(this);" onclick="DatePicker.datePicker.selectDate(this);" onfocus="hiOn(this);" onmouseout="hiOff(this);" onmouseover="hiOn(this);">&nbsp;</td><td onblur="hiOff(this);" onclick="DatePicker.datePicker.selectDate(this);" onfocus="hiOn(this);" onmouseout="hiOff(this);" onmouseover="hiOn(this);">&nbsp;</td></tr>
<tr class="calRow" id="calRow3"><td onblur="hiOff(this);" onclick="DatePicker.datePicker.selectDate(this);" onfocus="hiOn(this);" onmouseout="hiOff(this);" onmouseover="hiOn(this);">&nbsp;</td><td onblur="hiOff(this);" onclick="DatePicker.datePicker.selectDate(this);" onfocus="hiOn(this);" onmouseout="hiOff(this);" onmouseover="hiOn(this);">&nbsp;</td><td onblur="hiOff(this);" onclick="DatePicker.datePicker.selectDate(this);" onfocus="hiOn(this);" onmouseout="hiOff(this);" onmouseover="hiOn(this);">&nbsp;</td><td onblur="hiOff(this);" onclick="DatePicker.datePicker.selectDate(this);" onfocus="hiOn(this);" onmouseout="hiOff(this);" onmouseover="hiOn(this);">&nbsp;</td><td onblur="hiOff(this);" onclick="DatePicker.datePicker.selectDate(this);" onfocus="hiOn(this);" onmouseout="hiOff(this);" onmouseover="hiOn(this);">&nbsp;</td><td onblur="hiOff(this);" onclick="DatePicker.datePicker.selectDate(this);" onfocus="hiOn(this);" onmouseout="hiOff(this);" onmouseover="hiOn(this);">&nbsp;</td><td onblur="hiOff(this);" onclick="DatePicker.datePicker.selectDate(this);" onfocus="hiOn(this);" onmouseout="hiOff(this);" onmouseover="hiOn(this);">&nbsp;</td></tr>
<tr class="calRow" id="calRow4"><td onblur="hiOff(this);" onclick="DatePicker.datePicker.selectDate(this);" onfocus="hiOn(this);" onmouseout="hiOff(this);" onmouseover="hiOn(this);">&nbsp;</td><td onblur="hiOff(this);" onclick="DatePicker.datePicker.selectDate(this);" onfocus="hiOn(this);" onmouseout="hiOff(this);" onmouseover="hiOn(this);">&nbsp;</td><td onblur="hiOff(this);" onclick="DatePicker.datePicker.selectDate(this);" onfocus="hiOn(this);" onmouseout="hiOff(this);" onmouseover="hiOn(this);">&nbsp;</td><td onblur="hiOff(this);" onclick="DatePicker.datePicker.selectDate(this);" onfocus="hiOn(this);" onmouseout="hiOff(this);" onmouseover="hiOn(this);">&nbsp;</td><td onblur="hiOff(this);" onclick="DatePicker.datePicker.selectDate(this);" onfocus="hiOn(this);" onmouseout="hiOff(this);" onmouseover="hiOn(this);">&nbsp;</td><td onblur="hiOff(this);" onclick="DatePicker.datePicker.selectDate(this);" onfocus="hiOn(this);" onmouseout="hiOff(this);" onmouseover="hiOn(this);">&nbsp;</td><td onblur="hiOff(this);" onclick="DatePicker.datePicker.selectDate(this);" onfocus="hiOn(this);" onmouseout="hiOff(this);" onmouseover="hiOn(this);">&nbsp;</td></tr>
<tr class="calRow" id="calRow5"><td onblur="hiOff(this);" onclick="DatePicker.datePicker.selectDate(this);" onfocus="hiOn(this);" onmouseout="hiOff(this);" onmouseover="hiOn(this);">&nbsp;</td><td onblur="hiOff(this);" onclick="DatePicker.datePicker.selectDate(this);" onfocus="hiOn(this);" onmouseout="hiOff(this);" onmouseover="hiOn(this);">&nbsp;</td><td onblur="hiOff(this);" onclick="DatePicker.datePicker.selectDate(this);" onfocus="hiOn(this);" onmouseout="hiOff(this);" onmouseover="hiOn(this);">&nbsp;</td><td onblur="hiOff(this);" onclick="DatePicker.datePicker.selectDate(this);" onfocus="hiOn(this);" onmouseout="hiOff(this);" onmouseover="hiOn(this);">&nbsp;</td><td onblur="hiOff(this);" onclick="DatePicker.datePicker.selectDate(this);" onfocus="hiOn(this);" onmouseout="hiOff(this);" onmouseover="hiOn(this);">&nbsp;</td><td onblur="hiOff(this);" onclick="DatePicker.datePicker.selectDate(this);" onfocus="hiOn(this);" onmouseout="hiOff(this);" onmouseover="hiOn(this);">&nbsp;</td><td onblur="hiOff(this);" onclick="DatePicker.datePicker.selectDate(this);" onfocus="hiOn(this);" onmouseout="hiOff(this);" onmouseover="hiOn(this);">&nbsp;</td></tr>
<tr class="calRow" id="calRow6"><td onblur="hiOff(this);" onclick="DatePicker.datePicker.selectDate(this);" onfocus="hiOn(this);" onmouseout="hiOff(this);" onmouseover="hiOn(this);">&nbsp;</td><td onblur="hiOff(this);" onclick="DatePicker.datePicker.selectDate(this);" onfocus="hiOn(this);" onmouseout="hiOff(this);" onmouseover="hiOn(this);">&nbsp;</td><td onblur="hiOff(this);" onclick="DatePicker.datePicker.selectDate(this);" onfocus="hiOn(this);" onmouseout="hiOff(this);" onmouseover="hiOn(this);">&nbsp;</td><td onblur="hiOff(this);" onclick="DatePicker.datePicker.selectDate(this);" onfocus="hiOn(this);" onmouseout="hiOff(this);" onmouseover="hiOn(this);">&nbsp;</td><td onblur="hiOff(this);" onclick="DatePicker.datePicker.selectDate(this);" onfocus="hiOn(this);" onmouseout="hiOff(this);" onmouseover="hiOn(this);">&nbsp;</td><td onblur="hiOff(this);" onclick="DatePicker.datePicker.selectDate(this);" onfocus="hiOn(this);" onmouseout="hiOff(this);" onmouseover="hiOn(this);">&nbsp;</td><td onblur="hiOff(this);" onclick="DatePicker.datePicker.selectDate(this);" onfocus="hiOn(this);" onmouseout="hiOff(this);" onmouseover="hiOn(this);">&nbsp;</td></tr>
</tbody></table><div class="buttonBar"><a href="javascript:%20void%280%29%3B" class="calToday" onclick="DatePicker.datePicker.selectDate('today');return false;">Hoy</a></div></div></div><div style="background-color: rgb(255, 255, 255); border: 1px solid rgb(204, 204, 204); box-shadow: rgba(0, 0, 0, 0.2) 2px 2px 3px; position: absolute; transition: visibility 0s linear 0.3s, opacity 0.3s linear 0s; opacity: 0; visibility: hidden; z-index: 2000000000; left: 0px; top: -10000px;"><div style="width: 100%; height: 100%; position: fixed; top: 0px; left: 0px; z-index: 2000000000; background-color: rgb(255, 255, 255); opacity: 0.05;"></div><div class="g-recaptcha-bubble-arrow" style="border: 11px solid transparent; width: 0px; height: 0px; position: absolute; pointer-events: none; margin-top: -11px; z-index: 2000000000;"></div><div class="g-recaptcha-bubble-arrow" style="border: 10px solid transparent; width: 0px; height: 0px; position: absolute; pointer-events: none; margin-top: -10px; z-index: 2000000000;"></div><div style="z-index: 2000000000; position: relative;"><iframe title="El reCAPTCHA caduca dentro de dos minutos" name="c-v07sn4w3suo8" frameborder="0" scrolling="no" sandbox="allow-forms allow-popups allow-same-origin allow-scripts allow-top-navigation allow-modals allow-popups-to-escape-sandbox allow-storage-access-by-user-activation" src="https://www.google.com/recaptcha/api2/bframe?hl=es&amp;v=pPK749sccDmVW_9DSeTMVvh2&amp;k=6Let4pMUAAAAAOQEdaysDp9Juq02ZU_yiBQDi2tc" style="width: 100%; height: 100%;"></iframe></div></div></body></html>