$form->add('select', 'prox_country_id', ts('Country'), $country, $proxRequired);
$form->add('text', 'prox_distance', ts('Distance'), NULL, $proxRequired);
$form->add('select', 'prox_country_id', ts('Country'), $country, $proxRequired);
$form->add('text', 'prox_distance', ts('Distance'), NULL, $proxRequired);