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Mini Shell
<?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