ggdworkshop/registration.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" class="form-horizontal" action novalidate="novalidate">           
    
    <div class="form-group">
      <label class="control-label col-sm-2" for="nombre">First Name</label>
      <div class="col-sm-8">
         <input id="nombre" class="form-control" name="nombre" type="text">         
      </div>
    </div>

    <div class="form-group">
      <label class="control-label col-sm-2" for="apellido">Last Name</label>
      <div class="col-sm-8">
        <input id="apellido" class="form-control" name="apellido" type="text">
      </div>
    </div>

    <div class="form-group">
      <label class="control-label col-sm-2" for="titulo">Title</label>
      <div class="col-sm-8">
        <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">
      <label class="control-label col-sm-2" for="afiliacion">Affiliation</label>
      <div class="col-sm-8">
        <input id="afiliacion" class="form-control" name="afiliciacion"
        placeholder="Which university or organization"  type="text">
      </div>
    </div>

    <div class="form-group">
      <label class="col-sm-2 control-label" for="ciudad">City</label>
      <div class="col-sm-8">
        <input id="ciudad" name="ciudad" class="form-control" type="text">   
      </div>      
    </div>

    <div class="form-group">
      <label class="col-sm-2 control-label" for="pais">Country</label>
      <div class="col-sm-8">    
        <select id="pais">
          <option></optoon>
        </select>  
        
      </div>    
    </div>

     <div class="form-group">
      <label class="control-label col-sm-2" for="email">Email</label>
      <div class="col-sm-8">
        <input id="email" class="form-control" name="email" 
          placeholder="mail@example.com"  type="email">
      </div>
    </div>

    <div class="form-group">
      <label class="control-label col-sm-2" for="txtbda">Beginning date attending</label>
      <div class="col-sm-8">
        <input id="txtbda" class="form-control" placeholder="DD/MM/AAAA" name="bda">
      </div>
    </div>  
    <div class="form-group">
      <label class="control-label col-sm-2" for="txteda">Ending date attending</label>
      <div class="col-sm-8">
        <input id="txteda" class="form-control" placeholder="DD/MM/AAAA" name="eda">
      </div>
    </div>  
    
    <div class="form-group">
       <label class="control-label col-sm-2" for="sifinan">
        Are you asking for support from the conference? 
       </label>
      <div class="col-sm-1">
        <label class="radio-inline"><input id="sifinan" type="radio" name="financiacion" value="si">Yes</label><br>
        <label class="radio-inline"><input id="nofinan" type="radio" name="financiacion" value="no">No</label>      
      </div>
      <div class="col-sm-6 alert alert-info">

        <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 class="form-group">
      <!--requerido-->
       <label class="control-label col-sm-2" 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-2" 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-2" for="roomtype">Rooming Preference</label>
      <div class="col-sm-8">
        <select id="roomtype">
          <option></optoon>
        </select>
      </div>

    </div>
    <div class="form-group">
      <label class="col-sm-2 control-label" for="roomate">Name of preferred roommate (if any)</label>
      <div class="col-sm-8">

        <input id="roomate" name="roomate" class="form-control" 
             type="text">   
      </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> 
  
  <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 'footer.php'; ?>