170 lines
9.9 KiB
PHP
170 lines
9.9 KiB
PHP
<!DOCTYPE html>
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<html lang="en">
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<head>
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<meta charset="utf-8" />
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<title>Member Registration</title>
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<meta name="viewport" content="width=device-width, initial-scale=1.0">
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<meta content="A fully featured admin theme which can be used to build CRM, CMS, etc." name="description" />
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<meta content="Coderthemes" name="author" />
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<meta http-equiv="X-UA-Compatible" content="IE=edge" />
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<!-- App favicon -->
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<link rel="shortcut icon" href="<?= base_url()."/public"; ?>/assets/images/favicon.ico">
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<!-- App css -->
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<link href="<?= base_url()."/public"; ?>/assets/css/bootstrap-corporate.min.css" rel="stylesheet" type="text/css" id="bs-default-stylesheet" />
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<link href="<?= base_url()."/public"; ?>/assets/css/app-corporate.min.css" rel="stylesheet" type="text/css" id="app-default-stylesheet" />
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<link href="<?= base_url()."/public"; ?>/assets/css/bootstrap-corporate-dark.min.css" rel="stylesheet" type="text/css" id="bs-dark-stylesheet" />
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<link href="<?= base_url()."/public"; ?>/assets/css/app-corporate-dark.min.css" rel="stylesheet" type="text/css" id="app-dark-stylesheet" />
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<!-- icons -->
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<link href="<?= base_url()."/public"; ?>/assets/css/icons.min.css" rel="stylesheet" type="text/css" />
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<style>
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.text-danger {
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color: red !important;
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}
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.parsley-errors-list>li {
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color: red !important;
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}
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</style>
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</head>
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<body class="loading">
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<div class="account-pages mt-5 mb-5">
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<div class="container">
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<div class="row justify-content-center">
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<div class="col-lg-6">
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<div class="card">
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<div class="card-body">
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<h3 class="header-title" style="text-align: center;">Member Registration</h3>
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<p class="sub-header">
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</p>
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<form method="post" action="<?= base_url()."register"; ?>" role="form" class="parsley-examples">
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<div class="form-group row">
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<label for="inputEmail3" class="col-4 col-form-label">Name<span class="text-danger">*</span></label>
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<div class="col-7">
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<input type="text" required parsley-type="text" class="form-control"
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id="name" placeholder="Username" name="name">
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</div>
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</div>
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<div class="form-group row">
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<label for="inputEmail3" class="col-4 col-form-label">Email<span class="text-danger">*</span></label>
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<div class="col-7">
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<input type="email" required parsley-type="email" class="form-control"
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id="inputEmail3" placeholder="Email" name="email">
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</div>
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</div>
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<div class="form-group row">
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<label for="inputEmail3" class="col-4 col-form-label">Mobile<span class="text-danger">*</span></label>
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<div class="col-7">
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<input data-parsley-type="number" type="text" pattern="[6-9]{1}[0-9]{9}"
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class="form-control" required
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placeholder="Enter only numbers" name="mobile"/>
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</div>
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</div>
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<div class="form-group row">
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<label for="hori-pass1" class="col-4 col-form-label">Password<span class="text-danger">*</span></label>
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<div class="col-7">
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<input id="hori-pass1" type="password" placeholder="Password" required
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class="form-control" name="password">
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</div>
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</div>
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<div class="form-group row">
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<label for="hori-pass2" class="col-4 col-form-label">Confirm Password
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<span class="text-danger">*</span></label>
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<div class="col-7">
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<input data-parsley-equalto="#hori-pass1" type="password" required
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placeholder="Password" class="form-control" id="hori-pass2">
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</div>
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</div>
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<div class="form-group row">
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<label for="inputEmail3" class="col-4 col-form-label">Address<span class="text-danger">*</span></label>
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<div class="col-7">
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<input type="text" required parsley-type="text" class="form-control"
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id="address" placeholder="Address" name="address">
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</div>
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</div>
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<div class="form-group row">
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<label for="inputEmail3" class="col-4 col-form-label">City<span class="text-danger">*</span></label>
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<div class="col-7">
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<input type="text" required parsley-type="text" class="form-control"
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id="city" placeholder="City" name="city">
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</div>
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</div>
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<div class="form-group row">
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<label for="inputEmail3" class="col-4 col-form-label">State<span class="text-danger">*</span></label>
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<div class="col-7">
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<input type="text" required parsley-type="text" class="form-control"
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id="state" placeholder="State" name="state">
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</div>
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</div>
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<div class="form-group row">
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<label for="inputEmail3" class="col-4 col-form-label">Country<span class="text-danger">*</span></label>
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<div class="col-7">
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<input type="text" required parsley-type="text" class="form-control"
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id="country" placeholder="Country" name="country">
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</div>
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</div>
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<div class="form-group row">
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<label for="inputEmail3" class="col-4 col-form-label">pincode<span class="text-danger">*</span></label>
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<div class="col-7">
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<input type="text" required parsley-type="text" class="form-control"
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id="pincode" placeholder="pincode" name="pincode">
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</div>
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</div>
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<div class="form-group row">
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<div class="col-8 offset-4">
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<div class="checkbox checkbox-purple">
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<input id="checkbox6" type="checkbox">
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<label for="checkbox6">
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Remember me
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</label>
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</div>
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</div>
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</div>
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<div class="form-group row">
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<div class="col-8 offset-4">
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<button type="submit" class="btn btn-primary waves-effect waves-light mr-1">
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Register
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</button>
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<button type="reset"
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class="btn btn-secondary waves-effect">
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Cancel
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</button>
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</div>
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</div>
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</form>
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</div>
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</div> <!-- end card-box -->
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</div> <!-- end col -->
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</div>
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<!-- end row -->
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</div>
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<!-- end container -->
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</div>
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<!-- end page -->
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<!-- Right bar overlay-->
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<div class="rightbar-overlay"></div>
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<!-- Vendor js -->
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<script src="<?= base_url()."/public"; ?>/assets/js/vendor.min.js"></script>
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<!-- Plugin js-->
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<script src="<?= base_url()."/public"; ?>/assets/libs/parsleyjs/parsley.min.js"></script>
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<!-- Validation init js-->
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<script src="<?= base_url()."/public"; ?>/assets/js/pages/form-validation.init.js"></script>
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<!-- App js -->
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<script src="<?= base_url()."/public"; ?>/assets/js/app.min.js"></script>
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</body>
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</html> |