{"id":764,"date":"2026-01-30T22:10:29","date_gmt":"2026-01-31T04:10:29","guid":{"rendered":"https:\/\/app.galen.edu.bz\/admissions\/?page_id=764"},"modified":"2026-02-04T14:50:17","modified_gmt":"2026-02-04T20:50:17","slug":"create-account","status":"publish","type":"page","link":"https:\/\/app.galen.edu.bz\/admissions\/create-account\/","title":{"rendered":"Create Account"},"content":{"rendered":"\n<h2 class=\"wp-block-heading has-text-align-center\">Create Account<\/h2>\n\n\n<style id=\"wpforms-css-vars-755-block-37995259-c9da-45f1-af3c-e7155a784ccd\">\n\t\t\t\t#wpforms-755.wpforms-block-37995259-c9da-45f1-af3c-e7155a784ccd {\n\t\t\t\t--wpforms-field-size-input-height: 43px;\n--wpforms-field-size-input-spacing: 15px;\n--wpforms-field-size-font-size: 16px;\n--wpforms-field-size-line-height: 19px;\n--wpforms-field-size-padding-h: 14px;\n--wpforms-field-size-checkbox-size: 16px;\n--wpforms-field-size-sublabel-spacing: 5px;\n--wpforms-field-size-icon-size: 1;\n--wpforms-label-size-font-size: 16px;\n--wpforms-label-size-line-height: 19px;\n--wpforms-label-size-sublabel-font-size: 14px;\n--wpforms-label-size-sublabel-line-height: 17px;\n--wpforms-button-size-font-size: 17px;\n--wpforms-button-size-height: 41px;\n--wpforms-button-size-padding-h: 15px;\n--wpforms-button-size-margin-top: 10px;\n--wpforms-container-shadow-size-box-shadow: none;\n\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-container-quiz wpforms-container-save-resume wpforms-block wpforms-block-37995259-c9da-45f1-af3c-e7155a784ccd wpforms-render-modern\" id=\"wpforms-755\"><form id=\"wpforms-form-755\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"755\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/admissions\/wp-json\/wp\/v2\/pages\/764\" data-token=\"5b074781c91b92562fad1e1be93afa8b\" data-token-time=\"1779756318\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-755-field_1-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"1\"><fieldset><legend class=\"wpforms-field-label\">Applicant Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-first wpforms-two-fifths\"><input type=\"text\" id=\"wpforms-755-field_1\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][1][first]\" aria-errormessage=\"wpforms-755-field_1-error\" required><label for=\"wpforms-755-field_1\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-fifth\"><input type=\"text\" id=\"wpforms-755-field_1-middle\" class=\"wpforms-field-name-middle\" name=\"wpforms[fields][1][middle]\" aria-errormessage=\"wpforms-755-field_1-middle-error\" ><label for=\"wpforms-755-field_1-middle\" class=\"wpforms-field-sublabel after\">Middle<\/label><\/div><div class=\"wpforms-field-row-block wpforms-two-fifths\"><input type=\"text\" id=\"wpforms-755-field_1-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][1][last]\" aria-errormessage=\"wpforms-755-field_1-last-error\" required><label for=\"wpforms-755-field_1-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-755-field_8-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"8\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-755-field_2-container\" class=\"wpforms-field wpforms-field-email\" data-field-type=\"email\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-755-field_2\">Applicant Email <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-755-field_2\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][2]\" spellcheck=\"false\" aria-errormessage=\"wpforms-755-field_2-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-755-field_5-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"5\"><label class=\"wpforms-field-label\" for=\"wpforms-755-field_5\">Applicant Phone <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-755-field_5\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][5]\" aria-label=\"Applicant Phone\" aria-errormessage=\"wpforms-755-field_5-error\" required><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-755-field_6-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-755-field_6\">Username <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-755-field_6\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][6]\" aria-errormessage=\"wpforms-755-field_6-error\" aria-describedby=\"wpforms-755-field_6-description\" required><div id=\"wpforms-755-field_6-description\" class=\"wpforms-field-description\">create a unique username you will use for this portal.<\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-755-field_3-container\" class=\"wpforms-field wpforms-field-password wpforms-field-password-visibility-enabled\" data-field-type=\"password\" data-field-id=\"3\"><fieldset><legend class=\"wpforms-field-label\">Create Password <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><div class=\"wpforms-field-password-input\"><input type=\"password\" id=\"wpforms-755-field_3\" class=\"wpforms-field-required wpforms-field-password-primary\" name=\"wpforms[fields][3][primary]\" spellcheck=\"false\" aria-errormessage=\"wpforms-755-field_3-error\" required><a href=\"#\" class=\"wpforms-field-password-input-icon\" aria-label=\"Show Password\" title=\"Show Password\" data-switch-title=\"Hide Password\">\n\t\t\t\t\t<svg class=\"wpforms-field-password-input-icon-invisible\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 576 512\" role=\"img\"><!--!Font Awesome Free 6.7.2 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free Copyright 2025 Fonticons, Inc.--><path d=\"M288 32c-80.8 0-145.5 36.8-192.6 80.6C48.6 156 17.3 208 2.5 243.7c-3.3 7.9-3.3 16.7 0 24.6C17.3 304 48.6 356 95.4 399.4C142.5 443.2 207.2 480 288 480s145.5-36.8 192.6-80.6c46.8-43.5 78.1-95.4 93-131.1c3.3-7.9 3.3-16.7 0-24.6c-14.9-35.7-46.2-87.7-93-131.1C433.5 68.8 368.8 32 288 32zM144 256a144 144 0 1 1 288 0 144 144 0 1 1 -288 0zm144-64c0 35.3-28.7 64-64 64c-7.1 0-13.9-1.2-20.3-3.3c-5.5-1.8-11.9 1.6-11.7 7.4c.3 6.9 1.3 13.8 3.2 20.7c13.7 51.2 66.4 81.6 117.6 67.9s81.6-66.4 67.9-117.6c-11.1-41.5-47.8-69.4-88.6-71.1c-5.8-.2-9.2 6.1-7.4 11.7c2.1 6.4 3.3 13.2 3.3 20.3z\"\/><\/svg>\n\t\t\t\t\t<svg class=\"wpforms-field-password-input-icon-visible\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 640 512\" role=\"img\"><!--!Font Awesome Free 6.7.2 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free Copyright 2025 Fonticons, Inc.--><path d=\"M38.8 5.1C28.4-3.1 13.3-1.2 5.1 9.2S-1.2 34.7 9.2 42.9l592 464c10.4 8.2 25.5 6.3 33.7-4.1s6.3-25.5-4.1-33.7L525.6 386.7c39.6-40.6 66.4-86.1 79.9-118.4c3.3-7.9 3.3-16.7 0-24.6c-14.9-35.7-46.2-87.7-93-131.1C465.5 68.8 400.8 32 320 32c-68.2 0-125 26.3-169.3 60.8L38.8 5.1zM223.1 149.5C248.6 126.2 282.7 112 320 112c79.5 0 144 64.5 144 144c0 24.9-6.3 48.3-17.4 68.7L408 294.5c8.4-19.3 10.6-41.4 4.8-63.3c-11.1-41.5-47.8-69.4-88.6-71.1c-5.8-.2-9.2 6.1-7.4 11.7c2.1 6.4 3.3 13.2 3.3 20.3c0 10.2-2.4 19.8-6.6 28.3l-90.3-70.8zM373 389.9c-16.4 6.5-34.3 10.1-53 10.1c-79.5 0-144-64.5-144-144c0-6.9 .5-13.6 1.4-20.2L83.1 161.5C60.3 191.2 44 220.8 34.5 243.7c-3.3 7.9-3.3 16.7 0 24.6c14.9 35.7 46.2 87.7 93 131.1C174.5 443.2 239.2 480 320 480c47.8 0 89.9-12.9 126.2-32.5L373 389.9z\"\/><\/svg>\n\t\t\t\t<\/a><\/div><label for=\"wpforms-755-field_3\" class=\"wpforms-field-sublabel after\">Password<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><div class=\"wpforms-field-password-input\"><input type=\"password\" id=\"wpforms-755-field_3-secondary\" class=\"wpforms-field-password-secondary wpforms-field-required\" data-rule-confirm=\"#wpforms-755-field_3\" name=\"wpforms[fields][3][secondary]\" spellcheck=\"false\" aria-errormessage=\"wpforms-755-field_3-secondary-error\" required><a href=\"#\" class=\"wpforms-field-password-input-icon\" aria-label=\"Show Password\" title=\"Show Password\" data-switch-title=\"Hide Password\">\n\t\t\t\t\t<svg class=\"wpforms-field-password-input-icon-invisible\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 576 512\" role=\"img\"><!--!Font Awesome Free 6.7.2 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free Copyright 2025 Fonticons, Inc.--><path d=\"M288 32c-80.8 0-145.5 36.8-192.6 80.6C48.6 156 17.3 208 2.5 243.7c-3.3 7.9-3.3 16.7 0 24.6C17.3 304 48.6 356 95.4 399.4C142.5 443.2 207.2 480 288 480s145.5-36.8 192.6-80.6c46.8-43.5 78.1-95.4 93-131.1c3.3-7.9 3.3-16.7 0-24.6c-14.9-35.7-46.2-87.7-93-131.1C433.5 68.8 368.8 32 288 32zM144 256a144 144 0 1 1 288 0 144 144 0 1 1 -288 0zm144-64c0 35.3-28.7 64-64 64c-7.1 0-13.9-1.2-20.3-3.3c-5.5-1.8-11.9 1.6-11.7 7.4c.3 6.9 1.3 13.8 3.2 20.7c13.7 51.2 66.4 81.6 117.6 67.9s81.6-66.4 67.9-117.6c-11.1-41.5-47.8-69.4-88.6-71.1c-5.8-.2-9.2 6.1-7.4 11.7c2.1 6.4 3.3 13.2 3.3 20.3z\"\/><\/svg>\n\t\t\t\t\t<svg class=\"wpforms-field-password-input-icon-visible\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 640 512\" role=\"img\"><!--!Font Awesome Free 6.7.2 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free Copyright 2025 Fonticons, Inc.--><path d=\"M38.8 5.1C28.4-3.1 13.3-1.2 5.1 9.2S-1.2 34.7 9.2 42.9l592 464c10.4 8.2 25.5 6.3 33.7-4.1s6.3-25.5-4.1-33.7L525.6 386.7c39.6-40.6 66.4-86.1 79.9-118.4c3.3-7.9 3.3-16.7 0-24.6c-14.9-35.7-46.2-87.7-93-131.1C465.5 68.8 400.8 32 320 32c-68.2 0-125 26.3-169.3 60.8L38.8 5.1zM223.1 149.5C248.6 126.2 282.7 112 320 112c79.5 0 144 64.5 144 144c0 24.9-6.3 48.3-17.4 68.7L408 294.5c8.4-19.3 10.6-41.4 4.8-63.3c-11.1-41.5-47.8-69.4-88.6-71.1c-5.8-.2-9.2 6.1-7.4 11.7c2.1 6.4 3.3 13.2 3.3 20.3c0 10.2-2.4 19.8-6.6 28.3l-90.3-70.8zM373 389.9c-16.4 6.5-34.3 10.1-53 10.1c-79.5 0-144-64.5-144-144c0-6.9 .5-13.6 1.4-20.2L83.1 161.5C60.3 191.2 44 220.8 34.5 243.7c-3.3 7.9-3.3 16.7 0 24.6c14.9 35.7 46.2 87.7 93 131.1C174.5 443.2 239.2 480 320 480c47.8 0 89.9-12.9 126.2-32.5L373 389.9z\"\/><\/svg>\n\t\t\t\t<\/a><\/div><label for=\"wpforms-755-field_3-secondary\" class=\"wpforms-field-sublabel after\">Confirm Password<\/label><\/div><\/div><\/fieldset><\/div><\/div><\/div><\/div><\/div>\t\t<div id=\"wpforms-755-field_4-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"4\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-755-field_4\" >Birth Date Layout<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-755-field_4\" class=\"wpforms-field-medium\" name=\"wpforms[fields][4]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-755-field_7-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"7\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-755-field_9-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-type=\"date-time\" data-field-id=\"9\"><fieldset><legend class=\"wpforms-field-label\">Date of Birth <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-date-dropdown-wrap wpforms-field-medium\"><select name=\"wpforms[fields][9][date][m]\" id=\"wpforms-755-field_9-month\" class=\"wpforms-field-date-time-date-month wpforms-field-required\" aria-label=\"Month\"  required><option value=\"\" class=\"placeholder\" selected disabled>MM<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><\/select><select name=\"wpforms[fields][9][date][d]\" id=\"wpforms-755-field_9-day\" class=\"wpforms-field-date-time-date-day wpforms-field-required\" aria-label=\"Day\"  required><option value=\"\" class=\"placeholder\" selected disabled>DD<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><select name=\"wpforms[fields][9][date][y]\" id=\"wpforms-755-field_9-year\" class=\"wpforms-field-date-time-date-year wpforms-field-required\" aria-label=\"Year\"  required><option value=\"\" class=\"placeholder\" selected disabled>YYYY<\/option><option value=\"2027\" >2027<\/option><option value=\"2026\" >2026<\/option><option value=\"2025\" >2025<\/option><option value=\"2024\" >2024<\/option><option value=\"2023\" >2023<\/option><option value=\"2022\" >2022<\/option><option value=\"2021\" >2021<\/option><option value=\"2020\" >2020<\/option><option value=\"2019\" >2019<\/option><option value=\"2018\" >2018<\/option><option value=\"2017\" >2017<\/option><option value=\"2016\" >2016<\/option><option value=\"2015\" >2015<\/option><option value=\"2014\" >2014<\/option><option value=\"2013\" >2013<\/option><option value=\"2012\" >2012<\/option><option value=\"2011\" >2011<\/option><option value=\"2010\" >2010<\/option><option value=\"2009\" >2009<\/option><option value=\"2008\" >2008<\/option><option value=\"2007\" >2007<\/option><option value=\"2006\" >2006<\/option><option value=\"2005\" >2005<\/option><option value=\"2004\" >2004<\/option><option value=\"2003\" >2003<\/option><option value=\"2002\" >2002<\/option><option value=\"2001\" >2001<\/option><option value=\"2000\" >2000<\/option><option value=\"1999\" >1999<\/option><option value=\"1998\" >1998<\/option><option value=\"1997\" >1997<\/option><option value=\"1996\" >1996<\/option><option value=\"1995\" >1995<\/option><option value=\"1994\" >1994<\/option><option value=\"1993\" >1993<\/option><option value=\"1992\" >1992<\/option><option value=\"1991\" >1991<\/option><option value=\"1990\" >1990<\/option><option value=\"1989\" >1989<\/option><option value=\"1988\" >1988<\/option><option value=\"1987\" >1987<\/option><option value=\"1986\" >1986<\/option><option value=\"1985\" >1985<\/option><option value=\"1984\" >1984<\/option><option value=\"1983\" >1983<\/option><option value=\"1982\" >1982<\/option><option value=\"1981\" >1981<\/option><option value=\"1980\" >1980<\/option><option value=\"1979\" >1979<\/option><option value=\"1978\" >1978<\/option><option value=\"1977\" >1977<\/option><option value=\"1976\" >1976<\/option><option value=\"1975\" >1975<\/option><option value=\"1974\" >1974<\/option><option value=\"1973\" >1973<\/option><option value=\"1972\" >1972<\/option><option value=\"1971\" >1971<\/option><option value=\"1970\" >1970<\/option><option value=\"1969\" >1969<\/option><option value=\"1968\" >1968<\/option><option value=\"1967\" >1967<\/option><option value=\"1966\" >1966<\/option><option value=\"1965\" >1965<\/option><option value=\"1964\" >1964<\/option><option value=\"1963\" >1963<\/option><option value=\"1962\" >1962<\/option><option value=\"1961\" >1961<\/option><option value=\"1960\" >1960<\/option><option value=\"1959\" >1959<\/option><option value=\"1958\" >1958<\/option><option value=\"1957\" >1957<\/option><option value=\"1956\" >1956<\/option><option value=\"1955\" >1955<\/option><option value=\"1954\" >1954<\/option><option value=\"1953\" >1953<\/option><option value=\"1952\" >1952<\/option><option value=\"1951\" >1951<\/option><option value=\"1950\" >1950<\/option><option value=\"1949\" >1949<\/option><option value=\"1948\" >1948<\/option><option value=\"1947\" >1947<\/option><option value=\"1946\" >1946<\/option><option value=\"1945\" >1945<\/option><option value=\"1944\" >1944<\/option><option value=\"1943\" >1943<\/option><option value=\"1942\" >1942<\/option><option value=\"1941\" >1941<\/option><option value=\"1940\" >1940<\/option><option value=\"1939\" >1939<\/option><option value=\"1938\" >1938<\/option><option value=\"1937\" >1937<\/option><option value=\"1936\" >1936<\/option><option value=\"1935\" >1935<\/option><option value=\"1934\" >1934<\/option><option value=\"1933\" >1933<\/option><option value=\"1932\" >1932<\/option><option value=\"1931\" >1931<\/option><option value=\"1930\" >1930<\/option><option value=\"1929\" >1929<\/option><option value=\"1928\" >1928<\/option><option value=\"1927\" >1927<\/option><option value=\"1926\" >1926<\/option><option value=\"1925\" >1925<\/option><option value=\"1924\" >1924<\/option><option value=\"1923\" >1923<\/option><option value=\"1922\" >1922<\/option><option value=\"1921\" >1921<\/option><option value=\"1920\" >1920<\/option><\/select><\/div><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><\/div><\/div><\/div><\/div><script>\n\t\t\t\t( function() {\n\t\t\t\t\tconst style = document.createElement( 'style' );\n\t\t\t\t\tstyle.appendChild( document.createTextNode( '#wpforms-755-field_4-container { position: absolute !important; overflow: hidden !important; display: inline !important; height: 1px !important; width: 1px !important; z-index: -1000 !important; padding: 0 !important; } #wpforms-755-field_4-container input { visibility: hidden; } #wpforms-conversational-form-page #wpforms-755-field_4-container label { counter-increment: none; }' ) );\n\t\t\t\t\tdocument.head.appendChild( style );\n\t\t\t\t\tdocument.currentScript?.remove();\n\t\t\t\t} )();\n\t\t\t<\/script><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"755\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/app.galen.edu.bz\/admissions\/wp-json\/wp\/v2\/pages\/764\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-755\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Create Account\" aria-live=\"assertive\" value=\"wpforms-submit\">Create Account<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/app.galen.edu.bz\/admissions\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container -->","protected":false},"excerpt":{"rendered":"<p>Create 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