| Current Path : /home1/savoy/public_html/unova.in/application/views/site/ |
Linux gator3171.hostgator.com 4.19.286-203.ELK.el7.x86_64 #1 SMP Wed Jun 14 04:33:55 CDT 2023 x86_64 |
| Current File : /home1/savoy/public_html/unova.in/application/views/site/coaching-registration.php |
<?php
$this->load->view('site/header');
$publickey = "6Lfzh-ESAAAAADmW1n4Nx5oryPCdTv7ror8fWx34";
?>
<div class="banner">
<div class="banner_top"></div><!--banner_top end-->
<div class="banner_mid_inner"><img src="<?=base_url()?>/assets/images/training-registration.jpg" alt="Unova coaching"/></div><!--banner_mid end-->
<div class="banner_bot"></div><!--banner_bot end-->
</div><!--banner end-->
<div class="content">
<div class="content_left">
<h1>Coaching Registration</h1>
<h5> Please fill the form below. You shall hear from us soon for Training on <br/> <strong> <?php echo $coaching->coaching_title;?> </strong> </h5>
<script src="<?=base_url()?>/assets/js/formscript.js" type="text/javascript"></script>
<script type="text/javascript">
JotForm.init(function(){
$('input_4').hint('ex: myname@example.com');
});
</script>
<link href="<?=base_url()?>/assets/css/formstyle.css" rel="stylesheet" type="text/css" />
<form class="jotform-form" action="<?=site_url();?>/site/insert_coaching_registration" method="post" name="form_12312249228" id="12312249228" accept-charset="utf-8">
<input type="hidden" name="formID" value="12312249228" />
<div class="form-all">
<ul class="form-section">
<li class="form-line" id="id_3">
<label class="form-label-left" id="label_3" for="input_3">
Name<span class="form-required">*</span>
</label>
<div id="cid_3" class="form-input"><span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="10" name="q3_name[first]" id="first_3" />
<label class="form-sub-label" for="first_3" id="sublabel_first"> First Name </label></span><span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="15" name="q3_name[last]" id="last_3" />
<label class="form-sub-label" for="last_3" id="sublabel_last"> Last Name </label></span>
</div>
</li>
<li class="form-line" id="id_6">
<label class="form-label-left" id="label_6" for="input_6"> Organization </label>
<div id="cid_6" class="form-input">
<input type="text" class="form-textbox" id="input_6" name="q6_organization" size="20" />
</div>
</li>
<li class="form-line" id="id_5">
<label class="form-label-left" id="label_5" for="input_5">
Contact Number<span class="form-required">*</span>
</label>
<div id="cid_5" class="form-input"><span class="form-sub-label-container"><input class="form-textbox validate[required]" type="tel" name="q5_contactNumber[area]" id="input_5_area" size="3">
-
<label class="form-sub-label" for="input_5_area" id="sublabel_area"> Area Code </label></span><span class="form-sub-label-container"><input class="form-textbox validate[required]" type="tel" name="q5_contactNumber[phone]" id="input_5_phone" size="8">
<label class="form-sub-label" for="input_5_phone" id="sublabel_phone"> Phone Number </label></span>
</div>
</li>
<li class="form-line" id="id_4">
<label class="form-label-left" id="label_4" for="input_4">
E-mail<span class="form-required">*</span>
</label>
<div id="cid_4" class="form-input">
<input type="email" class="form-textbox validate[required, Email]" id="input_4" name="q4_email4" size="30" />
</div>
</li>
<li class="form-line" id="id_17">
<label class="form-label-left" id="label_17" for="input_17"> Your location / city </label>
<div id="cid_17" class="form-input">
<input type="text" class="form-textbox" id="input_17" name="q17_location" size="20" />
</div>
</li>
<li class="form-line" id="id_7">
<label class="form-label-left" id="label_7" for="input_7"> Website </label>
<div id="cid_7" class="form-input">
<input type="text" class="form-textbox" id="input_7" name="q7_website" size="20" />
</div>
</li>
<li class="form-line" id="id_8">
<label class="form-label-left" id="label_8" for="input_8"> In What capacity are you filling this up </label>
<div id="cid_8" class="form-input">
<div class="form-single-column"><span class="form-radio-item" style="clear:left;"><input type="radio" class="form-radio" id="input_8_0" name="q8_inWhat" value="Organization" checked />
<label for="input_8_0"> Organization </label></span><span class="clearfix"></span><span class="form-radio-item" style="clear:left;"><input type="radio" class="form-radio" id="input_8_1" name="q8_inWhat" value="Individual" />
<label for="input_8_1"> Individual </label></span><span class="clearfix"></span>
</div>
</div>
</li>
<li class="form-line" id="id_9">
<label class="form-label-left" id="label_9" for="input_9"> How did you hear about us? </label>
<div id="cid_9" class="form-input">
<input type="text" class="form-textbox" id="input_9" name="q9_howDid" size="20" />
</div>
</li>
<li class="form-line" id="id_10">
<?php echo recaptcha_get_html($publickey);?>
</li>
<li class="form-line" id="id_2">
<div id="cid_2" class="form-input-wide">
<div style="margin-left:156px" class="form-buttons-wrapper">
<button id="input_2" type="submit" class="form-submit-button">
Submit Form
</button>
</div>
</div>
</li>
<li style="display:none">
Should be Empty:
<input type="text" name="website" value="" />
</li>
</ul>
</div>
<input type="hidden" id="simple_spc" name="simple_spc" value="12312249228" />
<script type="text/javascript">
document.getElementById("si" + "mple" + "_spc").value = "12312249228-12312249228";
</script>
<input type="hidden" class="form-hidden" value="<?php echo $coaching->coaching_title;?>" id="input_11" name="q11_coachingService" />
<input type="hidden" class="form-hidden" value="<?php echo $coaching->coaching_id;?>" id="input_12" name="q12_coachingService_id" />
</form>
</div><!--content_left end-->
<?php
$this->load->view('site/right.php');
?>
</div><!--content end-->
<?php
$this->load->view('site/footer.php');
?>