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Code Editor : system_general_master_setup.html
<div class="portlet box green"> <div class="portlet-title"> <div class="caption"> <i class="fa fa-reorder"></i>Registration Form </div> </div> </div> <div class="portlet-body form" style='margin-top:20px;margin-left:100px;'> <div class="row"> <!-- BEGIN FORM--> <form class="form-horizontal" id='form_module_details_upload' enctype='multipart/form-data' method='POST'> <div class="col-md-7"> <input type='hidden' name= 'MAX_FILE_SIZE' value='10000000000' /> <div class="form-body"> <div class="form-group"> <label class="col-md-3 control-label" style="text-align:left" >Registration number</label> <div class="col-md-3"> <input type="text" name="candidate_name" id="candidate_name" class="form-control" title='University Registration no.' maxlength=10> </div> </div> <div class="form-group"> <label class="col-md-3 control-label" style="text-align:left" >Candidate name</label> <div class="col-md-7"> <input type="text" name="candidate_name" id="candidate_name" class="form-control" disabled maxlength=100 > </div> </div> <div class="form-group"> <label class="col-md-3 control-label" style="text-align:left" >College</label> <div class="col-md-7"> <input type="text" name="candidate_name" id="candidate_name" class="form-control" disabled maxlength=100 > </div> </div> <div class="form-group"> <label class="col-md-3 control-label" style="text-align:left" >Degree</label> <div class="col-md-7"> <input type="text" name="candidate_name" id="candidate_name" class="form-control" disabled maxlength=100 > </div> </div> <div class="form-group"> <label class="col-md-3 control-label" style="text-align:left" >Mobile No.</label> <div class="col-md-3"> <input type="text" name="candidate_name" id="candidate_name" class="form-control" maxlength=10> </div> </div> <div class="form-group"> <label class="col-md-3 control-label" style="text-align:left" >confirm Mobile No.</label> <div class="col-md-3"> <input type="text" name="candidate_name" id="candidate_name" class="form-control" maxlength=10> </div> </div> <div class="form-group"> <label class="col-md-3 control-label" style="text-align:left" >Email Id.</label> <div class="col-md-7"> <input type="text" name="candidate_name" id="candidate_name" class="form-control" maxlength=10> </div> </div> <div class="form-group"> <label class="col-md-3 control-label" style="text-align:left" >Postal Address</label> <div class="col-md-7"> <input type="text" name="candidate_name" id="candidate_name" class="form-control" maxlength=50><br> <input type="text" name="candidate_name" id="candidate_name" class="form-control" style='margin-top:-18px;' maxlength=50><br> <input type="text" name="candidate_name" id="candidate_name" class="form-control" style='margin-top:-18px;' maxlength=50><br> <input type="text" name="candidate_name" id="candidate_name" class="form-control" style='margin-top:-18px;' maxlength=50><br> </div> </div> </div> </div> </form> </div> <div class="form-body"> <h3 class="form-section">Declaration</h3> <div class="row"> <div class="col-md-2"> <div class="form-group"> <?php session_start(); $_SESSION = array(); include("captcha/simple-php-captcha.php"); $_SESSION['captcha'] = simple_php_captcha(); ?> <?php echo '<img src="' . $_SESSION['captcha']['image_src'] . '" alt="CAPTCHA code">'; ?> </div> </div> <div class="col-md-3"> <div class="form-group"> <label>Board name</label> <input type="text" id='board_name' placeholder="Board Name" maxlength=50 class="form-control"> </div> </div> <div class="col-md-2"> <div class="form-group"> <label>Exam Reg. no. / Roll no.</label> <input type="text" id='qreg_no' placeholder="Qualifying Exam Reg. No." maxlength=20 class="form-control"> </div> </div> <!--/span--> </div> <div class="row"> <div class="col-md-2"> <div class="form-group"> <label>Passing year</label> <input type="text" id='passing_year' placeholder="Passing Year" maxlength=4 class="form-control"> </div> </div> <!--/span--> <div class="col-md-5"> <div class="form-group"> <label>Board address</label> <input type="text" id='board_address' placeholder="Board Address" maxlength=110 class="form-control"> </div> </div> <!--/span--> </div> </div> </div> <div class="form-actions fluid"> <div class="row"> <div class="col-md-12"> <div class="col-md-offset-10 col-md-9"> <button class="btn purple" onclick='CMS.SendMailOtPToUser();' type="button"><i class="fa fa-check"></i> Submit</button> <button class="btn red" type="button" ><i class="fa fa-times">Cancel</i></button> </div> </div> </div> </div> <!-- END Row-->
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