ggdworkshop/registration.php

<?php include_once 'header.php'; ?>
<link href="https://cdnjs.cloudflare.com/ajax/libs/select2/4.0.6-rc.0/css/select2.min.css" rel="stylesheet" />
<script src="https://cdnjs.cloudflare.com/ajax/libs/select2/4.0.6-rc.0/js/select2.min.js"></script>
<div class="row">         
<div id="content" class="col-xs-12 col-sm-12">
  <h1>Registration</h1>

  <form id="registerform" action="register.php" method="post" class="form-horizontal">           
    <div class="form-group">
      <label class="control-label col-sm-3" for="txtnombre">First Name:</label>
      <div class="col-sm-8">
         <input id="txtnombre" class="form-control" name="nombre"
                     type="text" pattern="^[a-zA-Z][a-zA-Z\s\-.'`áéíóú]*[a-zA-Z]$" required>       
      </div>
    </div>
    <div class="form-group">
      <label class="control-label col-sm-3" for="txtapellido">Last Name:</label>
      <div class="col-sm-8">
        <input id="txtapellido" class="form-control" name="apellido"
          type="text" pattern="^[a-zA-Z][a-zA-Z\s\-.'`áéíóú]*[a-zA-Z]$" required>
      </div>
    </div>
    <div class="form-group">
      <label class="control-label col-sm-3" for="txtprof">Title:</label>
      <div class="col-sm-8">
        <input id="txttitle" class="form-control" name="titulo" 
          placeholder="Professor, Post Doc, Grad Student(1st year, 2nd year, etc..)"  type="text">
      </div>
    </div>
    <div class="form-group">
      <label class="control-label col-sm-3" for="txtprof">Affiliation:</label>
      <div class="col-sm-8">
        <input id="txtaffiliation" class="form-control" name="afiliciacion" 
          placeholder="Which university or organization"  type="text">
      </div>
    </div>

    <div class="form-group">
      <label class="col-sm-3 control-label" for="txtciudad">City:</label>
      <div class="col-sm-8">
        <input id="txtciudad" name="ciudad" class="form-control" 
             type="text">   
      </div>      
    </div>
    <div class="form-group">
      <label class="col-sm-3 control-label" for="txtpais">Country:</label>
      <div class="col-sm-8">        
        <input id="txtpais" name="pais" type="text" class="form-control">
      </div>    
    </div>
     <div class="form-group">
      <label class="control-label col-sm-3" for="txtmail">Email:</label>
      <div class="col-sm-8">
        <input id="txtmail" class="form-control" name="email" 
          placeholder="mail@example.com"  type="email" required>
      </div>
    </div>
    <div class="form-group">
      <label class="control-label col-sm-3" for="txtbda">Beginning date attending:</label>
      <div class="col-sm-8">
        <input id="txtbda" class="form-control" name="bda">
      </div>
    </div>  
    <div class="form-group">
      <label class="control-label col-sm-3" for="txteda">Ending date attending:</label>
      <div class="col-sm-8">
        <input id="txteda" class="form-control" name="eda">
      </div>
    </div>  
    
    <div class="form-group">
       <label class="control-label col-sm-3" for="sifinan">
        Are you asking for support from the conference? (we have submitted funding requests and hope to cover the housing for a shared room, but we cannot make a guarantee at this time)
       </label>
      <div class="col-sm-4">
        <label class="radio-inline"><input id="sifinan" type="radio" name="financiacion" value="si">Yes</label>
        <label class="radio-inline"><input id="nofinan" type="radio" name="financiacion" value="no">No</label>
        
      </div>             
    </div>
    <div class="form-group">
      <!--requerido-->
       <label class="control-label col-sm-3" for="invited">
        Were you invited to participate in this conference?
       </label>
      <div class="col-sm-4">
        <label class="radio-inline"><input id="sifinan" type="radio" name="invited" value="si">Yes, I was previously invited</label><br/>
        <label class="radio-inline"><input id="nofinan" type="radio" name="invited" value="no">No, I am applying(Registration committee will notifiy you if accepted)</label>
        
      </div>             
    </div>
    <div class="form-group">
       <label class="control-label col-sm-3" for="invited">
        Do you need a letter of invitation?
       </label>
      <div class="col-sm-4">
        <label class="radio-inline"><input id="sifinan" type="radio" name="letterinvited" value="si">Yes</label>
        <label class="radio-inline"><input id="nofinan" type="radio" name="letterinvited" value="no">No</label>        
      </div>             
    </div>
    <div class="form-group">
      <!-- es requerido -->
      <label class="control-label col-sm-3" for="roomtype">Rooming Preference</label>
      <div class="col-sm-4">
        <select id="roomtype" style="width:100px;">
          <option value="shared">Shared</option>
          <option value="private">Private</option>
        </select>
      </div>

    </div>
    <div class="form-group">
      <label class="col-sm-3 control-label" for="txtroomate">Name of preferred roommate (if any)</label>
      <div class="col-sm-8">
        <input id="txtroomate" name="roomate" class="form-control" 
             type="text">   
      </div>      
    </div>        
    <div id="detallefinan" class="form-group">
      <label class="control-label col-sm-2" for="txtfinan">Detalle estimación de costo:</label>
      <div class="col-sm-8">  
        <textarea id="txtfinan" class="form-control" name="detallefinan" rows="10" style="height:200px;" placeholder="Haga una breve aclaración de la solicitud incluyendo costos estimados">
        </textarea>
        
      </div>
    </div>
    <div class="form-group">
      <div class="g-recaptcha col-sm-8" data-sitekey="6LeLxy4UAAAAALcrNXxcOiW1B3QgcfgZ6u4l52kZ" data-callback="onReturnCallback"></div>              
    </div>
    <div class="form-group"> 
        <div class="col-sm-8">
          <button type="submit" class="btn-lg btn btn-primary">Registrar</button>
      </div>  
    </div>
  </form> 
  <p class="text-danger">
            <strong>*</strong> si por alguna razón necesita registrarse nuevamente, llene el formulario de nuevo y se tendrá en cuenta el último de los registros.
  </p>
  <div id="statusmsg" class="alert alert-success">
    <strong>Success!</strong> Indicates a successful or positive action.
  </div>
  <!--<div id="myModal" class="modal fade" role="dialog">
    <div class="modal-dialog">
      <!-- Modal content-->
      <!--<div class="modal-content">
        <div class="modal-header">
          <button type="button" class="close" data-dismiss="modal">&times;</button>
          <h4 class="modal-title">Revise sus datos cuidadosamente y confirme</h4>
        </div>
        <div class="modal-body">
          <p>Some text in the modal.</p>
          
        </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>-->
</div>
<!--<?php include_once 'sidebar.php'; ?>-->
<?php include_once 'footer.php'; ?>