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<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="utf-8">
<meta http-equiv="X-UA-Compatible" content="IE=edge">
<meta name="viewport" content="width=device-width, initial-scale=1">
<title>Halaman Registrasi</title>
<link href="assets/css/bootstrap.min.css" rel="stylesheet">
<link href="assets/css/style.css" rel="stylesheet">
<link href="assets/plugins/font-awesome-4.6.3/css/font-awesome.min.css" rel="stylesheet" type="text/css" />
</head>
<body>
<div class="col-md-4 col-md-offset-4 form-login">
<?php
/* handle error */
if (isset($_GET['error'])) : ?>
<div class="alert alert-warning alert-dismissible" role="alert">
<button type="button" class="close" data-dismiss="alert" aria-label="Close">
<span aria-hidden="true">×</span>
</button>
<strong>Warning!</strong> <?=base64_decode($_GET['error']);?>
</div>
<?php endif;?>
<div class="outter-form-login">
</div>
</div>
<div class="row">
<div class="col-md-8 col-md-offset-2 form-login">
<center><img src="images/user/smalllogoidi.jpg" width="200" height="120" alt=""/></center>
<h3 class="text-center "> <em class="glyphicon glyphicon-user"></em> Registrasi Kehadiran</h3>
<h2 class="text-center ">MUSCAB IDI CABANG KOTA BANDUNG 2024</h2>
<h3 class="text-center">The Papandayan Hotel | Minggu, 03 November 2024</h3>
<br><br>
</div>
<!-- Main content -->
<section class="content">
<div class="row">
<div class="col-md-10 col-md-offset-2 form-login">
<div class="box box-primary">
<!-- form start -->
<form role="form" class="form-horizontal" action="register.php" class="inner-login" method="POST">
<div class="box-body">
<div class="form-group">
<label class="col-sm-2 control-label"></label>
<div class="col-sm-5">
<div class="input-group">
<span class="input-group-addon"> <i class="fa fa-user icon-title"></i> </span>
<input type="text" class="form-control" name="nmlead" autocomplete="off" placeholder="Nama Lengkap" required>
</div>
</div>
</div>
<div class="form-group">
<label class="col-sm-2 control-label"></label>
<div class="col-sm-5">
<div class="input-group">
<span class="input-group-addon"> <i class="fa fa-home icon-title"></i> </span>
<input type="text" class="form-control" name="alamat" autocomplete="off" placeholder="Alamat" required>
</div>
</div>
</div>
<div class="form-group">
<label class="col-sm-2 control-label"></label>
<div class="col-sm-5">
<div class="input-group">
<span class="input-group-addon"> <i class="fa fa-phone icon-title"></i> </span>
<input type="text" class="form-control" id="hp" name="hp" autocomplete="off" onKeyPress="return goodchars(event,'0123456789',this)" placeholder="No WA /HP" required>
</div>
</div>
</div>
<div class="form-group">
<label class="col-sm-2 control-label"></label>
<div class="col-sm-5">
<div class="input-group">
<span class="input-group-addon"> <i class="fa fa-envelope icon-title"></i> </span>
<input type="email" class="form-control" name="email" autocomplete="off" placeholder="Email Aktif (cek barcode setelah Registrasi di mail anda)" required>
</div>
</div>
</div>
<div class="form-group">
<label class="col-sm-2 control-label"></label>
<div class="col-sm-5">
<div class="input-group">
<span class="input-group-addon"> <i class="fa fa-user-md icon-title"></i> </span>
<input type="text" class="form-control" name="npa" autocomplete="off" placeholder="Nomor KTA" required>
</div>
</div>
</div>
</div><!-- /.box body -->
<div class="box-footer">
<div class="form-group">
<div class="col-sm-offset-2 col-sm-10">
<input type="submit" class="btn btn-primary btn-submit" name="simpan" value="Registrasi">
<a href="event.php" class="btn btn-default btn-reset">Reset</a>
</div>
</div>
</div><!-- /.box footer -->
</form>
</div><!-- /.box -->
</div><!--/.col -->
</div> <!-- /.row -->
</section><!-- /.content -->
<script src="assets/js/jquery.min.js"></script>
<script src="assets/js/bootstrap.min.js"></script>
</body>
</html>