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Viewing / Editing File: signup.php

<?php 
    include("header.php");
?>

<div class="container">
        <div class="sing-up-text" style="">
            <div class="sing-up-text-bg">
                <h3> Sign <span> Up </span></h3>
                <h5>Already have an account ? <a href="login.php"><b> Log In</b></a></h5>
            </div>
    
            <div class="sing-up-form" style="width: 100%;">
                <form method="post" id="form" enctype="multipart/form-data">
                    <div class="log-input" id="b_name">
                        <span> Name <b>*</b></span>
                        <label><i class="fa fa-user" aria-hidden="true"></i></label>
                        <input type="text" placeholder=" Name" name="title" required="">
                    </div>

<div class="log-input" id="b_name">
                        <span>Email ID <b>*</b></span>
                        <label><i class="fa fa-envelope"></i></label>
                        <input type="email" placeholder="Email ID" id="email" name="email" required="">
                    </div>

<div class="log-input sex-input" id="b_name">
                        <span>SEX <b>*</b></span>
                        <label><i class="fa fa-venus"></i></label>
                        <dd><input type="radio" id="male" name="sex" value="Male"> Male</dd>
                        <dd><input type="radio" id="female" name="sex" value="Female">  Female  </dd>                     
                        <dd><input type="radio" id="other" name="sex" value="Other"> Other   </dd>                       
                    </div>

<div class="log-input" id="b_name">
                        <span>Mobile Number <b>*</b></span>
                        <label><i class="fa fa-phone" aria-hidden="true"></i></label>
                        <input type="text" placeholder="Register Number" id="phone" name="phone" required="">
                    </div>

<div class="log-input" id="b_name">
                        <span>Date of Birth <b>*</b></span>
                        <label><i class="fa fa-calendar"></i></label>
                        <input type="date" placeholder="" id="dob" name="dob" required="">
                    </div>

<div class="log-input" id="b_name">
                        <span> Preferred City-Center <b>*</b></span>
                        <label><i class="fa fa-user" aria-hidden="true"></i></label>
                        <select name="stream" id="stream">
                            <option>Enter your Preferred City-Center</option>
                            <option value="">Kolkata North</option>
                            <option value="">Kolkata South</option> 
                            <option value="">Kolkata Center</option>                                                        
                        </select>
                    </div>
                    
                    <div class="log-input" id="b_name">
                        <span>Last Qualification  <b>*</b></span>
                        <label><i class="fa fa-book" aria-hidden="true"></i></label>
                        <input type="text" placeholder="Qualification" id="Qualification" name="Qualification" required="">                     
                    </div>                    
                    
                    <div class="log-input" id="b_name">
                        <span> Adderss  <b>*</b></span>
                        <label><i class="fa fa-map" aria-hidden="true"></i></label>
                        <textarea name="adderss" id="adderss" placeholder="Full Adderss"></textarea>                     
                    </div>

<div class="log-input" id="b_name">
                        <span>Password <b>*</b></span>
                        <label><i class="fa fa-lock" aria-hidden="true"></i></label>
                        <input type="password" placeholder="Password" id="pass1" onkeyup="checkPass(); return false;" name="password" required="">
                    </div>

<div class="log-input" id="b_name">
                        <span>Confirm  Password <b>*</b></span>
                        <label><i class="fa fa-lock" aria-hidden="true"></i></label>
                        <input type="password" placeholder="Confirm  Password" id="pass2" onkeyup="checkPass(); return false;" name="cpassword1" required="">
                        <div id="error-nwl"></div>                      
                    </div>

<div class="log-input checkboxbox" id="b_name">
                        <label style="display: block;font-weight: bold;border: none;">
                            <input type="checkbox" id="Terms" name="Terms" value="Terms" style="" required=""> I agree to the <a href="terms.php">Terms &amp; Conditions</a>
                        </label>
                    </div>

<?php 
    include("footer.php");
?>

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