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registration.php
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registration.php
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<!DOCTYPE html>
<html lang="en">
<?php include 'head.php'; ?>
<body>
<?php include 'header.php'; ?>
<div class="container">
<div class="page-header">
<h1 class="text-center">Who am I?</h1>
</div>
<div class="center wow fadeInDown">
<h2>Devenez membre authentique du (CRIC)</h2>
<p class="lead" style="color: green"><i>... Et si nous parlions desormain avec le coeur, la tete et les bras... Au lieu de la bouche ?</i></p>
</div>
<div class="container">
<div class="row stylish-panel">
<div class="container">
<div class="row clearfix">
<div class="col-xs-12 col-sm-12 col-md-8 col-lg-6 column col-sm-offset-0 col-md-offset-2 col-lg-offset-3">
<form class="form-horizontal">
<fieldset>
<!-- Form Name -->
<div class="form-group">
<label class="col-md-3 control-label" for="textinput">Information de connexion</label>
<div class="col-md-5">
<input id="textinput" name="textinput" type="text" placeholder="ex: [email protected]" class="form-control input-md">
</div>
<div class="col-md-4">
<input id="textinput" name="textinput" type="text" placeholder="ex: mapouka" class="form-control input-md">
</div>
</div>
<div class="form-group">
<label class="col-md-3 control-label" for="textinput">Mots de passe</label>
<div class="col-md-5">
<input id="textinput" name="textinput" type="password" placeholder="mots de passe" class="form-control input-md">
</div>
<div class="col-md-4">
<input id="textinput" name="textinput" type="password" placeholder="confirmer mots de passe" class="form-control input-md">
</div>
</div>
<div class="form-group">
<label class="col-md-3 control-label" for="selectbasic">Nom complet</label>
<div class="col-md-5">
<input type="text" class="form-control" placeholder="ex: Saint - Cyr MAPOUKA"/>
</div>
<div class="col-md-4">
<label class="radio-inline" for="radios-0">
<input type="radio" name="radios" id="radios-0" value="1" checked="checked">
Male
</label>
<label class="radio-inline" for="radios-1">
<input type="radio" name="radios" id="radios-1" value="2">
Female
</label>
</div>
</div>
<div class="form-group">
<label class="col-md-3 control-label" for="selectbasic">Tel. personel</label>
<div class="col-md-9">
<input type="text" class="form-control" placeholder="ex: 00233268568006"/>
</div>
</div>
<!-- Text input-->
<div class="form-group">
<label class="col-md-3 control-label" for="textinput">Date / pays de Naissance</label>
<div class="col-md-4">
<input id="textinput" name="textinput" type="date" placeholder="placeholder" class="form-control">
</div>
<div class="form-group">
<div class="col-md-4">
<select id="selectbasic" name="selectbasic" class="form-control">
<option value="1">Country</option>
<option value="2">Option two</option>
<option value="3">Option three</option>
</select>
</div>
</div>
<!-- Multiple Radios (inline) -->
</div>
<div class="form-group">
<label class="col-md-3 control-label" for="textinput">Adresse / pays de Residence actuel</label>
<div class="col-md-5">
<input id="textinput" name="textinput" type="text" placeholder="ex: St. IBE Rd. Korlebu #233 Accra Ghana PB. 234" class="form-control">
</div>
<div class="form-group">
<div class="col-md-4">
<select id="selectbasic" name="selectbasic" class="form-control">
<option value="1">Country</option>
<option value="2">Option two</option>
<option value="3">Option three</option>
</select>
</div>
</div>
<!-- Multiple Radios (inline) -->
</div>
<div class="form-group">
<label class="col-md-3 control-label" for="textinput">Dernier diplome (.pdf .doc)</label>
<div class="col-md-3">
<input id="textinput" name="textinput" type="file" placeholder="placeholder" class="form-control input-md">
</div>
<label class="col-md-3 control-label" for="textinput">Photo d'identite (.png .jpg)</label>
<div class="col-md-3">
<input id="textinput" name="textinput" type="file" placeholder="placeholder" class="form-control input-md">
</div>
<!-- Multiple Radios (inline) -->
</div>
<div class="form-group">
<label class="col-md-3 control-label" for="selectbasic">Certificat du travail ou contrat</label>
<div class="col-md-3">
<input id="textinput" name="textinput" type="file" placeholder="placeholder" class="form-control input-md">
</div>
<div class="col-md-4">
<input id="textinput" name="textinput" type="text" placeholder="site web employeur" class="form-control input-md">
</div>
</div>
<!-- Textarea -->
<div class="form-group">
<label class="col-md-3 control-label" for="textarea">Commentaire personel</label>
<div class="col-md-9">
<textarea class="form-control" placeholder="ex: Je travail presentement a YAME GROUP comme software engineer" id="textarea" name="textarea"></textarea>
</div>
</div>
<!-- Button (Double) -->
<div class="form-group">
<label class="col-md-3 control-label" for="button1id"></label>
<div class="col-md-8">
<button class="btn btn-success">Envoyer</button>
<button id="button2id" name="button2id" class="btn btn-danger">Annuler</button>
</div>
</div>
</fieldset>
</form>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<!-- /container -->
<?php include 'footer.php'; ?>
<script src="js/jquery.js"></script>
<script type="text/javascript">
$('.carousel').carousel()
</script>
<script src="js/bootstrap.min.js"></script>
<script src="js/jquery.prettyPhoto.js"></script>
<script src="js/jquery.isotope.min.js"></script>
<script src="js/main.js"></script>
<script src="js/wow.min.js"></script>
</body>
</html>