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registration.html
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<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8" />
<meta http-equiv="X-UA-Compatible" content="IE=edge" />
<meta name="viewport" content="width=device-width, initial-scale=1.0" />
<title>ABGEC Meet Registration</title>
<!-- Favicon -->
<link href="./assets/img/abgecLogo/favicon.ico" rel="icon">
<!-- Font Awesome -->
<link rel="stylesheet" href="https://cdnjs.cloudflare.com/ajax/libs/font-awesome/4.7.0/css/font-awesome.min.css" />
<!-- Bootstrap CSS -->
<link href="https://cdn.jsdelivr.net/npm/bootstrap@5.0.2/dist/css/bootstrap.min.css" rel="stylesheet"
integrity="sha384-EVSTQN3/azprG1Anm3QDgpJLIm9Nao0Yz1ztcQTwFspd3yD65VohhpuuCOmLASjC" crossorigin="anonymous" />
<!--date picker-->
<link href="https://cdnjs.cloudflare.com/ajax/libs/bootstrap-datepicker/1.7.1/css/bootstrap-datepicker.min.css"
rel="stylesheet" />
<!-- CSS -->
<link rel="stylesheet" href="./assets/css/registration.css" />
<!--pageclip-->
<link rel="stylesheet" href="https://s.pageclip.co/v1/pageclip.css" media="screen">
<script type="text/javascript">
</script>
</head>
<body>
<!--header-->
<header>
<section id="heading">
<!--header details-->
<div class="header-background">
<div>
<h1 class="main-heading">Global Alumni Meet 2022</h1>
<h3 class="heading-des-college">Alumni of Bilaspur Government Engineering College (ABGEC)</h3>
<h3 class="heading-des1">
(1<sup>st</sup> batch <strong>1969</strong> to
<strong>2015</strong> passout)
</h3>
<h3 class="heading-des2">
On <strong>10</strong><sup>th</sup> & <strong>11</strong><sup>th</sup>
<strong>December 2022</strong>
</h3>
<h3 class="heading-des3">Venue: <strong>GEC Bilaspur Campus</strong></h3>
</div>
<div class="Office-address">
<p>
ABGEC Reg. Office : Near Luthra Hospital, Nehru Nagar,
Bilaspur-495001 (C.G.)
</p>
<div class="links">
<a href="mailto:abgecbilaspur@gmail.com">Email:
abgecbilaspur@gmail.com</a>     
<a href="https://www.abgec.in">Website: www.abgec.in</a>
</div>
</div>
<div class="registration-fees">
Registration Fees (Excluding Lodging & Travelling Expenses)
<ul class="reg-ul">
<li>
Individual - <strong> <i class="fa fa-rupee"></i> 5000</strong>
</li>
<li>
Spouse - <strong> <i class="fa fa-rupee"></i> 3000</strong>
</li>
<li>
Children - <strong> <i class="fa fa-rupee"></i> 3000</strong> (for age above 10 years)
</li>
</ul>
</div>
</div>
<!--header details end-->
<!--subheading-->
<h2 class="sub-heading">Registration Form</h2>
</section>
</header>
<!--header end-->
<main class="justify-content-center container">
<form action="https://send.pageclip.co/ZQ0aVLjeN7mowSQlcMux4ir2nNWQ8FRV/ABGEC" class="pageclip-form"
method="post">
<!-- personal details -->
<div class="details">
<h3>Personal Details</h3>
<li class="note-style">Fill your personal details, and decide the number of participants attending the
<b>Global Alumni Meet 2022</b>.
</li>
<!--image upload-->
<div class="embed-responsive embed-responsive-16by9 m-1">
<iframe class="embed-responsive-item"
src="https://script.google.com/macros/s/AKfycbwqL0akfoYefvtsERUWuPckM9-9uxBR9hvR8IwX0-JWb8b14DrRV7YyAfyZ1Q5d6Dgp/exec"
scrolling="no" height="172" width="100%" frameBorder="0" allowfullscreen></iframe>
</div>
<!--image upload end-->
<!--Name ,branch-->
<div class="row g-2">
<div class="col-md">
<label for="floatingInputGrid">(Mr./Mrs./Ms./Prof./Dr./Er.)</label>
<div class="form-floating">
<select class="form-select" id="name-title" name="name-title" required>
<option value="">Select a Title</option>
<option value="Mr.">Mr.</option>
<option value="Mrs.">Mrs.</option>
<option value="Ms.">Ms.</option>
<option value="Prof.">Prof.</option>
<option value="Dr.">Dr.</option>
<option value="Er.">Er.</option>
</select>
</div>
</div>
<div class="col-md name">
<label for="floatingInputGrid">Name</label>
<div class="form-floating">
<input type="text" class="form-control" id="name" name="name" required />
</div>
</div>
<div class="col-md branch">
<label for="floatingSelectGrid">Branch</label>
<div class="form-floating">
<select class="form-select" id="branch" name="branch" required>
<option value="">Select a Branch</option>
<option value="CIVIL">CIVIL</option>
<option value="CSE">CSE</option>
<option value="ELECTRICAL">ELECTRICAL</option>
<option value="ET&T">ET&T</option>
<option value="IT">IT</option>
<option value="MECHANICAL">MECHANICAL</option>
<option value="MINING">MINING</option>
</select>
<label for="floatingSelectGrid">Branch</label>
</div>
</div>
</div>
<!--Name , branch end-->
<!--Year ,DOB-->
<div class="row g-2">
<div class="col-md year">
<label for="floatingInputGrid">Passout year</label>
<div class="form-floating">
<select class="form-select" id="year" name="year" aria-label="Floating label select example"
required>
<option value="">Select Passout year</option>
<script>
for (var i = 2015; i > 1968; i--) {
document.write("<option value='" + i + "'> " + i + " </option>");
}
</script>
</select>
<label for="floatingSelectGrid">Passout year</label>
</div>
</div>
<div class="col-md year">
<label for="floatingSelectGrid">DOB (DD/MM/YYYY)</label>
<div class="form-floating">
<input class="form-control" data-date-format="dd/mm/yyyy" id="datepicker" name="birthDate"
required>
</div>
</div>
</div>
<!--Year,DOB end-->
<!--Gender , Anniversary-->
<div class="row g-2">
<div class="col-md year">
<label for="floatingSelectGrid">Gender</label>
<div class="form-floating">
<select class="form-select" id="gender" name="gender" required>
<option value="">Gender</option>
<option value="Male">Male</option>
<option value="Female">Female</option>
<option value="Other">Other</option>
</select>
</div>
</div>
<div class="col-md year">
<label for="floatingSelectGrid">Marriage Anniversary (DD/MM/YYYY)</label>
<div class="form-floating">
<input class="form-control" data-date-format="dd/mm/yyyy" id="datepicker2"
name="MarriageAnniversary">
</div>
</div>
</div>
<!--Gender , Anniversary end-->
<!--Phone , email-->
<div class="row g-2">
<div class="col-md organisation">
<label for="floatingInputGrid">Phone Number(Preferably Whatsapp)</label>
<div class="form-floating">
<input type="text" class="form-control" id="number" name="phoneNumber" required />
</div>
</div>
<div class="col-md organisation">
<label for="floatingInputGrid">Email</label>
<div class="form-floating">
<input type="text" class="form-control" id="email" name="email" required />
</div>
</div>
</div>
<!--phone , email end-->
<!--Address-->
<div class="row g-2">
<div class="col-md organisation">
<label class="form-label" for="textAreaExample">Address</label>
<div class="form-floating">
<textarea class="form-control" id="address" name="address" rows="3" required></textarea>
</div>
</div>
</div>
<!--Address end-->
<!--country state-->
<div class="row g-2">
<div class="col-md organisation">
<label for="floatingInputGrid">Country</label>
<div class="form-floating">
<!-- <input type="text" class="form-control" id="country" name="country" required /> onchange="checkCountry(this.value)"-->
<select id="country" name="country" class="form-control"
onchange="checkCountry(this.value)">
<option value="Afghanistan">Afghanistan</option>
<option value="Åland Islands">Åland Islands</option>
<option value="Albania">Albania</option>
<option value="Algeria">Algeria</option>
<option value="American Samoa">American Samoa</option>
<option value="Andorra">Andorra</option>
<option value="Angola">Angola</option>
<option value="Anguilla">Anguilla</option>
<option value="Antarctica">Antarctica</option>
<option value="Antigua and Barbuda">Antigua and Barbuda</option>
<option value="Argentina">Argentina</option>
<option value="Armenia">Armenia</option>
<option value="Aruba">Aruba</option>
<option value="Australia">Australia</option>
<option value="Austria">Austria</option>
<option value="Azerbaijan">Azerbaijan</option>
<option value="Bahamas">Bahamas</option>
<option value="Bahrain">Bahrain</option>
<option value="Bangladesh">Bangladesh</option>
<option value="Barbados">Barbados</option>
<option value="Belarus">Belarus</option>
<option value="Belgium">Belgium</option>
<option value="Belize">Belize</option>
<option value="Benin">Benin</option>
<option value="Bermuda">Bermuda</option>
<option value="Bhutan">Bhutan</option>
<option value="Bolivia">Bolivia</option>
<option value="Bosnia and Herzegovina">Bosnia and Herzegovina</option>
<option value="Botswana">Botswana</option>
<option value="Bouvet Island">Bouvet Island</option>
<option value="Brazil">Brazil</option>
<option value="British Indian Ocean Territory">British Indian Ocean Territory</option>
<option value="Brunei Darussalam">Brunei Darussalam</option>
<option value="Bulgaria">Bulgaria</option>
<option value="Burkina Faso">Burkina Faso</option>
<option value="Burundi">Burundi</option>
<option value="Cambodia">Cambodia</option>
<option value="Cameroon">Cameroon</option>
<option value="Canada">Canada</option>
<option value="Cape Verde">Cape Verde</option>
<option value="Cayman Islands">Cayman Islands</option>
<option value="Central African Republic">Central African Republic</option>
<option value="Chad">Chad</option>
<option value="Chile">Chile</option>
<option value="China">China</option>
<option value="Christmas Island">Christmas Island</option>
<option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands</option>
<option value="Colombia">Colombia</option>
<option value="Comoros">Comoros</option>
<option value="Congo">Congo</option>
<option value="Congo, The Democratic Republic of The">Congo, The Democratic Republic of
The</option>
<option value="Cook Islands">Cook Islands</option>
<option value="Costa Rica">Costa Rica</option>
<option value="Cote D'ivoire">Cote D'ivoire</option>
<option value="Croatia">Croatia</option>
<option value="Cuba">Cuba</option>
<option value="Cyprus">Cyprus</option>
<option value="Czech Republic">Czech Republic</option>
<option value="Denmark">Denmark</option>
<option value="Djibouti">Djibouti</option>
<option value="Dominica">Dominica</option>
<option value="Dominican Republic">Dominican Republic</option>
<option value="Ecuador">Ecuador</option>
<option value="Egypt">Egypt</option>
<option value="El Salvador">El Salvador</option>
<option value="Equatorial Guinea">Equatorial Guinea</option>
<option value="Eritrea">Eritrea</option>
<option value="Estonia">Estonia</option>
<option value="Ethiopia">Ethiopia</option>
<option value="Falkland Islands (Malvinas)">Falkland Islands (Malvinas)</option>
<option value="Faroe Islands">Faroe Islands</option>
<option value="Fiji">Fiji</option>
<option value="Finland">Finland</option>
<option value="France">France</option>
<option value="French Guiana">French Guiana</option>
<option value="French Polynesia">French Polynesia</option>
<option value="French Southern Territories">French Southern Territories</option>
<option value="Gabon">Gabon</option>
<option value="Gambia">Gambia</option>
<option value="Georgia">Georgia</option>
<option value="Germany">Germany</option>
<option value="Ghana">Ghana</option>
<option value="Gibraltar">Gibraltar</option>
<option value="Greece">Greece</option>
<option value="Greenland">Greenland</option>
<option value="Grenada">Grenada</option>
<option value="Guadeloupe">Guadeloupe</option>
<option value="Guam">Guam</option>
<option value="Guatemala">Guatemala</option>
<option value="Guernsey">Guernsey</option>
<option value="Guinea">Guinea</option>
<option value="Guinea-bissau">Guinea-bissau</option>
<option value="Guyana">Guyana</option>
<option value="Haiti">Haiti</option>
<option value="Heard Island and Mcdonald Islands">Heard Island and Mcdonald Islands
</option>
<option value="Holy See (Vatican City State)">Holy See (Vatican City State)</option>
<option value="Honduras">Honduras</option>
<option value="Hong Kong">Hong Kong</option>
<option value="Hungary">Hungary</option>
<option value="Iceland">Iceland</option>
<option value="India" selected>India</option>
<option value="Indonesia">Indonesia</option>
<option value="Iran, Islamic Republic of">Iran, Islamic Republic of</option>
<option value="Iraq">Iraq</option>
<option value="Ireland">Ireland</option>
<option value="Isle of Man">Isle of Man</option>
<option value="Israel">Israel</option>
<option value="Italy">Italy</option>
<option value="Jamaica">Jamaica</option>
<option value="Japan">Japan</option>
<option value="Jersey">Jersey</option>
<option value="Jordan">Jordan</option>
<option value="Kazakhstan">Kazakhstan</option>
<option value="Kenya">Kenya</option>
<option value="Kiribati">Kiribati</option>
<option value="Korea, Democratic People's Republic of">Korea, Democratic People's
Republic of</option>
<option value="Korea, Republic of">Korea, Republic of</option>
<option value="Kuwait">Kuwait</option>
<option value="Kyrgyzstan">Kyrgyzstan</option>
<option value="Lao People's Democratic Republic">Lao People's Democratic Republic
</option>
<option value="Latvia">Latvia</option>
<option value="Lebanon">Lebanon</option>
<option value="Lesotho">Lesotho</option>
<option value="Liberia">Liberia</option>
<option value="Libyan Arab Jamahiriya">Libyan Arab Jamahiriya</option>
<option value="Liechtenstein">Liechtenstein</option>
<option value="Lithuania">Lithuania</option>
<option value="Luxembourg">Luxembourg</option>
<option value="Macao">Macao</option>
<option value="Macedonia, The Former Yugoslav Republic of">Macedonia, The Former
Yugoslav Republic of</option>
<option value="Madagascar">Madagascar</option>
<option value="Malawi">Malawi</option>
<option value="Malaysia">Malaysia</option>
<option value="Maldives">Maldives</option>
<option value="Mali">Mali</option>
<option value="Malta">Malta</option>
<option value="Marshall Islands">Marshall Islands</option>
<option value="Martinique">Martinique</option>
<option value="Mauritania">Mauritania</option>
<option value="Mauritius">Mauritius</option>
<option value="Mayotte">Mayotte</option>
<option value="Mexico">Mexico</option>
<option value="Micronesia, Federated States of">Micronesia, Federated States of</option>
<option value="Moldova, Republic of">Moldova, Republic of</option>
<option value="Monaco">Monaco</option>
<option value="Mongolia">Mongolia</option>
<option value="Montenegro">Montenegro</option>
<option value="Montserrat">Montserrat</option>
<option value="Morocco">Morocco</option>
<option value="Mozambique">Mozambique</option>
<option value="Myanmar">Myanmar</option>
<option value="Namibia">Namibia</option>
<option value="Nauru">Nauru</option>
<option value="Nepal">Nepal</option>
<option value="Netherlands">Netherlands</option>
<option value="Netherlands Antilles">Netherlands Antilles</option>
<option value="New Caledonia">New Caledonia</option>
<option value="New Zealand">New Zealand</option>
<option value="Nicaragua">Nicaragua</option>
<option value="Niger">Niger</option>
<option value="Nigeria">Nigeria</option>
<option value="Niue">Niue</option>
<option value="Norfolk Island">Norfolk Island</option>
<option value="Northern Mariana Islands">Northern Mariana Islands</option>
<option value="Norway">Norway</option>
<option value="Oman">Oman</option>
<option value="Pakistan">Pakistan</option>
<option value="Palau">Palau</option>
<option value="Palestinian Territory, Occupied">Palestinian Territory, Occupied</option>
<option value="Panama">Panama</option>
<option value="Papua New Guinea">Papua New Guinea</option>
<option value="Paraguay">Paraguay</option>
<option value="Peru">Peru</option>
<option value="Philippines">Philippines</option>
<option value="Pitcairn">Pitcairn</option>
<option value="Poland">Poland</option>
<option value="Portugal">Portugal</option>
<option value="Puerto Rico">Puerto Rico</option>
<option value="Qatar">Qatar</option>
<option value="Reunion">Reunion</option>
<option value="Romania">Romania</option>
<option value="Russian Federation">Russian Federation</option>
<option value="Rwanda">Rwanda</option>
<option value="Saint Helena">Saint Helena</option>
<option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option>
<option value="Saint Lucia">Saint Lucia</option>
<option value="Saint Pierre and Miquelon">Saint Pierre and Miquelon</option>
<option value="Saint Vincent and The Grenadines">Saint Vincent and The Grenadines
</option>
<option value="Samoa">Samoa</option>
<option value="San Marino">San Marino</option>
<option value="Sao Tome and Principe">Sao Tome and Principe</option>
<option value="Saudi Arabia">Saudi Arabia</option>
<option value="Senegal">Senegal</option>
<option value="Serbia">Serbia</option>
<option value="Seychelles">Seychelles</option>
<option value="Sierra Leone">Sierra Leone</option>
<option value="Singapore">Singapore</option>
<option value="Slovakia">Slovakia</option>
<option value="Slovenia">Slovenia</option>
<option value="Solomon Islands">Solomon Islands</option>
<option value="Somalia">Somalia</option>
<option value="South Africa">South Africa</option>
<option value="South Georgia and The South Sandwich Islands">South Georgia and The South
Sandwich Islands</option>
<option value="Spain">Spain</option>
<option value="Sri Lanka">Sri Lanka</option>
<option value="Sudan">Sudan</option>
<option value="Suriname">Suriname</option>
<option value="Svalbard and Jan Mayen">Svalbard and Jan Mayen</option>
<option value="Swaziland">Swaziland</option>
<option value="Sweden">Sweden</option>
<option value="Switzerland">Switzerland</option>
<option value="Syrian Arab Republic">Syrian Arab Republic</option>
<option value="Taiwan">Taiwan</option>
<option value="Tajikistan">Tajikistan</option>
<option value="Tanzania, United Republic of">Tanzania, United Republic of</option>
<option value="Thailand">Thailand</option>
<option value="Timor-leste">Timor-leste</option>
<option value="Togo">Togo</option>
<option value="Tokelau">Tokelau</option>
<option value="Tonga">Tonga</option>
<option value="Trinidad and Tobago">Trinidad and Tobago</option>
<option value="Tunisia">Tunisia</option>
<option value="Turkey">Turkey</option>
<option value="Turkmenistan">Turkmenistan</option>
<option value="Turks and Caicos Islands">Turks and Caicos Islands</option>
<option value="Tuvalu">Tuvalu</option>
<option value="Uganda">Uganda</option>
<option value="Ukraine">Ukraine</option>
<option value="United Arab Emirates">United Arab Emirates</option>
<option value="United Kingdom">United Kingdom</option>
<option value="United States">United States</option>
<option value="United States Minor Outlying Islands">United States Minor Outlying
Islands</option>
<option value="Uruguay">Uruguay</option>
<option value="Uzbekistan">Uzbekistan</option>
<option value="Vanuatu">Vanuatu</option>
<option value="Venezuela">Venezuela</option>
<option value="Viet Nam">Viet Nam</option>
<option value="Virgin Islands, British">Virgin Islands, British</option>
<option value="Virgin Islands, U.S.">Virgin Islands, U.S.</option>
<option value="Wallis and Futuna">Wallis and Futuna</option>
<option value="Western Sahara">Western Sahara</option>
<option value="Yemen">Yemen</option>
<option value="Zambia">Zambia</option>
<option value="Zimbabwe">Zimbabwe</option>
</select>
</div>
</div>
<div class="col-md organisation">
<label for="floatingInputGrid">State</label>
<div class="form-floating">
<input type="text" class="form-control" id="state" name="state" required />
</div>
</div>
</div>
<!--country state end -->
<!--city, Pincode-->
<div class="row g-2">
<div class="col-md organisation">
<label for="floatingInputGrid">City</label>
<div class="form-floating">
<input type="text" class="form-control" id="city" name="city" required />
</div>
</div>
<div class="col-md organisation">
<label for="floatingInputGrid">Pincode</label>
<div class="form-floating">
<input type="text" class="form-control" id="pincode" name="pincode" required />
</div>
</div>
</div>
<!--City, pincode end-->
</div>
<!--personal details end-->
<!-- occupations details -->
<div class="details">
<h3>Occupation</h3>
<div class="row g-2">
<div class="col-md organisation">
<label for="floatingSelectGrid">Occupation</label>
<div class="form-floating">
<select class="form-select" id="occupation" name="occupation"
aria-label="Floating label select example">
<option value="">--Select an occupation--</option>
<option value="Service">Service</option>
<option value="Self Employed">Self Employed</option>
</select>
</div>
</div>
<div class="col-md organisation">
<label for="floatingInputGrid">Current Holding Position (Designation)</label>
<div class="form-floating">
<input type="text" class="form-control" id="desg" name="Designation" />
</div>
</div>
</div>
<div class="row g-2">
<div class="col-md organisation">
<label for="floatingInputGrid">Organisation</label>
<div class="form-floating">
<input type="text" class="form-control" id="Organisation" name="Organisation" />
</div>
</div>
<div class="col-md organisation">
<label class="form-label" for="textAreaExample">Career Track Path</label>
<div class="form-floating">
<textarea class="form-control" name="CareerTrackPath" id="textAreaExample1"
rows="3"></textarea>
</div>
</div>
</div>
<div class="row g-2">
<div class="col-md organisation">
<label class="form-label" for="textAreaExample">Major career Achievements</label>
<div class="form-floating">
<textarea class="form-control" name="careerAchievements" id="careerAchievements"
rows="3"></textarea>
</div>
</div>
<div class="col-md organisation">
<label for="floatingInputGrid">Hobbies</label>
<div class="form-floating">
<input type="text" class="form-control" id="hobbies" name="hobbies" />
</div>
</div>
</div>
</div>
<!-- occupations details end-->
<!--mode of attending the meeting (onclick="checkMode(this.value);")-->
<div class="attending-mode" id="attending-mode">
<h3>Mode of attending the global alumni meet 2022</h3>
<div class="mode-options">
<input type="radio" id="mode-physical" name="mode" value="physical"
onclick="checkMode(this.value);">
<label for="mode-physical">Physical</label>
<input type="radio" id="mode-virtual" name="mode" value="virtual" onclick="checkMode(this.value);">
<label for="mode-virtual">Virtual</label>
</div>
</div>
<!--mode of attending the meet Ends-->
<!-- member attending details -->
<div class="details" id="details">
<h3>Details of members attending Global Alumni Meet 2022 (Excluding You)</h3>
<div class="row g-2">
<div class="col-md organisation">
<label for="member-one-name">Name</label>
<div class="form-floating">
<input type="text" class="form-control" id="member-one-name" name="member-one-name" />
</div>
</div>
<div class="col-md year">
<label for="member-one-relation">Relation</label>
<div class="form-floating">
<select class="form-select" id="member-one-relation" name="member-one-relation"
aria-label="Floating label select example" onchange='CheckRelation(this.value,"age1");'>
<option value=""></option>
<option value="Spouse">Spouse</option>
<option value="Children">Children</option>
<option value="Other">Other</option>
</select>
</div>
</div>
<div class="col-md" id="age1" style="display: none;">
<label for="floatingSelectGrid">DOB (DD/MM/YYYY)</label>
<div class="form-floating">
<input class="form-control" data-date-format="dd/mm/yyyy" id="member-one-age"
name="member-one-age">
</div>
</div>
</div>
<div class="row g-2">
<div class="col-md organisation">
<label for="member-two-name">Name</label>
<div class="form-floating">
<input type="text" class="form-control" id="member-two-name" name="member-two-name" />
</div>
</div>
<div class="col-md year">
<label for="member-two-relation">Relation</label>
<div class="form-floating">
<select class="form-select" id="member-two-relation" name="member-two-relation"
aria-label="Floating label select example" onchange='CheckRelation(this.value,"age2");'>
<option selecteotiontion>
<option value="Spouse">Spouse</option>
<option value="Children">Children</option>
<option value="Other">Other</option>
</select>
</div>
</div>
<div class="col-md" id="age2" style="display: none;">
<label for="floatingSelectGrid">DOB (DD/MM/YYYY)</label>
<div class="form-floating">
<input class="form-control" data-date-format="dd/mm/yyyy" id="member-two-age"
name="member-two-age">
</div>
</div>
</div>
<div class="row g-2">
<div class="col-md organisation">
<label for="member-three-name">Name</label>
<div class="form-floating">
<input type="text" class="form-control" id="member-three-name" name="member-three-name" />
</div>
</div>
<div class="col-md year">
<label for="member-three-relation">Relation</label>
<div class="form-floating">
<select class="form-select" id="member-three-relation" name="member-three-relation"
aria-label="Floating label select example" onchange='CheckRelation(this.value,"age3");'>
<option value=""></option>
<option value="Spouse">Spouse</option>
<option value="Children">Children </option>
<option value="Other">Other</option>
</select>
</div>
</div>
<div class="col-md" id="age3" style="display: none;">
<label for="floatingSelectGrid">DOB (DD/MM/YYYY)</label>
<div class="form-floating">
<input class="form-control" data-date-format="dd/mm/yyyy" id="member-three-age"
name="member-three-age">
</div>
</div>
</div>
<div class="row g-2">
<div class="col-md organisation">
<label for="member-four-name">Name</label>
<div class="form-floating">
<input type="text" class="form-control" id="member-four-name" name="member-four-name" />
</div>
</div>
<div class="col-md year">
<label for="member-four-relation">Relation</label>
<div class="form-floating">
<select class="form-select" id="member-four-relation" name="member-four-relation"
aria-label="Floating label select example" onchange='CheckRelation(this.value,"age4");'>
<option value=""></option>
<option value="Spouse">Spouse</option>
<option value="Children">Children</option>
<option value="Other">Other</option>
</select>
</div>
</div>
<div class="col-md" id="age4" style="display: none;">
<label for="floatingSelectGrid">DOB (DD/MM/YYYY)</label>
<div class="form-floating">
<input class="form-control" data-date-format="dd/mm/yyyy" id="member-four-age"
name="member-four-age">
</div>
</div>
</div>
<div class="row g-2">
<div class="col-md organisation">
<label for="member-five-name">Name</label>
<div class="form-floating">
<input type="text" class="form-control" name="member-five-name" id="member-five-name" />
</div>
</div>
<div class="col-md year">
<label for="member-five-relation">Relation</label>
<div class="form-floating">
<select class="form-select" id="member-five-relation" name="member-five-relation"
aria-label="Floating label select example" onchange='CheckRelation(this.value,"age5");'>
<option value=""></option>
<option value="Spouse">Spouse</option>
<option value="Children">Children</option>
<option value="Other">Other</option>
</select>
</div>
</div>
<div class="col-md" id="age5" style="display: none;">
<label for="floatingSelectGrid">DOB (DD/MM/YYYY)</label>
<div class="form-floating">
<input class="form-control" data-date-format="dd/mm/yyyy" id="member-five-age"
name="member-five-age">
</div>
</div>
</div>
</div>
<!-- member attending details -->
<!-- Next Button-->
<div class="row g-2 " id="next-btn">
<div class="col">
<div class="form-floating">
<a type="button" onclick="nextButton();" class="btn btn-primary btn-lg">
Next ➡️
</a>
</div>
</div>
</div>
<!--Button end-->
<div id="note-before-payment" style="display: none; margin-top:1em;">
<li class="note-style">Go to the QR code and make payment by using GPay, Paytm, PhonePe, WhatsApp
payment app, PayPal, Bhim, or net banking online payment modes.</li>
<li class="note-style">Next, come back to the registration page, and in the transaction details section,
please enter the transaction Id and other relevant information. Then <b>SUBMIT</b> your form.</li>
</div>
<!-- payment details - physical-->
<section id="payment-physical">
<div class="first-section">
<h4>Total Number of Members Attending Event: <span id="totalMember"></span></h4>
<h4>Total member eligible for payment: <span id="payableMember"></span></h4>
<h3 class="total-amount">Total Payable Amount: <span id="amount">
</span></h3>
<div class="bank-details"></div>
<h2>Payment Methods</h2>
<h2 class="payment-modes">Pay via Internet Banking</h2>
<div>
<h3 class="account-details">Bank Name: IDBI(Industrial Development Bank of India)</h3>
<h3 class="account-details">Account No.: 2149104000066477</h3>
<h3 class="account-details">IFSC Code: IBKL0002149</h3>
</div>
<h2 class="payment-modes">or Scan the QR code</h2>
<div>
<a href="upi://pay?pa=1000221012000115.9425219490@idbi&pn=ALUMNIOFBILASPURGEC&cu=INR">
<img class="img-qrcode" src="./assets/img/qrcode.png">
</a>
</div>
<div>
</div>
</div>
</section>
<!-- payment details physical end-->
<!-- payment details - virtual(India)-->
<!--<section id="payment-virtual-india">
<div class="first-section">
<h3 class="total-amount">Total Payable Amount: ₹1000.00</h3>
<div class="bank-details"></div>
<h2>Payment Methods</h2>
<h2 class="payment-modes">Pay via Internet Banking</h2>
<div>
<h3 class="account-details">Bank Name: IDBI(Industrial Development Bank of India)</h3>
<h3 class="account-details">Account No.: 2149104000066477</h3>
<h3 class="account-details">IFSC Code: IBKL0002149</h3>
</div>
<h2 class="payment-modes">or Scan the QR code</h2>
<div>
<a href="upi://pay?pa=10000221012000115.9425219490@idbi&pn=ALUMNIOFBILASPURGEC&cu=INR">
<img class="img-qrcode" src="./assets/img/qrcode.png">
</a>
</div>
<div>
</div>
</div>
</section>-->
<!-- payment details virtual end-->
<!-- payment details - virtual-->
<section id="payment-virtual">
<div class="first-section">
<h3 class="total-amount">Total Payable Amount: <span> $50 (USD)
</span></h3>
<h3>For Payment information contact:</h3>
<ul style="list-style:none; font-size:1.5rem;">
<li>Mr. Tavinder Pal Singh Arora (President) : +91 94252-19490</li>
<li>Mr. R.K. Awasthi (Vice President): +91 98261-16738</li>
<li>Dr. B.S. Chawla (Vice President): +91 94241-44099</li>
<li>Mr. Sudheer Gupta (Secretary): +91 99935-96555</li>
</ul>
</div>
</section>
<!-- payment details virtual end-->
<!-- trasaction id -->
<div class="row g-2" id="transaction-input" style="display: none;">
<div class="col-md transaction">
<label class="form-label" for="floatingInputGrid">Bank Account Holder Name</label>
<div class="form-floating">
<input type="text" class="form-control" id="account_holder_name" name="account_holder_name"
size="25"></textarea>
</div>
<label class="form-label" for="floatingInputGrid">Transaction ID</label>
<div class="form-floating">
<input type="text" class="form-control" id="transaction-id" name="transaction-id" size="25"
onkeyup="EnableDisable(document.getElementById('amount-paid'))"></textarea>
</div>
<label class="form-label" for="floatingInputGrid">Total Amount Paid</label>
<div class="form-floating">
<input type="number" class="form-control" id="amount-paid" name="amount-paid" size="25"
onkeyup="EnableDisable(this)"></textarea>
</div>
</div>
</div>
<!-- transaction id -->
<!--Button-->
<div class="row g-2">
<div class="col-md organisation">
<div class="form-floating">
<button type="submit" value="submitForm();" class="btn btn-primary btn-lg register-btn"
disabled="disabled">
SUBMIT
</button>
</div>
</div>
</div>
<!--Button end-->
</form>
<div class="last-date" id="btn_note">
<h3>Note:</h3>
<h3 style="text-align: justify;">Only after entry in all mandatory fields and successful payment of
registration fee <b>SUBMIT</b> button will be enabled.</h3>
</div>
<div class="last-date">
<h3>Last Date to register : <strong>30<sup>th</sup> Nov 2022</strong></h3>
</div>
<div class="footer">
<h4 class="screenshot"> To ensure payment confirmation, please share the transaction details along with
payment screenshot to whatsapp no . <strong>+91 89621-30661</strong></h4>
<h3>You will be updated in 24 hours.</h3>
</div>
</main>
<!--Payment Modal -->
<div class="modal fade" id="exampleModal" tabindex="-1" aria-labelledby="exampleModalLabel" aria-hidden="true">
<div class="modal-dialog">
<div class="modal-content">
<div class="modal-header">
<h5 class="modal-title" id="exampleModalLabel">Payment Info</h5>
<button type="button" class="btn-close" data-bs-dismiss="modal" aria-label="Close"></button>
</div>
<div class="modal-body">
<div class="outputContainer">
<div>
<p><strong>Thankyou</strong>, you are <span style="color: green;">successfully</span>
registered.
<br><br>
<!-- Total Payable Amount: Rs. <strong><span id="amount">
<script>document.write(localStorage.getItem("totalAmount"));</script>
</span> -->
</p>
</div>
<div class="payment">
<!-- <p>Bank Details For Payment: </p>
<p><strong>Bank Name:</strong> IDBI (Industrial Development Bank of India)</p>
<p><strong>Account Name:</strong> ALUMNI OF BILASPUR GEC MEET </p>
<p><strong>Branch:</strong> Dayalband, Bilaspur</p>
<p><strong>Account Number:</strong> 2149104000066477</p>
<p><strong>IFSC Code:</strong> IBKL0002149</p> -->
<div class="register-notify">
<!-- <p><b>If Already paid then ignore this message.</b></p> -->
<p class="screenshot"> Please to ensure payment confirmation, share the transaction
details along with payment screenshot to whatsapp no . <strong><br>+91
89621-30661</strong></p>
<p>You will be updated in 24 hours.</p>
<!-- <p style="color:green"><b>If Already paid then ignore this message.</b></p> -->
</div>
</div>
</div>
</div>
<div class="modal-footer">
<button type="button" class="btn btn-secondary" data-bs-dismiss="modal">Close</button>
</div>
</div>
</div>
</div>
<script src="https://cdn.jsdelivr.net/npm/@popperjs/core@2.9.2/dist/umd/popper.min.js"
integrity="sha384-IQsoLXl5PILFhosVNubq5LC7Qb9DXgDA9i+tQ8Zj3iwWAwPtgFTxbJ8NT4GN1R8p"
crossorigin="anonymous"></script>
<script src="https://cdn.jsdelivr.net/npm/bootstrap@5.0.2/dist/js/bootstrap.min.js"
integrity="sha384-cVKIPhGWiC2Al4u+LWgxfKTRIcfu0JTxR+EQDz/bgldoEyl4H0zUF0QKbrJ0EcQF"
crossorigin="anonymous"></script>
<script src="https://ajax.googleapis.com/ajax/libs/jquery/3.3.1/jquery.min.js"></script>
<!--datepicker-->
<script
src="https://cdnjs.cloudflare.com/ajax/libs/bootstrap-datepicker/1.7.1/js/bootstrap-datepicker.min.js"></script>
<!--pageclip-->
<script src="https://s.pageclip.co/v1/pageclip.js" charset="utf-8"></script>
<script type="text/javascript">
$('#datepicker').datepicker({
weekStart: 1,
daysOfWeekHighlighted: "6,0",
autoclose: true,
todayHighlight: true,
});
$('#datepicker').datepicker("setDate", new Date());
$('#datepicker2').datepicker({
weekStart: 1,
daysOfWeekHighlighted: "6,0",
autoclose: true,
todayHighlight: true,
});
$('#datepicker2').datepicker("setDate", new Date());
$('#member-one-age').datepicker({
weekStart: 1,
daysOfWeekHighlighted: "6,0",
autoclose: true,
todayHighlight: true,
});
$('#member-one-age').datepicker("setDate", new Date());
$('#member-two-age').datepicker({
weekStart: 1,
daysOfWeekHighlighted: "6,0",
autoclose: true,
todayHighlight: true,
});
$('#member-two-age').datepicker("setDate", new Date());
$('#member-three-age').datepicker({
weekStart: 1,
daysOfWeekHighlighted: "6,0",
autoclose: true,
todayHighlight: true,
});