90 lines
4.9 KiB
HTML
90 lines
4.9 KiB
HTML
<!DOCTYPE HTML>
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<html>
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<head>
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<title>6to Coloquio Uruguayo de Matémática-Registro</title>
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<meta name="description" content="website description" />
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<meta name="keywords" content="website keywords, website keywords" />
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<meta http-equiv="content-type" content="text/html; charset=utf8" />
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<meta name="viewport" content="width=device-width, initial-scale=1">
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<link rel="stylesheet" href="https://maxcdn.bootstrapcdn.com/bootstrap/3.3.7/css/bootstrap.min.css" integrity="sha384-BVYiiSIFeK1dGmJRAkycuHAHRg32OmUcww7on3RYdg4Va+PmSTsz/K68vbdEjh4u" crossorigin="anonymous">-->
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<link rel="stylesheet" type="text/css" href="style/style.css" />
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<script type="text/javascript" src="js/jquery-3.2.1.min.js"></script>
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<!-- Latest compiled and minified JavaScript -->
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<script src="https://maxcdn.bootstrapcdn.com/bootstrap/3.3.7/js/bootstrap.min.js" integrity="sha384-Tc5IQib027qvyjSMfHjOMaLkfuWVxZxUPnCJA7l2mCWNIpG9mGCD8wGNIcPD7Txa" crossorigin="anonymous"></script>
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<script type="text/javascript" src="js/app.js"></script>
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</head>
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<body>
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<div id="main">
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<div id="header" class="row"></div>
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<div id="site_content" class="container">
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<div class="row">
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<div class="sidebar" class="col-xs-12 col-sm-4"></div>
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<div id="content" class="col-xs-12 col-sm-8">
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<h1>Registrarse</h1>
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<form id="registerform" action="register.php" method="post">
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<div class="form_settings">
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<p class="inline-input">
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<span>Nombre</span>
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<!--bel for="nombre" class="control-label">Nombre</label>-->
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<input placeholder="Juan" name="nombre" type="text" class="form-control" id="nombre" required>
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<label for="apellido" class="control-label">Apellido</label>
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<input name="apellido" placeholder="Rodriguez" type="text" class="form-control" id="apellido" required>
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</p>
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<p class="inline-input">
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<span>Documento:</span>
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<select class="small" name="doctype" required id="doctype">
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<option>Tipo:</option>
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<option>C.I</option>
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<option>PSP</option>
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</select>
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<label for="docnro" class="control-label">Nro.</label>
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<input placeholder="Seleccione Tipo.. " type="text" id="txtdocnro" name="docnro" required>
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</p>
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<p>
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<span>Dirección:</span>
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<input name="dir" placeholder="18 de Julio 1544" type="text" name="dir" required>
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</p>
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<p class="inline-input">
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<span>Pais: </span>
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<!--<label for="pais" class="control-label">Pais</label>-->
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<input placeholder="Uruguay" type="text" class="form-control" name="pais" required>
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<label for="estado" class="control-label">Ciudad</label>
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<input placeholder="Montevideo" type="text" name="ciudad" required>
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</p>
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<p><span>Teléfono:</span><input placeholder="099 123 456" class="contact" type="text" name="tel" required /></p>
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<p><span>Email:</span><input placeholder="mail@example.com" class="contact" type="email" name="email" value="" required/></p>
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<p><span>Profesión:</span><input placeholder="Profesor" class="contact" type="text" name="profesion" required/></p>
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<p>
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<span style="width:150px;">Precisa financiación?</span>
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<label>Si</label><input type="radio" name="financiacion" value="si" id="sifinan"/>
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<label>No</label><input type="radio" checked="True" name="financiacion" value="no" id="nofinan"/>
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</p>
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<br/>
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<p id="detallefinan">
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<span>Detalle, con estimación de costo:</span>
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<textarea class="contact textarea" type="text" rows="8" cols="50" name="detallefinan"></textarea>
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</p>
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<p style="padding-top: 15px"><span> </span><input class="submit" type="submit" name="contact_submitted" value="submit" /></p>
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</div>
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</form>
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<div id="statusmsg" class="alert alert-success">
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<strong>Success!</strong> Indicates a successful or positive action.
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</div>
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</div>
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</div>
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</div>
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<div id="footer">
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<p><a href="index.html">Home</a> | <a href="examples.html">Examples</a> | <a href="page.html">A Page</a> | <a href="another_page.html">Another Page</a> | <a href="contact.html">Contact Us</a></p>
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<p>Copyright © night_sky_2 | <a href="http://validator.w3.org/check?uri=referer">HTML5</a> | <a href="http://jigsaw.w3.org/css-validator/check/referer">CSS</a> | <a href="http://www.html5webtemplates.co.uk">Website templates</a></p>
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</div>
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</div>
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</body>
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</html>
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