ok

Mini Shell

Direktori : /proc/self/root/home2/selectio/www/wedding-info-new/
Upload File :
Current File : //proc/self/root/home2/selectio/www/wedding-info-new/astrologer_form.php

<?php
include "header.php"; ?>

     <!-- login section start -->
     <section class="form-section px-15  section-b-space">
         <div class="row"
         style="margin-top: 50px;">
             <div class="col-12 col-sm-12">
                 <center><h1>Astrologers Register Form</h1></center>
             </div>
         </div>
         
         <form id="profile_verification">
             
             <div id="profile_info">
                 <center><h3><b>Profile Info</b></h3></center><br>
             <div class="form-floating mb-4">
                 <select name="profile_created_for" class="form-control" >
                      <option value="">Profile Created For</option>
                      <option value="Father">Father</option>
                      <option value="Mother">Mother</option>
                      <op   tion value="Brother">Brother</option>
                      
                  </select>
                 <label for="one">Profile Created For </label>
             </div>
             <div class="form-floating mb-4">
                 <input type="text" class="form-control" name="profile_name" id="profile_name" placeholder="Enter Your Legal Name" />
                 <label for="profile_name">Your Name </label>
             </div>
             <div class="form-floating mb-4">
                 <select name="gender" id="gender" class="form-control" >
                      <option value="">Chosse The Gender</option>
                      <option value="Male">Male</option>
                      <option value="Female">Female</option>
                  </select>
                 <label for="one">Gender</label>
             </div>
             <div class="form-floating mb-4">
                 <input type="date" class="form-control" name="dob" id="dob" />
                 <label for="dob">Date Of Birth</label>
             </div>
             <div class="form-floating mb-4">
                 <input type="number" class="form-control" name="age" id="age" />
                 <label for="age">Age</label>
             </div>
       
             <div class="form-floating mb-4">
                 <input type="text" class="form-control" name="mobile_no" id="mobile_no" style="width:100%;"/>
                 <label for="age"> Mobile Number</label>
             </div>
             <div class="form-floating mb-4">
                 <input type="text" class="form-control" name="alter_mobile_no" id="alter_mobile_no" />
                 <label for="age"> Alternate Mobile Number</label>
             </div>
             <div class="form-floating mb-4">
                 <input type="text" class="form-control" name="address" id="address" placeholder="Search Your Address"/>
                 <label for="age"> Your Legal Address</label>
             </div>
             <div class="row mb-2">
                 <div class="col-6"><input type="text" name="city" id="city" class="form-control" placeholder="City" /></div>
                 <div class="col-6"><input type="text" name="state" id="state" class="form-control" placeholder="State" /></div>
             </div>
             <div class="row mb-4">
                 <div class="col-6"><input type="text" name="pin_code" id="pin_code" class="form-control" placeholder="Pincode" /></div>
                 <div class="col-6"><input type="text" name="land_mark" id="land_mark" class="form-control" placeholder="Landmark" /></div>
             </div>
             <div class="form-floating mb-4">
                 <input type="email" class="form-control" name="email_id" id="email_id" placeholder="Email Id" />
                 <label for="age">Your Email id</label>
             </div>
             <div class="form-floating mb-4">
                 <select name="occupation" id="occupation" class="form-control" >
                      <option value="">Chosse The Occupation</option>
                      <option value="Farmer">Farmer</option>
                      
                  </select>
                 <label for="one">Occupation</label>
             </div>
             <div class="form-floating mb-4">
                 
                 <input type="text" class="form-control" name="education" id="education" placeholder="Enter Your Education"/>
                 <label for="education">Education</label>
             </div>
             <div class="form-floating mb-4">
                 
                 <input type="text" class="form-control" name="experience" id="experience" placeholder="Enter Your experience"/>
                 <label for="experience">Experience</label>
             </div>
            
             <div class="form-floating mb-4">
                 <select name="language" id="language" class="form-control" >
                      <option value="">Chosse Your Language</option>
                      <option value="Tamil">Tamil</option>
                      <option value="Telugu">Telugu</option>
                      <option value="Kannada">Kannada</option>
                      <option value="Urudu">Urudu</option>
                      <option value="English">English</option>
                      <option value="Others">Others</option>
                      
                  </select>
                 <label for="one">Choolse Language</label>
             </div>
             <div class="form-floating mb-4">
                 <input type="c_time" id="c_time" name="c_time" class="form-control" placeholder="Calling time" />
                 <label>People Calling Time </label>
                 <div id="btnToggle" class="password-hs">
                     <i id="eyeIcon" class="iconly-Hide icli hide"></i>
                 </div>
             </div>
             <div class="form-floating mb-4">
                 <input type="price" id="price" name="price" class="form-control" placeholder="Calling time" />
                 <label>Price</label>
             </div>
             </div>
        <!--testing-->
          <div class="form-group">
    <label for="profileImage" class="form-label">Profile Image</label>
    <input type="file" class="form-control-file" id="profileImage" name="profileImage" accept="image/*" onchange="displaySelectedImage(this, 'previewImage');" />
    <small class="form-text text-muted">Upload a profile image (JPEG or JPG).</small>
</div>
<div class="form-group">
    <img id="previewImage" src="" alt="Preview" class="img-fluid" style="max-width: 200px; margin-top: 10px; display: none;">
</div>



<BR>
    <!--Testing end-->
    
             <!--<a href="#" class="btn btn-solid w-100">Sign UP </a>-->
             <button class="btn btn-solid w-100"> Sign UP</button>
             <!--<a href="#" class="btn btn-solid w-100">Sign UP </a>-->
         </form>
         
     </section>
     <!-- login section end -->


     <!-- panel space start -->
     <section class="panel-space"></section>
     <!-- panel space end -->



<script>
   var input = document.querySelector("#mobile_no");
   window.intlTelInput(input, {
       separateDialCode: true,
       excludeCountries: ["il"],
       preferredCountries: ["in"]
   });
   var alter_input = document.querySelector("#alter_mobile_no");
   window.intlTelInput(alter_input, {
       separateDialCode: true,
       excludeCountries: ["il"],
       preferredCountries: ["in"]
   });
</script>
<script>
    function displaySelectedImage(input, imgId) {
    const imgElement = document.getElementById(imgId);

    if (input.files && input.files[0]) {
        const reader = new FileReader();

        reader.onload = function(e) {
            imgElement.src = e.target.result;
        };

        reader.readAsDataURL(input.files[0]);
    } else {
        imgElement.src = '';
    }
}
</script>

<script>
    $(document).ready(function() {
   
    $('#profile_verification').submit(function(e) {
        e.preventDefault();
        alert('hello');
        var formData = new FormData(this);
        formData.append('type', 'astrology_reg');
        console.log(formData);
        $.ajax({
            url: 'api/profile_add.php',
            type: 'post',
            dataType: 'json',
            data: formData,
            cache: false,
            contentType: false,
            processData: false,
            success: function(response) {
                console.log(response);
                if (response['status'] == 200) {
                    alert(response['message']);
                    $(this).trigger("reset");

                } else {
                    alert(response['message']);
                }
            }
        });
    });
});
</script>
<?php
include "footer2.php"; ?>


Zerion Mini Shell 1.0