Gecko [ gandhischool.edu.np ]

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pwnkit	10.99 KB	-rwxr-xr-x

Code Editor : 44a8c5b5b0ea34b0f701dc552962600e537513cc.php

<?php $__env->startSection('content'); ?>
<style>
    body {
    background-image: url(/frontend/images/about-banner-33.jpg) ;
    background-color: rgba(6, 6, 32, 0.795);
    background-repeat: no-repeat;
    /* background-size: 100%; */
    background-position-y: center;
    background-position-y: center;
    background-attachment: fixed;
    position: relative;
    color: #000;
    /* z-index: 99; */
}
</style>

<div>

<?php if($message = Session::get('success')): ?>
            <div class="alert alert-success">
                <p><?php echo e($message); ?></p>
            </div>
        <?php endif; ?>
        <?php if($message = Session::get('error')): ?>
            <div class="alert alert-danger">
                <p><?php echo e($message); ?></p>
            </div>
        <?php endif; ?>
        <?php if($errors->any()): ?>
            <div class="alert alert-danger">
                <label>Whoops!</label> There were some problems with your input.<br><br>
                <ul>
                    <?php $__currentLoopData = $errors->all(); $__env->addLoop($__currentLoopData); foreach($__currentLoopData as $error): $__env->incrementLoopIndices(); $loop = $__env->getLastLoop(); ?>
                        <li><?php echo e($error); ?></li>
                    <?php endforeach; $__env->popLoop(); $loop = $__env->getLastLoop(); ?>
                </ul>
            </div>
        <?php endif; ?>
        <section class="py-5 my-5">
            <div class="container">
                <form action="<?php echo e(route('membership.apply')); ?>" enctype="multipart/form-data" method="POST" id="membershipForm">
                    <?php echo e(csrf_field()); ?>

<div class="row">
                        <div class="col-lg-12">
                            <div class="form-background text-center">
                                <h1 class="display-3 animated slideInDown fontt text-center ">Membership Apply
                                </h1>

</div>
                        </div>
                        <div class="form-background mt-1">
                            <div class="text-center">
                                <p>(Please submit the form below with your full details.)</p>
                            </div>
                            <div class="row ">
                                <div class="col-sm-6 formm">
                                    <div class="row">
                                        <div class="col-12"><label for="name">Full name</label> <em>*</em></div>
                                        <div class="col-sm-2 col-3 pt-0 pe-0">
                                            <div class="form-group ">
                                                
                                                <select class="form-control" name="name_prefix"
                                                    style="border-right: 0px !important; border-radius: 3px !important; padding-right: 4px !important; padding-left: 7px !important;">
                                                    <option value="DR.">DR.</option>
                                                    <option value="PROF. DR.">PROF. DR.</option>
                                                </select>
                                            </div>
                                        </div>
                                        <div class="col-sm-10 col-9 form-group  pt-0 ps-1">
                                            
                                            <input style="border-radius: 0px 3px 3px 0px !important;" class="form-control"
                                                required="required" name="name" type="text"
                                                value="<?php echo e(old('name')); ?>" id="name">
                                        </div>
                                    </div>
                                </div>
                                <div class="col-sm-6 form-group formm">
                                    <label for="dob">Date of Birth</label>
                                    <input class="form-control"  name="dob" type="date"
                                        value="<?php echo e(old('dob')); ?>" id="dob">
                                </div>
                                <div class="col-sm-6 form-group formm">
                                    <label for="full_address">Residential Address</label> <em>*</em>
                                    <input class="form-control" required="required" name="full_address" type="text"
                                        value="<?php echo e(old('full_address')); ?>" id="address">
                                </div>
                                <div class="col-sm-6 form-group formm">
                                    <label for="phone">Contact number (mobile number)</label> <em>*</em>
                                    <input class="form-control" required="required" name="phone" type="text"
                                        value="<?php echo e(old('phone')); ?>" id="contact_number">
                                </div>

<div class="col-sm-6 form-group formm">
                                    <label for="alt_contact_number">Residential Phone number (alt. mobile number)</label>
                                    <input class="form-control" name="alt_contact_number" type="text"
                                        value="<?php echo e(old('alt_contact_number')); ?>" id="alt_contact_number">
                                </div>

<div class="col-sm-6 form-group formm">
                                    <label for="email">Personal Email/Gmail/Yahoo</label> <em>*</em>
                                    <input class="form-control" required="required" name="email" type="email"
                                        value="<?php echo e(old('email')); ?>" id="email">
                                </div>

<div class="col-sm-6 form-group formm">
                                    <label for="phd_subject">Faculty/Department of the Ph.D. Subject</label> <em>*</em>
                                    <input class="form-control" required="required" name="phd_subject" type="text"
                                        value="<?php echo e(old('phd_subject')); ?>" id="subject">
                                </div>

<div class="col-sm-6 form-group formm">
                                    <label for="phd_title">Ph.D. Thesis/Decertation Title</label> <em>*</em>
                                    <input class="form-control" required="required" name="phd_title" type="text"
                                        value="<?php echo e(old('phd_title')); ?>" id="thesis">
                                </div>

<div class="col-sm-6 form-group formm">
                                    <label for="completion_year">Name of University/Completion year(as per the Ph.D. Certificate)</label>
                                    <em>*</em>
                                    <input class="form-control" required="required" name="completion_year" type="text"
                                        value="<?php echo e(old('completion_year')); ?>" id="phd_date">
                                </div>

<div class="col-sm-6 form-group formm">
                                    <label for="current_occupation">Current Occupation/Present Involvement</label>
                                    <input class="form-control"  name="current_occupation" type="text"
                                        value="<?php echo e(old('current_occupation')); ?>" id="occupation">
                                </div>

<div class="col-sm-6 form-group formm">
                                    <label for="institute_name">Name of the Institution (if you are working at
                                        present)</label>
                                    <input class="form-control"  name="institute_name" type="text"
                                        value="<?php echo e(old('institute_name')); ?>" id="institution">
                                </div>
                                <div class="col-sm-6 form-group formm">
                                    <label for="institute_address">Address of the Institution (if you do work at
                                        present)</label>
                                    <input class="form-control"  name="institute_address"
                                        type="text" value="<?php echo e(old('institute_address')); ?>" id="institution_address">
                                </div>
                                <div class="col-sm-6 form-group formm">
                                    <label for="office_contact_number">Office Contact Number (if you have no objection to
                                        contact)</label>
                                    <input class="form-control"  name="office_contact_number"
                                        type="text" value="<?php echo e(old('office_contact_number')); ?>"
                                        id="institution_number">
                                </div>
                                <div class="col-sm-6 form-group formm">
                                    <label for="member_types_id">Type of NPA Membership</label> <em>*</em>
                                    <select class="form-control" name="member_types_id" required="required"
                                        id="type">
                                        <option selected="selected">-- Select --</option>
                                        <?php $__currentLoopData = $member_types; $__env->addLoop($__currentLoopData); foreach($__currentLoopData as $type): $__env->incrementLoopIndices(); $loop = $__env->getLastLoop(); ?>
                                            <option value="<?php echo e($type->id); ?>"><?php echo e($type->name); ?></option>
                                        <?php endforeach; $__env->popLoop(); $loop = $__env->getLastLoop(); ?>
                                    </select>
                                </div>
                                <div class="col-sm-12  form-group formm">
                                    <label for="skill_experiences">What skills, experiences, interests do you have/possess,
                                        which might be helpful to NPA</label>
                                    <input class="form-control"  name="skill_experiences"
                                        type="text" value="<?php echo e(old('skill_experiences')); ?>" id="skills">
                                </div>
                                <div class="col-md-12 col-sm-12 form-group formm">
                                    <label for="message">Message</label>
                                    <textarea class="form-control" rows="2"  name="message" cols="50" id="comments"><?php echo e(old('message')); ?></textarea>
                                    <input type="hidden" name="status" value="0" >
                                </div>
                                
                                <div class="row">
                                    <div class="col-lg-6">
                                        <div class="form-inline mt-4 ">
                                            <label>Please upload your PP Size Photograph <br>
                                                <input type="file" name="image" id="upload_image" required>
                                            </label>
                                        </div>
                                    </div>
                                    <div class="col-lg-6">
                                        <div class="form-inline mt-4 ">
                                            <label>Please upload TU equivalent Certificate <br>
                                                <input type="file" name="certificate_file" id="upload_certificate_file" required>
                                            </label>
                                        </div>
                                    </div>
                                </div>
                                <div>
                                    <hr>
                                    <input type="hidden" name="g-recaptcha-response" id="recaptcha-response">
                                    <div class="row">
                                        <div class="col-lg-12 text-center membership-apply-button">
                                          
                                            <button class="btn btn-light" type="submit"> Submit </button>
                                        </div>
                                    </div>
                                </div>
                        </div>
                    </div>
                </form>
            </div>
        </section>
    </div>
    <script src="https://www.google.com/recaptcha/api.js?render=<?php echo e(config('services.recaptcha.site')); ?>"></script>
    <script>
        grecaptcha.ready(function() {
            grecaptcha.execute('<?php echo e(config('services.recaptcha.site')); ?>', { action: 'submit' }).then(function(token) {
                document.getElementById('recaptcha-response').value = token;
            });
        });
    </script>
<?php $__env->stopSection(); ?>

<?php echo $__env->make('frontend.app', \Illuminate\Support\Arr::except(get_defined_vars(), ['__data', '__path']))->render(); ?><?php /**PATH /var/www/html/nepalphd/resources/views/frontend/membershipApply.blade.php ENDPATH**/ ?>

${this.title}

Code Editor : 44a8c5b5b0ea34b0f701dc552962600e537513cc.php