body {
    margin: 0;
    padding: 0;
    font-family: sans-serif;
    background: #f2f2f2;
}

.header {
    background: #0c7f00;
    color: #fff;
}

h3 {
padding: 20px 15px;
font-size: 24px;
font-weight: 100;
margin: 0;
    margin-bottom: 0px;
margin-bottom: 20px;
}

.input1 {
    width: 100%;
    height: 39px;
    border: 1px solid #c8c7cc;
    padding: 0 43px;
    background: url('data:image/png;base64,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');
    background-repeat: no-repeat;
    background-color: #fff;
    font-size: 16px;
}

.input2 {
    width: 100%;
    height: 39px;
    border: 1px solid #c8c7cc;
    border-top: 0;
    padding: 0 43px;
    background: url('data:image/png;base64,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');
    background-repeat: no-repeat;
    background-color: #fff;
    font-size: 16px;
}

.fielderror1 {
    width: 100%;
    height: 39px;
    border: 1px solid #f00;
    padding: 0 43px;
    background: url('data:image/png;base64,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');
    background-repeat: no-repeat;
    background-color: #fff;
    font-size: 16px;
}

.fielderror2 {
    width: 100%;
    height: 39px;
    border: 1px solid #f00;
    padding: 0 43px;
    background: url('data:image/png;base64,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');
    background-repeat: no-repeat;
    background-color: #fff;
    font-size: 16px;
}

#input_submitBtn {
    background: #2fa8ac;
    width: 96%;
    height: 45px;
    border: 0;
    color: #fff;
    display: block;
    margin: 0 auto;
    font-size: 18px;
}
*{font-family: 'Roboto', sans-serif;}

@keyframes click-wave {
0% {
height: 40px;
width: 40px;
opacity: 0.35;
position: relative;
}
100% {
height: 200px;
width: 200px;
margin-left: -80px;
margin-top: -80px;
opacity: 0;
}
}

.option-input {
-webkit-appearance: none;
-moz-appearance: none;
-ms-appearance: none;
-o-appearance: none;
appearance: none;
position: relative;
top: 13.33333px;
right: 0;
bottom: 0;
left: 0;
float: left;
height: 20px;
width: 20px;
transition: all 0.15s ease-out 0s;
background: #f2f2f2;
border: 1px solid #bfbfc0;
color: #fff;
cursor: pointer;
display: inline-block;
outline: none;
position: relative;
z-index: 1000;
}
.option-input:hover {
background: #9faab7;
}
.option-input:checked {
background: #929292;
}
.option-input:checked::before {
height: 20px;
width: 20px;
position: absolute;
content: '✔';
display: inline-block;
font-size: 14px;
text-align: center;
line-height: 20px;
}
.option-input.radio {
border-radius: 50%;
}
.option-input.radio::after {
border-radius: 50%;
}
h5 {
width: 60%;
display: initial;
color: #6d6d72;
font-weight: 100;
font-family: sans-serif;
float: left;
margin-top: 19px;
text-align: left;
margin-left: 5px;
margin-bottom: 15px;
}