return function() {
	$stpl = '
		{form.begin}

		<div class="pull-left col-md-3">
			{form.currency}
			{form.language}
		</div>
		<div class="pull-center col-md-3">
			{form.country}
		</div>
		<div class="pull-center col-md-3">
			<h1>Some header</h1>
		</div>
		<div class="pull-right col-md-3">
			{form.timezone}
		</div>

		{form.end}
	';
	return form((array)$_POST + (array)$a, [
			'stpl' => $stpl,
		])
		->currency_box(['selected' => 'RUB'])
		->language_box(['selected' => 'uk'])
		->timezone_box(['selected' => 'UTC'])
		->country_box(['selected' => 'US'])
		->save()
	;
};
€   Euro [EUR]
₴   Hryvnia [UAH]
р.   Russian Ruble [RUB]
Fr   Swiss Franc [CHF]
$   US Dollar [USD]
¥   Yen [JPY]
English [en]
русский язык [ru]
українська мова [uk]
Великобритания [GB]
Германия [DE]
Испания [ES]
Россия [RU]
США [US]
Украина [UA]
Франция [FR]

Some header

UTC-11:00 Pacific/Midway
UTC-11:00 Pacific/Niue
UTC-11:00 Pacific/Pago_Pago
UTC-10:00 Pacific/Honolulu
UTC-10:00 Pacific/Johnston
UTC-10:00 Pacific/Rarotonga
UTC-10:00 Pacific/Tahiti
UTC-09:30 Pacific/Marquesas
UTC-09:00 America/Adak
UTC-09:00 Pacific/Gambier
UTC-08:00 America/Anchorage
UTC-08:00 America/Juneau
UTC-08:00 America/Metlakatla
UTC-08:00 America/Nome
UTC-08:00 America/Sitka
UTC-08:00 America/Yakutat
UTC-08:00 Pacific/Pitcairn
UTC-07:00 America/Creston
UTC-07:00 America/Dawson
UTC-07:00 America/Dawson_Creek
UTC-07:00 America/Fort_Nelson
UTC-07:00 America/Hermosillo
UTC-07:00 America/Los_Angeles
UTC-07:00 America/Phoenix
UTC-07:00 America/Tijuana
UTC-07:00 America/Vancouver
UTC-07:00 America/Whitehorse
UTC-06:00 America/Belize
UTC-06:00 America/Boise
UTC-06:00 America/Cambridge_Bay
UTC-06:00 America/Chihuahua
UTC-06:00 America/Costa_Rica
UTC-06:00 America/Denver
UTC-06:00 America/Edmonton
UTC-06:00 America/El_Salvador
UTC-06:00 America/Guatemala
UTC-06:00 America/Inuvik
UTC-06:00 America/Managua
UTC-06:00 America/Mazatlan
UTC-06:00 America/Ojinaga
UTC-06:00 America/Regina
UTC-06:00 America/Swift_Current
UTC-06:00 America/Tegucigalpa
UTC-06:00 America/Yellowknife
UTC-06:00 Pacific/Galapagos
UTC-05:00 America/Atikokan
UTC-05:00 America/Bahia_Banderas
UTC-05:00 America/Bogota
UTC-05:00 America/Cancun
UTC-05:00 America/Cayman
UTC-05:00 America/Chicago
UTC-05:00 America/Eirunepe
UTC-05:00 America/Guayaquil
UTC-05:00 America/Indiana/Knox
UTC-05:00 America/Indiana/Tell_City
UTC-05:00 America/Jamaica
UTC-05:00 America/Lima
UTC-05:00 America/Matamoros
UTC-05:00 America/Menominee
UTC-05:00 America/Merida
UTC-05:00 America/Mexico_City
UTC-05:00 America/Monterrey
UTC-05:00 America/North_Dakota/Beulah
UTC-05:00 America/North_Dakota/Center
UTC-05:00 America/North_Dakota/New_Salem
UTC-05:00 America/Panama
UTC-05:00 America/Port-au-Prince
UTC-05:00 America/Rainy_River
UTC-05:00 America/Rankin_Inlet
UTC-05:00 America/Resolute
UTC-05:00 America/Rio_Branco
UTC-05:00 America/Winnipeg
UTC-05:00 Pacific/Easter
UTC-04:00 America/Anguilla
UTC-04:00 America/Antigua
UTC-04:00 America/Aruba
UTC-04:00 America/Asuncion
UTC-04:00 America/Barbados
UTC-04:00 America/Blanc-Sablon
UTC-04:00 America/Boa_Vista
UTC-04:00 America/Campo_Grande
UTC-04:00 America/Caracas
UTC-04:00 America/Cuiaba
UTC-04:00 America/Curacao
UTC-04:00 America/Detroit
UTC-04:00 America/Dominica
UTC-04:00 America/Grand_Turk
UTC-04:00 America/Grenada
UTC-04:00 America/Guadeloupe
UTC-04:00 America/Guyana
UTC-04:00 America/Havana
UTC-04:00 America/Indiana/Indianapolis
UTC-04:00 America/Indiana/Marengo
UTC-04:00 America/Indiana/Petersburg
UTC-04:00 America/Indiana/Vevay
UTC-04:00 America/Indiana/Vincennes
UTC-04:00 America/Indiana/Winamac
UTC-04:00 America/Iqaluit
UTC-04:00 America/Kentucky/Louisville
UTC-04:00 America/Kentucky/Monticello
UTC-04:00 America/Kralendijk
UTC-04:00 America/La_Paz
UTC-04:00 America/Lower_Princes
UTC-04:00 America/Manaus
UTC-04:00 America/Marigot
UTC-04:00 America/Martinique
UTC-04:00 America/Montserrat
UTC-04:00 America/Nassau
UTC-04:00 America/New_York
UTC-04:00 America/Nipigon
UTC-04:00 America/Pangnirtung
UTC-04:00 America/Porto_Velho
UTC-04:00 America/Port_of_Spain
UTC-04:00 America/Puerto_Rico
UTC-04:00 America/Santo_Domingo
UTC-04:00 America/St_Barthelemy
UTC-04:00 America/St_Kitts
UTC-04:00 America/St_Lucia
UTC-04:00 America/St_Thomas
UTC-04:00 America/St_Vincent
UTC-04:00 America/Thunder_Bay
UTC-04:00 America/Toronto
UTC-04:00 America/Tortola
UTC-03:00 America/Araguaina
UTC-03:00 America/Argentina/Buenos_Aires
UTC-03:00 America/Argentina/Catamarca
UTC-03:00 America/Argentina/Cordoba
UTC-03:00 America/Argentina/Jujuy
UTC-03:00 America/Argentina/La_Rioja
UTC-03:00 America/Argentina/Mendoza
UTC-03:00 America/Argentina/Rio_Gallegos
UTC-03:00 America/Argentina/Salta
UTC-03:00 America/Argentina/San_Juan
UTC-03:00 America/Argentina/San_Luis
UTC-03:00 America/Argentina/Tucuman
UTC-03:00 America/Argentina/Ushuaia
UTC-03:00 America/Bahia
UTC-03:00 America/Belem
UTC-03:00 America/Cayenne
UTC-03:00 America/Fortaleza
UTC-03:00 America/Glace_Bay
UTC-03:00 America/Goose_Bay
UTC-03:00 America/Halifax
UTC-03:00 America/Maceio
UTC-03:00 America/Moncton
UTC-03:00 America/Montevideo
UTC-03:00 America/Paramaribo
UTC-03:00 America/Recife
UTC-03:00 America/Santarem
UTC-03:00 America/Santiago
UTC-03:00 America/Sao_Paulo
UTC-03:00 America/Thule
UTC-03:00 Antarctica/Palmer
UTC-03:00 Antarctica/Rothera
UTC-03:00 Atlantic/Bermuda
UTC-03:00 Atlantic/Stanley
UTC-02:30 America/St_Johns
UTC-02:00 America/Godthab
UTC-02:00 America/Miquelon
UTC-02:00 America/Noronha
UTC-02:00 Atlantic/South_Georgia
UTC-01:00 Atlantic/Cape_Verde
UTC Africa/Abidjan
UTC Africa/Accra
UTC Africa/Bamako
UTC Africa/Banjul
UTC Africa/Bissau
UTC Africa/Conakry
UTC Africa/Dakar
UTC Africa/Freetown
UTC Africa/Lome
UTC Africa/Monrovia
UTC Africa/Nouakchott
UTC Africa/Ouagadougou
UTC Africa/Sao_Tome
UTC America/Danmarkshavn
UTC America/Scoresbysund
UTC Atlantic/Azores
UTC Atlantic/Reykjavik
UTC Atlantic/St_Helena
UTC UTC
UTC+01:00 Africa/Algiers
UTC+01:00 Africa/Bangui
UTC+01:00 Africa/Brazzaville
UTC+01:00 Africa/Casablanca
UTC+01:00 Africa/Douala
UTC+01:00 Africa/El_Aaiun
UTC+01:00 Africa/Kinshasa
UTC+01:00 Africa/Lagos
UTC+01:00 Africa/Libreville
UTC+01:00 Africa/Luanda
UTC+01:00 Africa/Malabo
UTC+01:00 Africa/Ndjamena
UTC+01:00 Africa/Niamey
UTC+01:00 Africa/Porto-Novo
UTC+01:00 Africa/Tunis
UTC+01:00 Africa/Windhoek
UTC+01:00 Atlantic/Canary
UTC+01:00 Atlantic/Faroe
UTC+01:00 Atlantic/Madeira
UTC+01:00 Europe/Dublin
UTC+01:00 Europe/Guernsey
UTC+01:00 Europe/Isle_of_Man
UTC+01:00 Europe/Jersey
UTC+01:00 Europe/Lisbon
UTC+01:00 Europe/London
UTC+02:00 Africa/Blantyre
UTC+02:00 Africa/Bujumbura
UTC+02:00 Africa/Cairo
UTC+02:00 Africa/Ceuta
UTC+02:00 Africa/Gaborone
UTC+02:00 Africa/Harare
UTC+02:00 Africa/Johannesburg
UTC+02:00 Africa/Kigali
UTC+02:00 Africa/Lubumbashi
UTC+02:00 Africa/Lusaka
UTC+02:00 Africa/Maputo
UTC+02:00 Africa/Maseru
UTC+02:00 Africa/Mbabane
UTC+02:00 Africa/Tripoli
UTC+02:00 Antarctica/Troll
UTC+02:00 Arctic/Longyearbyen
UTC+02:00 Europe/Amsterdam
UTC+02:00 Europe/Andorra
UTC+02:00 Europe/Belgrade
UTC+02:00 Europe/Berlin
UTC+02:00 Europe/Bratislava
UTC+02:00 Europe/Brussels
UTC+02:00 Europe/Budapest
UTC+02:00 Europe/Busingen
UTC+02:00 Europe/Copenhagen
UTC+02:00 Europe/Gibraltar
UTC+02:00 Europe/Kaliningrad
UTC+02:00 Europe/Ljubljana
UTC+02:00 Europe/Luxembourg
UTC+02:00 Europe/Madrid
UTC+02:00 Europe/Malta
UTC+02:00 Europe/Monaco
UTC+02:00 Europe/Oslo
UTC+02:00 Europe/Paris
UTC+02:00 Europe/Podgorica
UTC+02:00 Europe/Prague
UTC+02:00 Europe/Rome
UTC+02:00 Europe/San_Marino
UTC+02:00 Europe/Sarajevo
UTC+02:00 Europe/Skopje
UTC+02:00 Europe/Stockholm
UTC+02:00 Europe/Tirane
UTC+02:00 Europe/Vaduz
UTC+02:00 Europe/Vatican
UTC+02:00 Europe/Vienna
UTC+02:00 Europe/Warsaw
UTC+02:00 Europe/Zagreb
UTC+02:00 Europe/Zurich
UTC+03:00 Africa/Addis_Ababa
UTC+03:00 Africa/Asmara
UTC+03:00 Africa/Dar_es_Salaam
UTC+03:00 Africa/Djibouti
UTC+03:00 Africa/Juba
UTC+03:00 Africa/Kampala
UTC+03:00 Africa/Khartoum
UTC+03:00 Africa/Mogadishu
UTC+03:00 Africa/Nairobi
UTC+03:00 Antarctica/Syowa
UTC+03:00 Asia/Aden
UTC+03:00 Asia/Amman
UTC+03:00 Asia/Baghdad
UTC+03:00 Asia/Bahrain
UTC+03:00 Asia/Beirut
UTC+03:00 Asia/Damascus
UTC+03:00 Asia/Gaza
UTC+03:00 Asia/Hebron
UTC+03:00 Asia/Jerusalem
UTC+03:00 Asia/Kuwait
UTC+03:00 Asia/Nicosia
UTC+03:00 Asia/Qatar
UTC+03:00 Asia/Riyadh
UTC+03:00 Europe/Athens
UTC+03:00 Europe/Bucharest
UTC+03:00 Europe/Chisinau
UTC+03:00 Europe/Helsinki
UTC+03:00 Europe/Istanbul
UTC+03:00 Europe/Kiev
UTC+03:00 Europe/Kirov
UTC+03:00 Europe/Mariehamn
UTC+03:00 Europe/Minsk
UTC+03:00 Europe/Moscow
UTC+03:00 Europe/Riga
UTC+03:00 Europe/Simferopol
UTC+03:00 Europe/Sofia
UTC+03:00 Europe/Tallinn
UTC+03:00 Europe/Uzhgorod
UTC+03:00 Europe/Vilnius
UTC+03:00 Europe/Volgograd
UTC+03:00 Europe/Zaporozhye
UTC+03:00 Indian/Antananarivo
UTC+03:00 Indian/Comoro
UTC+03:00 Indian/Mayotte
UTC+04:00 Asia/Baku
UTC+04:00 Asia/Dubai
UTC+04:00 Asia/Muscat
UTC+04:00 Asia/Tbilisi
UTC+04:00 Asia/Yerevan
UTC+04:00 Europe/Astrakhan
UTC+04:00 Europe/Samara
UTC+04:00 Europe/Ulyanovsk
UTC+04:00 Indian/Mahe
UTC+04:00 Indian/Mauritius
UTC+04:00 Indian/Reunion
UTC+04:30 Asia/Kabul
UTC+04:30 Asia/Tehran
UTC+05:00 Antarctica/Mawson
UTC+05:00 Asia/Aqtau
UTC+05:00 Asia/Aqtobe
UTC+05:00 Asia/Ashgabat
UTC+05:00 Asia/Dushanbe
UTC+05:00 Asia/Karachi
UTC+05:00 Asia/Oral
UTC+05:00 Asia/Samarkand
UTC+05:00 Asia/Tashkent
UTC+05:00 Asia/Yekaterinburg
UTC+05:00 Indian/Kerguelen
UTC+05:00 Indian/Maldives
UTC+05:30 Asia/Colombo
UTC+05:30 Asia/Kolkata
UTC+05:45 Asia/Kathmandu
UTC+06:00 Antarctica/Vostok
UTC+06:00 Asia/Almaty
UTC+06:00 Asia/Bishkek
UTC+06:00 Asia/Dhaka
UTC+06:00 Asia/Novosibirsk
UTC+06:00 Asia/Omsk
UTC+06:00 Asia/Qyzylorda
UTC+06:00 Asia/Thimphu
UTC+06:00 Asia/Tomsk
UTC+06:00 Asia/Urumqi
UTC+06:00 Indian/Chagos
UTC+06:30 Asia/Rangoon
UTC+06:30 Indian/Cocos
UTC+07:00 Antarctica/Davis
UTC+07:00 Asia/Bangkok
UTC+07:00 Asia/Barnaul
UTC+07:00 Asia/Ho_Chi_Minh
UTC+07:00 Asia/Jakarta
UTC+07:00 Asia/Krasnoyarsk
UTC+07:00 Asia/Novokuznetsk
UTC+07:00 Asia/Phnom_Penh
UTC+07:00 Asia/Pontianak
UTC+07:00 Asia/Vientiane
UTC+07:00 Indian/Christmas
UTC+08:00 Antarctica/Casey
UTC+08:00 Asia/Brunei
UTC+08:00 Asia/Hong_Kong
UTC+08:00 Asia/Hovd
UTC+08:00 Asia/Irkutsk
UTC+08:00 Asia/Kuala_Lumpur
UTC+08:00 Asia/Kuching
UTC+08:00 Asia/Macau
UTC+08:00 Asia/Makassar
UTC+08:00 Asia/Manila
UTC+08:00 Asia/Shanghai
UTC+08:00 Asia/Singapore
UTC+08:00 Asia/Taipei
UTC+08:00 Australia/Perth
UTC+08:30 Asia/Pyongyang
UTC+08:45 Australia/Eucla
UTC+09:00 Asia/Chita
UTC+09:00 Asia/Choibalsan
UTC+09:00 Asia/Dili
UTC+09:00 Asia/Jayapura
UTC+09:00 Asia/Khandyga
UTC+09:00 Asia/Seoul
UTC+09:00 Asia/Tokyo
UTC+09:00 Asia/Ulaanbaatar
UTC+09:00 Asia/Yakutsk
UTC+09:00 Pacific/Palau
UTC+09:30 Australia/Adelaide
UTC+09:30 Australia/Broken_Hill
UTC+09:30 Australia/Darwin
UTC+10:00 Antarctica/DumontDUrville
UTC+10:00 Asia/Ust-Nera
UTC+10:00 Asia/Vladivostok
UTC+10:00 Australia/Brisbane
UTC+10:00 Australia/Currie
UTC+10:00 Australia/Hobart
UTC+10:00 Australia/Lindeman
UTC+10:00 Australia/Melbourne
UTC+10:00 Australia/Sydney
UTC+10:00 Pacific/Chuuk
UTC+10:00 Pacific/Guam
UTC+10:00 Pacific/Port_Moresby
UTC+10:00 Pacific/Saipan
UTC+10:30 Australia/Lord_Howe
UTC+11:00 Antarctica/Macquarie
UTC+11:00 Asia/Magadan
UTC+11:00 Asia/Sakhalin
UTC+11:00 Asia/Srednekolymsk
UTC+11:00 Pacific/Bougainville
UTC+11:00 Pacific/Efate
UTC+11:00 Pacific/Guadalcanal
UTC+11:00 Pacific/Kosrae
UTC+11:00 Pacific/Norfolk
UTC+11:00 Pacific/Noumea
UTC+11:00 Pacific/Pohnpei
UTC+12:00 Antarctica/McMurdo
UTC+12:00 Asia/Anadyr
UTC+12:00 Asia/Kamchatka
UTC+12:00 Pacific/Auckland
UTC+12:00 Pacific/Fiji
UTC+12:00 Pacific/Funafuti
UTC+12:00 Pacific/Kwajalein
UTC+12:00 Pacific/Majuro
UTC+12:00 Pacific/Nauru
UTC+12:00 Pacific/Tarawa
UTC+12:00 Pacific/Wake
UTC+12:00 Pacific/Wallis
UTC+12:45 Pacific/Chatham
UTC+13:00 Pacific/Apia
UTC+13:00 Pacific/Enderbury
UTC+13:00 Pacific/Fakaofo
UTC+13:00 Pacific/Tongatapu
UTC+14:00 Pacific/Kiritimati