205 lines
7.3 KiB
PHP
205 lines
7.3 KiB
PHP
<?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'; ?>
|