<?php include_once 'header.php'; ?>
<script src="js/data.js"></script>
<script src="js/registerform.js"></script>
<div class="row">
<div id="content" class="col-xs-12 col-sm-12">
<h1>Registration</h1>
<form id="registerform" method="post" action novalidate="novalidate">
<!-- Nombre y Apellido -->
<div class="row">
<div class="form-group col-xs-12 col-sm-6">
<label class="control-label" for="nombre">First Name</label>
<div class="input-container">
<input id="nombre" class="form-control" name="nombre" type="text">
</div>
</div>
<div class="form-group col-xs-12 col-sm-6">
<label class="control-label" for="apellido">Last Name</label>
<div class="input-container">
<input id="apellido" class="form-control" name="apellido" type="text">
</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">Title</label>
<div class="input-container">
<input id="titulo" class="form-control" name="titulo"
placeholder="Professor, Post Doc, Grad Student(1st year, 2nd year, etc..)" type="text">
</div>
</div>
<div class="form-group col-xs-12 col-sm-6">
<label class="control-label " for="afiliacion">Affiliation</label>
<div class="input-container">
<input id="afiliacion" class="form-control" name="afiliciacion"
placeholder="Which university or organization" type="text">
</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">City</label>
<div class="input-container">
<input id="ciudad" 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">Country</label>
<div class="input-container">
<select id="pais" name="pais">
<option></optoon>
</select>
</div>
</div>
</div>
<!-- Email -->
<div class="row">
<div class="form-group col-xs-12">
<label class="control-label" for="email">Email</label>
<div class="input-container">
<input id="email" class="form-control" name="email"
placeholder="mail@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="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">
<!--requerido-->
<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-6">
<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 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="g-recaptcha" data-sitekey="6LesRDsUAAAAAJvyoODvjiza9u75qEGJmbKHEV6s"></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>
</form>
<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">×</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 'footer.php'; ?>