>
								<option value="31">31</option>
							</select>
						</div>
						<div class="col-4">
							<select name="dob-year" class="form-select">
								<option value="">Year</option>
							</select>
						</div>
					</div>
				</div>
				<div class="mb-3">
					<div class="form-label">Birth place</div>
					<input type="text" class="form-control" name="birth_place" placeholder="City, State/Country">
				</div>
				<div class="mb-3">
					<div class="form-label">Email addresses</div>
					<input type=