{% extends "layout.html" %} {% block content %} <script src="js/data.js"></script> <script src="js/registerform.js"></script> {% if closed %} {% set disabled="disabled" %} <div class="alert alert-danger"> <strong>Registration has been closed!</strong><br/> For any further questions, please contact: <a class="alert-link" href="mailto:ggdworkshop@cmat.edu.uy">ggdworkshop@cmat.edu.uy</a> </div> {% endif %} <div class="row"> <div class="col-xs-12"> <h1><strong>Inscripción</strong></h1> </div> </div> <div class="row"> <div class="col-xs-12"> <div class="alert alert-info"> <i class="glyphicon glyphicon-info-sign"></i> <strong>Inscripciones abiertas desde el domingo 20 de Junio al domingo 5 de Septiembre. </strong><br /> </div> <div class="alert alert-info"> <i class="glyphicon glyphicon-info-sign"></i> <strong>Al momento de la inscripción el participante deberá registrar el e-mail de su cuenta Zoom.</strong><br /> </div> <hr class="separador"/> </div> </div> <form id="registerform" method="POST" action novalidate="novalidate"> <fieldset {{ disabled }}> <!-- Nombre y Apellido --> <div class="row"> <div class="form-group col-xs-12 col-sm-6"> <label class="control-label" for="nombre">Nombre</label> <div class="input-container"> <input id="nombre" class="form-control" placeholder="Juan" name="nombre" type="text"> </div> </div> <div class="form-group col-xs-12 col-sm-6"> <label class="control-label" for="apellido">Apellido</label> <div class="input-container"> <input id="apellido" class="form-control" placeholder="Perez" name="apellido" type="text"> </div> </div> </div> <!-- Email --> <div class="row"> <div class="form-group col-xs-12"> <label class="control-label" for="email">Email de contacto</label> <div class="input-container"> <input id="email" class="form-control" name="email" placeholder="mail@example.com" type="email"> </div> </div> </div> <!-- Ciudad y Pais --> <div class="row"> <div class="form-group col-xs-12 col-sm-6"> <label class=" control-label" for="ciudad">Ciudad</label> <div class="input-container"> <input id="ciudad" placeholder="Montevideo" name="ciudad" class="form-control" type="text"> </div> </div> <div class="form-group col-xs-12 col-sm-6"> <label class=" control-label" for="pais">País</label> <div class="input-container"> <select {{ disabled }} id="pais" name="pais"> <option></optoon> </select> </div> </div> </div> <!-- Título y Afiliación --> <div class="row"> <div class="form-group col-xs-12 col-sm-6"> <label class="control-label" for="titulo">Profesión o Actividad</label> <div class="input-container"> <select {{ disabled }} id="titulo" name="titulo"> <option></optoon> </select> </div> <div id="otrotitulohidden" style="margin-top:10px;" class="input-container"> <input id="otrotitulo" placeholder="Detalle otro..." class="form-control" name="otrotitulo"> </div> </div> <div class="form-group col-xs-12 col-sm-6"> <label class="control-label " for="afiliacion">Afiliación</label> <div class="input-container"> <input id="afiliacion" class="form-control" name="afiliacion" placeholder="Universidad u organización" type="text"> </div> </div> </div> <!-- Email Zoom --> <div class="row"> <div class="form-group col-xs-12"> <label class="control-label" for="emailzoom">Email de cuenta Zoom</label> <div class="input-container"> <input id="emailzoom" class="form-control" name="emailzoom" placeholder="mailzoom@example.com" type="email"> </div> </div> </div> <!-- Beggining date and Endig Date--> <!--<div class="row"> <div class="form-group col-xs-12 col-sm-6"> <label class="control-label " for="txtbda">Beginning date attending</label> <div class="input-container"> <input id="txtbda" class="form-control" placeholder="DD/MM/AAAA" name="bda"> </div> </div> <div class="form-group col-xs-12 col-sm-6"> <label class="control-label " for="txteda">Ending date attending</label> <div class="input-container"> <input id="txteda" class="form-control" placeholder="DD/MM/AAAA" name="eda"> </div> </div> </div>--> <!-- Financial Support --> <!-- <div class="row"> <div class="form-group col-xs-12"> <label class="control-label" for="sifinan"> Are you asking for support from the conference? </label> <div class="radios input-container"> <label class="radio-inline"><input id="sifinan" type="radio" name="financiacion" value="1">Yes</label> <label class="radio-inline"><input id="nofinan" type="radio" name="financiacion" value="0">No</label> </div> <div class="col-sm-8 alert alert-info" style="display:none;margin:10px 0px 5px 0px;"> <em class="text-justify"> We have submitted funding requests and hope to cover the housing for a shared room, but we cannot make a guarantee at this time </em> </div> </div> </div>--> <!-- Invitation and letter of --> <!--<div class="row"> <div class="form-group col-xs-12 col-sm-6"> <label class="control-label" for="invited"> Were you invited to participate in this conference? </label> <div class="input-container"> <div class="radio"> <label><input id="invited" type="radio" name="invited" value="1">Yes, I was previously invited</label> </div> <div class="radio"> <label><input id="noinvited" type="radio" name="invited" value="0">No, I am applying (Registration committee will notifiy you if accepted)</label> </div> </div> </div>--> <!-- <div class="form-group col-xs-12 col-sm-12"> <label class="control-label" for="invited"> Do you need a letter of invitation? </label> <div class="input-container"> <label class="radio-inline"><input id="sifinan" type="radio" name="letterinvited" value="1">Yes</label> <label class="radio-inline"><input id="nofinan" type="radio" name="letterinvited" value="0">No</label> </div> </div> </div>--> <!-- Rooming Preferences --> <!-- <div class="row"> <div class="form-group col-xs-12 col-sm-6"> <label class="control-label " for="roomtype">Rooming Preference</label> <div class="input-container"> <select {{ disabled }} id="roomtype" name="roomtype"> <option></optoon> </select> </div> </div> <div class="form-group col-xs-12 col-sm-6"> <label class=" control-label" for="roomate">Name of preferred roommate (if any)</label> <div class="input-container"> <input id="roomate" name="roomate" class="form-control" type="text"> </div> </div> </div>--> <!--Captcha --> <div class="row"> <div class="form-group col-xs-12"> <div class="input-container"> <div class="g-recaptcha" data-sitekey="{{ sitekey }}" data-callback="recaptchaCallback"> </div> <input type="hidden" class="hiddenRecaptcha required" name="hiddenRecaptcha" id="hiddenRecaptcha"> </div> </div> </div> <!-- Confirm Button --> <div class="row"> <div class="form-group col-xs-12 col-sm-8"> <button type="submit" class="btn-lg btn btn-primary">Register</button> </div> </div> <!--<fieldset disabled="disabled">--> </form> <div id="msgModal" class="modal fade" role="dialog" tabindex="-1" aria-hidden="true" labelledby="msgModal"> <div class="modal-dialog"> <div class="modal-content"> <div class="modal-header"> <button type="button" class="close" data-dismiss="modal">×</button> <h4 class="modal-title">Registro CLAM2021</h4> </div> <div class="modal-body"> <div class="alert"> </div> </div> <!-- <div class="modal-footer"> <button type="button" class="btn btn-default" data-dismiss="modal">Sí </button> <button type="button" class="btn btn-default" data-dismiss="modal">No </button> </div>--> </div> </div> </div> {% endblock %}