231 lines
7.7 KiB
HTML
231 lines
7.7 KiB
HTML
{% extends "layout.html" %}
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{% block content %}
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<script src="js/data.js"></script>
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<script src="js/registerform.js"></script>
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<h1>Registration</h1>
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{% if closed %}
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{% set disabled="disabled" %}
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<div class="alert alert-danger">
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<strong>Registration has been closed!</strong><br/>
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For any further questions, please contact: <a class="alert-link" href="mailto:ggdworkshop@cmat.edu.uy">ggdworkshop@cmat.edu.uy</a>
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</div>
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{% endif %}
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<form id="registerform" method="POST" action novalidate="novalidate">
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<fieldset {{ disabled }}>
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<!-- Nombre y Apellido -->
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<div class="row">
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<div class="form-group col-xs-12 col-sm-6">
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<label class="control-label" for="nombre">First Name</label>
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<div class="input-container">
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<input id="nombre" class="form-control" name="nombre" type="text">
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</div>
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</div>
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<div class="form-group col-xs-12 col-sm-6">
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<label class="control-label" for="apellido">Last Name</label>
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<div class="input-container">
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<input id="apellido" class="form-control" name="apellido" type="text">
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</div>
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</div>
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</div>
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<!-- Título y Afiliación -->
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<div class="row">
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<div class="form-group col-xs-12 col-sm-6">
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<label class="control-label" for="titulo">Title</label>
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<div class="input-container">
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<input id="titulo" class="form-control" name="titulo"
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placeholder="Professor, Post Doc, Grad Student(1st year, 2nd year, etc..)" type="text">
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</div>
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</div>
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<div class="form-group col-xs-12 col-sm-6">
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<label class="control-label " for="afiliacion">Affiliation</label>
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<div class="input-container">
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<input id="afiliacion" class="form-control" name="afiliacion"
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placeholder="Which university or organization" type="text">
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</div>
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</div>
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</div>
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<!-- Ciudad y Pais -->
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<div class="row">
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<div class="form-group col-xs-12 col-sm-6">
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<label class=" control-label" for="ciudad">City</label>
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<div class="input-container">
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<input id="ciudad" name="ciudad" class="form-control" type="text">
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</div>
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</div>
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<div class="form-group col-xs-12 col-sm-6">
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<label class=" control-label" for="pais">Country</label>
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<div class="input-container">
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<select {{ disabled }} id="pais" name="pais">
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<option></optoon>
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</select>
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</div>
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</div>
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</div>
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<!-- Email -->
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<div class="row">
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<div class="form-group col-xs-12">
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<label class="control-label" for="email">Email</label>
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<div class="input-container">
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<input id="email" class="form-control" name="email"
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placeholder="mail@example.com" type="email">
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</div>
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</div>
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</div>
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<!-- Beggining date and Endig Date-->
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<div class="row">
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<div class="form-group col-xs-12 col-sm-6">
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<label class="control-label " for="txtbda">Beginning date attending</label>
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<div class="input-container">
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<input id="txtbda" class="form-control" placeholder="DD/MM/AAAA" name="bda">
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</div>
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</div>
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<div class="form-group col-xs-12 col-sm-6">
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<label class="control-label " for="txteda">Ending date attending</label>
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<div class="input-container">
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<input id="txteda" class="form-control" placeholder="DD/MM/AAAA" name="eda">
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</div>
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</div>
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</div>
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<!-- Financial Support -->
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<div class="row">
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<div class="form-group col-xs-12">
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<label class="control-label" for="sifinan">
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Are you asking for support from the conference?
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</label>
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<div class="radios input-container">
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<label class="radio-inline"><input id="sifinan" type="radio" name="financiacion" value="1">Yes</label>
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<label class="radio-inline"><input id="nofinan" type="radio" name="financiacion" value="0">No</label>
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</div>
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<div class="col-sm-8 alert alert-info" style="display:none;margin:10px 0px 5px 0px;">
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<em class="text-justify">
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We have submitted funding requests and hope to cover the housing
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for a shared room, but we cannot make a guarantee at this time
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</em>
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</div>
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</div>
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</div>
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<!-- Invitation and letter of -->
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<div class="row">
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<div class="form-group col-xs-12 col-sm-6">
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<!--requerido-->
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<label class="control-label" for="invited">
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Were you invited to participate in this conference?
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</label>
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<div class="input-container">
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<div class="radio">
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<label><input id="invited" type="radio" name="invited" value="1">Yes, I was previously invited</label>
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</div>
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<div class="radio">
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<label><input id="noinvited" type="radio" name="invited" value="0">No, I am applying (Registration committee will notifiy you if accepted)</label>
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</div>
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</div>
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</div>
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<div class="form-group col-xs-12 col-sm-6">
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<label class="control-label" for="invited">
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Do you need a letter of invitation?
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</label>
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<div class="input-container">
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<label class="radio-inline"><input id="sifinan" type="radio" name="letterinvited" value="1">Yes</label>
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<label class="radio-inline"><input id="nofinan" type="radio" name="letterinvited" value="0">No</label>
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</div>
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</div>
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</div>
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<!-- Rooming Preferences -->
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<div class="row">
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<div class="form-group col-xs-12 col-sm-6">
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<label class="control-label " for="roomtype">Rooming Preference</label>
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<div class="input-container">
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<select {{ disabled }} id="roomtype" name="roomtype">
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<option></optoon>
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</select>
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</div>
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</div>
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<div class="form-group col-xs-12 col-sm-6">
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<label class=" control-label" for="roomate">Name of preferred roommate (if any)</label>
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<div class="input-container">
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<input id="roomate" name="roomate" class="form-control"
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type="text">
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</div>
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</div>
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</div>
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<!--Captcha -->
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<div class="row">
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<div class="form-group col-xs-12">
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<div class="input-container">
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<!--
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<div id="testing" class="g-recaptcha"
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data-sitekey="6LeIxAcTAAAAAJcZVRqyHh71UMIEGNQ_MXjiZKhI"
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data-callback="recaptchaCallback"></div>
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-->
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<div class="g-recaptcha"
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data-sitekey="6LesRDsUAAAAAJvyoODvjiza9u75qEGJmbKHEV6s"
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data-callback="recaptchaCallback"></div>
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<input type="hidden" class="hiddenRecaptcha required" name="hiddenRecaptcha" id="hiddenRecaptcha">
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</div>
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</div>
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</div>
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<!-- Confirm Button -->
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<div class="row">
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<div class="form-group col-xs-12 col-sm-8">
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<button type="submit" class="btn-lg btn btn-primary">Register</button>
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</div>
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</div>
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<!--<fieldset disabled="disabled">-->
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</form>
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<div id="statusmsg" class="alert alert-error">
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</div>
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<div id="msgModal" class="modal fade" role="dialog">
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<div class="modal-dialog">
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<div class="modal-content">
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<div class="modal-header">
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<button type="button" class="close" data-dismiss="modal">×</button>
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<h4 class="modal-title">GGDWorkshop Registration</h4>
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</div>
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<div class="modal-body">
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<div class="alert">
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</div>
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</div>
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<!--<div class="modal-footer">
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<button type="button" class="btn btn-default" data-dismiss="modal">Sí
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</button>
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<button type="button" class="btn btn-default" data-dismiss="modal">No
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</button>
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</div>-->
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</div>
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</div>
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</div>
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{% endblock %}
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