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Mini Shell

Mini Shell

Direktori : /var/www/pn/beta/64801_wp-content/themes/intosai/templates/forms/
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Current File : /var/www/pn/beta/64801_wp-content/themes/intosai/templates/forms/registration_form.php

<section class="content_section">
    <div class="wrapper">

        <div class="centered_title">
            <h2>Registration Request</h2>
        </div>

        <form id="registrationform" class="form" name="registrationform" method="post" action="/smtp_wp_mailer.php?registrationform" novalidate="novalidate">

            <div class="form_sec full">
                <label for="org">Organization<span>*</span></label>
                <input type="text" class="inputbox" name="org" />
            </div>

            <div class="form_sec half">
                <div class="left">
                    <label for="firstname">First Name<span>*</span></label>
                    <input type="text" class="inputbox" name="firstname" />
                </div>
                <div class="right">
                    <label for="lastname">Last Name<span>*</span></label>
                    <input type="text" class="inputbox" name="lastname" />
                </div>
            </div>

            <div class="form_sec third">
                <div class="left">
                    <label for="email">E-mail Address<span>*</span></label>
                    <input type="email" class="inputbox" name="email" />
                </div>
                <div class="middle">
                    <label for="password">Choose Password<span>*</span></label>
                    <input type="password" class="inputbox" id="password" name="password" />
                    <span class="instructions">
                        min. 5 characters
                    </span>
                </div>
                <div class="right">
                    <label for="retypepass">Re-type Password<span>*</span></label>
                    <input type="password" class="inputbox" name="retypepass" />
                </div>
            </div>

            <div class="form_sec third">
                <div class="left">
                    <label for="position">Position</label>
                    <input type="text" class="inputbox" name="position" />
                </div>
                <div class="middle">
                    <label for="department">Department</label>
                    <input type="text" class="inputbox" name="department" />
                </div>
                <div class="right">
                    <label for="telephone">Telephone</label>
                    <input type="tel" class="inputbox" name="telephone" />
                    <span class="instructions">
                        Please include country code
                    </span>
                </div>
            </div>

            <input type="hidden" name="url" value="<?php echo $_SERVER['REQUEST_URI'];?>"/>

            <div class="form_instructions">
                <span class="req">*</span> Indicates a required field
            </div>

            <button type="submit" class="submit-btn">
                Send user registration request
            </button>
        </form>

    </div>
</section>

Zerion Mini Shell 1.0