German Correa
619a1e73b5
Selector de Paises cargando de una lista local en json, hay que corregirle detalles.
167 lines
7.1 KiB
PHP
167 lines
7.1 KiB
PHP
<?php include_once 'header.php'; ?>
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<link href="https://cdnjs.cloudflare.com/ajax/libs/select2/4.0.6-rc.0/css/select2.min.css" rel="stylesheet" />
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<script src="https://cdnjs.cloudflare.com/ajax/libs/select2/4.0.6-rc.0/js/select2.min.js"></script>
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<div class="row">
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<div id="content" class="col-xs-12 col-sm-12">
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<h1>Registration</h1>
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<form id="registerform" action="register.php" method="post" class="form-horizontal">
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<div class="form-group">
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<label class="control-label col-sm-3" for="txtnombre">First Name:</label>
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<div class="col-sm-8">
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<input id="txtnombre" class="form-control" name="nombre"
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type="text" pattern="^[a-zA-Z][a-zA-Z\s\-.'`áéíóú]*[a-zA-Z]$" required>
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</div>
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</div>
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<div class="form-group">
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<label class="control-label col-sm-3" for="txtapellido">Last Name:</label>
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<div class="col-sm-8">
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<input id="txtapellido" class="form-control" name="apellido"
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type="text" pattern="^[a-zA-Z][a-zA-Z\s\-.'`áéíóú]*[a-zA-Z]$" required>
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</div>
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</div>
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<div class="form-group">
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<label class="control-label col-sm-3" for="txtprof">Title:</label>
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<div class="col-sm-8">
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<input id="txttitle" 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">
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<label class="control-label col-sm-3" for="txtprof">Affiliation:</label>
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<div class="col-sm-8">
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<input id="txtaffiliation" class="form-control" name="afiliciacion"
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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 class="form-group">
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<label class="col-sm-3 control-label" for="txtciudad">City:</label>
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<div class="col-sm-8">
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<input id="txtciudad" name="ciudad" class="form-control"
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type="text">
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</div>
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</div>
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<div class="form-group">
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<label class="col-sm-3 control-label" for="txtpais">Country:</label>
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<div class="col-sm-8">
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<input id="txtpais" name="pais" type="text" class="form-control">
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</div>
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</div>
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<div class="form-group">
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<label class="control-label col-sm-3" for="txtmail">Email:</label>
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<div class="col-sm-8">
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<input id="txtmail" class="form-control" name="email"
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placeholder="mail@example.com" type="email" required>
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</div>
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</div>
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<div class="form-group">
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<label class="control-label col-sm-3" for="txtbda">Beginning date attending:</label>
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<div class="col-sm-8">
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<input id="txtbda" class="form-control" name="bda">
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</div>
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</div>
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<div class="form-group">
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<label class="control-label col-sm-3" for="txteda">Ending date attending:</label>
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<div class="col-sm-8">
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<input id="txteda" class="form-control" name="eda">
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</div>
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</div>
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<div class="form-group">
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<label class="control-label col-sm-3" for="sifinan">
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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)
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</label>
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<div class="col-sm-4">
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<label class="radio-inline"><input id="sifinan" type="radio" name="financiacion" value="si">Yes</label>
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<label class="radio-inline"><input id="nofinan" type="radio" name="financiacion" value="no">No</label>
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</div>
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</div>
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<div class="form-group">
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<!--requerido-->
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<label class="control-label col-sm-3" 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="col-sm-4">
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<label class="radio-inline"><input id="sifinan" type="radio" name="invited" value="si">Yes, I was previously invited</label><br/>
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<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>
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</div>
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</div>
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<div class="form-group">
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<label class="control-label col-sm-3" for="invited">
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Do you need a letter of invitation?
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</label>
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<div class="col-sm-4">
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<label class="radio-inline"><input id="sifinan" type="radio" name="letterinvited" value="si">Yes</label>
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<label class="radio-inline"><input id="nofinan" type="radio" name="letterinvited" value="no">No</label>
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</div>
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</div>
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<div class="form-group">
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<!-- es requerido -->
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<label class="control-label col-sm-3" for="roomtype">Rooming Preference</label>
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<div class="col-sm-4">
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<select id="roomtype" style="width:100px;">
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<option value="shared">Shared</option>
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<option value="private">Private</option>
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</select>
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</div>
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</div>
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<div class="form-group">
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<label class="col-sm-3 control-label" for="txtroomate">Name of preferred roommate (if any)</label>
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<div class="col-sm-8">
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<input id="txtroomate" 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 id="detallefinan" class="form-group">
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<label class="control-label col-sm-2" for="txtfinan">Detalle estimación de costo:</label>
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<div class="col-sm-8">
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<textarea id="txtfinan" class="form-control" name="detallefinan" rows="10" style="height:200px;" placeholder="Haga una breve aclaración de la solicitud incluyendo costos estimados">
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</textarea>
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</div>
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</div>
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<div class="form-group">
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<div class="g-recaptcha col-sm-8" data-sitekey="6LeLxy4UAAAAALcrNXxcOiW1B3QgcfgZ6u4l52kZ" data-callback="onReturnCallback"></div>
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</div>
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<div class="form-group">
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<div class="col-sm-8">
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<button type="submit" class="btn-lg btn btn-primary">Registrar</button>
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</div>
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</div>
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</form>
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<p class="text-danger">
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<strong>*</strong> si por alguna razón necesita registrarse nuevamente, llene el formulario de nuevo y se tendrá en cuenta el último de los registros.
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</p>
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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 id="myModal" class="modal fade" role="dialog">
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<div class="modal-dialog">
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<!-- Modal content-->
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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">Revise sus datos cuidadosamente y confirme</h4>
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</div>
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<div class="modal-body">
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<p>Some text in the modal.</p>
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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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</div>
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<!--<?php include_once 'sidebar.php'; ?>-->
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<?php include_once 'footer.php'; ?>
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