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signup.php
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signup.php
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<!DOCTYPE html>
<html>
<title>Sign Up</title>
<meta charset="UTF-8">
<meta name="viewport" content="width=device-width, initial-scale=1">
<link rel="stylesheet" href="css/w3.css">
<link rel="stylesheet" href="css/css.css">
<link rel="stylesheet" href="css/font-awesome.min.css">
<style>
body,h1,h2,h3,h4,h5,h6 {font-family: "Raleway", sans-serif}
body, html {
height: 100%;
line-height: 1.8;
}
/* Full height image header */
.bgimg-1 {
background-position: center;
background-size: cover;
background-image: url("images/flowers.jpg");
min-height: 100%;
}
.tooltip {
position: relative;
display: inline-block;
border-bottom: 1px dotted black;
}
.tooltip .tooltiptext {
visibility: hidden;
width: 120px;
background-color: #555;
color: #fff;
text-align: center;
border-radius: 6px;
padding: 5px 0;
position: absolute;
z-index: 1;
bottom: 125%;
left: 50%;
margin-left: -60px;
opacity: 0;
transition: opacity 1s;
}
.tooltip .tooltiptext::after {
content: "";
position: absolute;
top: 100%;
left: 50%;
margin-left: -5px;
border-width: 5px;
border-style: solid;
border-color: #555 transparent transparent transparent;
}
.tooltip:hover .tooltiptext {
visibility: visible;
opacity: 1;
}
#User_body
{
height:100%;
width:100%;
background-color:#ffffff;
color:#000000;
font-size:20px;
padding-left:2%;
}
</style>
<script type="text/javascript" src="js/jquery.js"></script>
<script type="text/javascript" src="js/jquery-1.7.1"></script>
<script type="text/javascript">
function check()
{
password=document.getElementById('Password').value;
confirm=document.getElementById('ConfirmPassword').value;
if(password==confirm)
{
return true;
}
else
{
alert("Password Mismatched");
return false;
}
}
</script>
<body class="w3-light-grey">
<!-- Header -->
<header class="bgimg-1 w3-display-container">
<div class="w3-display-left w3-padding w3-col l6 m8" style="margin-left:50px;">
<span class="w3-xxxlarge w3-hide-small w3-text-white">Blood4Life</span>
<div class="w3-container w3-red">
<h3><i class="fa fa-user-plus w3-margin-right"></i>Sign Up!</h3>
</div>
<div id='User_body'>
<div class="w3-container w3-white w3-padding-16">
<form action="signup.php" method="post">
<div class="w3-row-padding" style="margin:0 -16px;">
<div class="w3-half w3-margin-bottom">
<label>First Name *</label>
<input class="w3-input w3-border w3-round-xlarge" type="text" placeholder="e.g. Chandler" name="FirstName" required>
</div>
<div class="w3-half">
<label>Last Name *</label>
<input class="w3-input w3-border w3-round-xlarge" type="text" placeholder="e.g. Bing" name="LastName" required>
</div>
</div>
<div class="w3-row-padding" style="margin:8px -16px;">
<div class="w3-half w3-margin-bottom">
<label>Gender *</label><br>
<input class="w3-radio" type="radio" name="gender" value="male" checked required>
<label class="w3-validate">Male</label>
<input class="w3-radio" type="radio" name="gender" value="female">
<label class="w3-validate">Female</label>
<input class="w3-radio" type="radio" name="gender" value="unspecified">
<label class="w3-validate">Unspecified</label>
</div>
<div class="w3-half">
<label>Blood Group *</label>
<select class="w3-select w3-border w3-round-xlarge" name="option" required>
<option value="" disabled selected>Select your blood group</option>
<option value="oPosSel">O+</option>
<option value="oNegSel">O-</option>
<option value="aPosSel">A+</option>
<option value="aNegSel">A-</option>
<option value="bPosSel">B+</option>
<option value="bNegSel">B-</option>
<option value="abPosSel">AB+</option>
<option value="abNegSel">AB-</option>
<option value="notknown">Unspecified / Not Known</option>
</select>
</div>
</div>
<div class="w3-row-padding" style="margin:0 -16px;">
<div class="w3-half w3-margin-bottom">
<label>Phone Number *</label>
<input class="w3-input w3-border w3-round-xlarge" type="text" placeholder="Mobile Number" name="PhoneNumber" required>
</div>
<div class="w3-half">
<label>Email *</label>
<input class="w3-input w3-border w3-round-xlarge" type="text" placeholder="Email id" name="Email" required>
</div>
</div>
<div class="w3-row-padding" style="margin:0 -16px;">
<div class="w3-half w3-margin-bottom">
<label>Zip Code *</label>
<input class="w3-input w3-border w3-round-xlarge" type="text" placeholder="Zipcode" name="Zipcode" required>
</div>
<div class="w3-half">
<label>Username *</label>
<input class="w3-input w3-border w3-round-xlarge" type="text" placeholder="Username" name="Username" required>
</div>
</div>
<div class="w3-row-padding" style="margin:0 -16px;">
<div class="w3-half w3-margin-bottom">
<label>Password *</label>
<input class="w3-input w3-border w3-round-xlarge" type="password" placeholder="Password" name="Password" id="Password" required>
</div>
<div class="w3-half">
<label>Confirm Password *</label>
<input class="w3-input w3-border w3-round-xlarge" type="password" placeholder="Confirm Password" name="ConfirmPassword" id="ConfirmPassword" onblur="check()" required>
</div>
</div>
<div class="w3-row">
<div class="w3-col" style="width:100%; text-align: center; padding-top:3px;">
<input class="w3-check" type="checkbox" id="anonymChk" name='anonymChk' value='checked'>
<div class="tooltip"><label class="w3-validate">I want to be Anonymous</label><span class="tooltiptext">Your Personal information expect for email id will not be disclosed to the blood banks</span></div>
<p><a href="terms.html" title="Terms and Conditions" target="_blank" class="w3-hover-text-green">Terms and Conditions / Privacy Policy</a></p>
<label>* marked fields are mandatory</label>
</div>
<div class="w3-row">
<div class="w3-col" style="width:100%; text-align: center; padding-top:3px;">
<i class="fa fa-plus-square w3-margin-right"></i><input class="w3-button w3-red w3-round-xlarge" type="submit" name="sign_up" value='Sign Up'/>
</div>
</form>
</div>
</div>
</div>
</div>
</header>
<!-- End page content -->
</div>
<!-- Footer -->
<footer class="w3-center w3-black w3-padding-4">
<p><a href="https://www.bloodservice.fi/" title="Red Cross" target="_blank" class="w3-hover-text-green">Finnish Red Cross Service</a></p>
</footer>
</body>
</html>
<?php
include('sign_up_form.php');
?>