189 lines
6.7 KiB
PHP
189 lines
6.7 KiB
PHP
<?php include_once 'header.php'; ?>
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<script src="js/data.js"></script>
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<script src="js/registerform.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" method="post" class="form-horizontal" action novalidate="novalidate">
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<div class="form-group">
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<label class="control-label col-sm-2" for="nombre">First Name</label>
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<div class="col-sm-8 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">
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<label class="control-label col-sm-2" for="apellido">Last Name</label>
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<div class="col-sm-8 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 class="form-group">
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<label class="control-label col-sm-2" for="titulo">Title</label>
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<div class="col-sm-8 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">
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<label class="control-label col-sm-2" for="afiliacion">Affiliation</label>
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<div class="col-sm-8 input-container">
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<input id="afiliacion" 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-2 control-label" for="ciudad">City</label>
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<div class="col-sm-8 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">
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<label class="col-sm-2 control-label" for="pais">Country</label>
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<div class="col-sm-8 input-container">
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<select 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 class="form-group">
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<label class="control-label col-sm-2" for="email">Email</label>
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<div class="col-sm-8 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 class="form-group">
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<label class="control-label col-sm-2" for="txtbda">Beginning date attending</label>
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<div class="col-sm-8 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">
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<label class="control-label col-sm-2" for="txteda">Ending date attending</label>
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<div class="col-sm-8 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 class="form-group">
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<label class="control-label col-sm-2" 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="col-sm-1 radios input-container">
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<label class="radio-inline"><input id="sifinan" type="radio" name="financiacion" value="si">Yes</label><br>
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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 class="col-sm-6 alert alert-info">
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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 class="col-sm-7 col-sm-offset-2 radioerror">
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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-2" 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 input-container">
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<div class="radio">
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<label><input id="invited" type="radio" name="invited" value="si">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="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="col-sm-7 col-sm-offset-2 radioerror">
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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-2" 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 input-container">
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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 class="col-sm-10 col-sm-offset-2 radioerror">
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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-2" for="roomtype">Rooming Preference</label>
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<div class="col-sm-8 input-container">
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<select 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">
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<label class="col-sm-2 control-label" for="roomate">Name of preferred roommate (if any)</label>
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<div class="col-sm-8 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 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">Register</button>
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</div>
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</div>
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</form>
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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 'footer.php'; ?>
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