 <style>
        * {
            margin: 0;
            padding: 0;
            box-sizing: border-box;
        }

        body {
            font-family: 'Segoe UI', Tahoma, Geneva, Verdana, sans-serif;
            background: linear-gradient(135deg, #1a5f3f 0%, #2d8659 100%);
            min-height: 100vh;
            padding: 20px;
        }

        .container {
            max-width: 800px;
            margin: 0 auto;
            background: white;
            border-radius: 15px;
            box-shadow: 0 10px 40px rgba(0,0,0,0.2);
            overflow: hidden;
        }

        .header {
            background: linear-gradient(135deg, #1a5f3f 0%, #2d8659 100%);
            color: white;
            padding: 40px 30px;
            text-align: center;
        }

        .header h1 {
            font-size: 2em;
            margin-bottom: 10px;
            color: #ffd700;
        }

        .header p {
            font-size: 1.1em;
            opacity: 0.95;
        }

        .form-container {
            padding: 40px 30px;
        }

        .form-section {
            margin-bottom: 35px;
        }

        .section-title {
            color: #1a5f3f;
            font-size: 1.3em;
            margin-bottom: 20px;
            padding-bottom: 10px;
            border-bottom: 3px solid #ffd700;
            font-weight: 600;
        }

        .form-group {
            margin-bottom: 20px;
        }

        label {
            display: block;
            color: #333;
            font-weight: 500;
            margin-bottom: 8px;
            font-size: 0.95em;
        }

        label.required::after {
            content: " *";
            color: #dc2626;
        }

        input[type="text"],
        input[type="email"],
        input[type="date"],
        input[type="tel"],
        select,
        textarea {
            width: 100%;
            padding: 12px 15px;
            border: 2px solid #e5e7eb;
            border-radius: 8px;
            font-size: 1em;
            transition: all 0.3s;
            font-family: inherit;
        }

        input:focus,
        select:focus,
        textarea:focus {
            outline: none;
            border-color: #2d8659;
            box-shadow: 0 0 0 3px rgba(45, 134, 89, 0.1);
        }

        textarea {
            resize: vertical;
            min-height: 120px;
        }

        .radio-group {
            display: flex;
            gap: 20px;
            margin-top: 10px;
        }

        .radio-option {
            display: flex;
            align-items: center;
            gap: 8px;
        }

        .radio-option input[type="radio"] {
            width: 18px;
            height: 18px;
            accent-color: #2d8659;
        }

        .file-upload {
            position: relative;
            display: inline-block;
            width: 100%;
        }

        .file-upload input[type="file"] {
            position: absolute;
            opacity: 0;
            width: 100%;
            height: 100%;
            cursor: pointer;
        }

        .file-upload-label {
            display: flex;
            align-items: center;
            justify-content: center;
            padding: 15px;
            background: #f3f4f6;
            border: 2px dashed #9ca3af;
            border-radius: 8px;
            cursor: pointer;
            transition: all 0.3s;
        }

        .file-upload-label:hover {
            background: #e5e7eb;
            border-color: #2d8659;
        }

        .preview-container {
            margin-top: 15px;
            text-align: center;
        }

        .preview-image {
            max-width: 200px;
            max-height: 200px;
            border-radius: 8px;
            border: 3px solid #2d8659;
            display: none;
        }

        .info-box {
            background: #ecfdf5;
            border-left: 4px solid #2d8659;
            padding: 15px;
            border-radius: 6px;
            margin-top: 15px;
            display: none;
        }

        .info-box h4 {
            color: #1a5f3f;
            margin-bottom: 8px;
        }

        .info-box p {
            color: #374151;
            line-height: 1.6;
            font-size: 0.95em;
        }

        .captcha-box {
            background: #f9fafb;
            padding: 20px;
            border-radius: 8px;
            border: 2px solid #e5e7eb;
            display: flex;
            align-items: center;
            gap: 15px;
        }

        .captcha-question {
            font-weight: 600;
            color: #1a5f3f;
            font-size: 1.1em;
        }

        .captcha-input {
            width: 150px !important;
        }

        .button-group {
            display: flex;
            gap: 15px;
            justify-content: center;
            margin-top: 30px;
        }

        .btn {
            padding: 15px 40px;
            border: none;
            border-radius: 8px;
            font-size: 1.1em;
            font-weight: 600;
            cursor: pointer;
            transition: all 0.3s;
            text-transform: uppercase;
            letter-spacing: 0.5px;
        }

        .btn-preview {
            background: #fbbf24;
            color: #1a5f3f;
        }

        .btn-preview:hover {
            background: #f59e0b;
            transform: translateY(-2px);
            box-shadow: 0 5px 15px rgba(251, 191, 36, 0.3);
        }

        .btn-submit {
            background: #2d8659;
            color: white;
        }

        .btn-submit:hover {
            background: #1a5f3f;
            transform: translateY(-2px);
            box-shadow: 0 5px 15px rgba(45, 134, 89, 0.3);
        }

        .btn-submit:disabled {
            background: #9ca3af;
            cursor: not-allowed;
            transform: none;
        }

        .error {
            color: #dc2626;
            font-size: 0.85em;
            margin-top: 5px;
            display: none;
        }

        .modal {
            display: none;
            position: fixed;
            z-index: 1000;
            left: 0;
            top: 0;
            width: 100%;
            height: 100%;
            background: rgba(0,0,0,0.5);
            overflow-y: auto;
        }

        .modal-content {
            background: white;
            margin: 50px auto;
            padding: 0;
            border-radius: 15px;
            max-width: 800px;
            box-shadow: 0 10px 40px rgba(0,0,0,0.3);
        }

        .modal-header {
            background: linear-gradient(135deg, #1a5f3f 0%, #2d8659 100%);
            color: white;
            padding: 25px 30px;
            border-radius: 15px 15px 0 0;
        }

        .modal-body {
            padding: 30px;
            max-height: 70vh;
            overflow-y: auto;
        }

        .preview-row {
            display: grid;
            grid-template-columns: 200px 1fr;
            gap: 15px;
            padding: 15px;
            border-bottom: 1px solid #e5e7eb;
        }

        .preview-row:last-child {
            border-bottom: none;
        }

        .preview-label {
            font-weight: 600;
            color: #1a5f3f;
        }

        .preview-value {
            color: #374151;
        }

        .close {
            color: white;
            float: right;
            font-size: 28px;
            font-weight: bold;
            cursor: pointer;
            line-height: 1;
        }

        .close:hover {
            opacity: 0.8;
        }

        .success-message {
            background: #10b981;
            color: white;
            padding: 20px;
            border-radius: 8px;
            text-align: center;
            margin-bottom: 20px;
            display: none;
        }

        @media (max-width: 768px) {
            .container {
                margin: 10px;
            }

            .form-container {
                padding: 30px 20px;
            }

            .preview-row {
                grid-template-columns: 1fr;
                gap: 5px;
            }

            .button-group {
                flex-direction: column;
            }

            .btn {
                width: 100%;
            }
        }
    </style>