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<?php session_start(); include("config.php"); //$id=$_SESSION['matriid'] ; $_SESSION['Name'] = strip_tags($_POST['txtName']); $_SESSION['Gender']= strip_tags($_POST['txtGender']); $sDay = strip_tags($_POST['dobDay']); $sMonth = strip_tags($_POST['dobMonth']); $syear = strip_tags($_POST['dobYear']); $slash = "-"; $_SESSION['DateofBirth'] = $syear.$slash.$sMonth.$slash.$sDay; $sMs = $_POST['MARITAL_STATUS']; if ($sMs == "1") { $_SESSION['MaritalStatus'] = "Unmarried"; } elseif ($sMs == "2") { $_SESSION['MaritalStatus'] = "Widow/Widower"; } elseif ($sMs == "3") { $_SESSION['MaritalStatus'] = "Divorcee"; } elseif ($sMs == "4") { $_SESSION['MaritalStatus'] = "Separated"; } elseif ($sMs == "5") { $_SESSION['MaritalStatus'] = "Handicapped"; } $Strnochild = strip_tags($_POST['NOOFCHILDREN']); $Strchildwithme = strip_tags($_POST['CHILDLIVINGWITHME']); $_SESSION['ChildrenLivingStatus'] = $Strnochild.$Strchildwithme; //$_SESSION['Mothertongue']= strip_tags($_POST['Language']); $_SESSION['Religion']= strip_tags($_POST['religion']); $_SESSION['Caste']= strip_tags($_POST['caste']); $_SESSION['SubCaste']= strip_tags($_POST['txtSubcaste']); $_SESSION['ProfileCreatedby']= strip_tags($_POST['txtPC']); $_SESSION['Referenceby']= strip_tags($_POST['txtRef']); $_SESSION['hand']= strip_tags($_POST['hand']); /// Accounts Datas //$_SESSION['ConfirmEmail']= strip_tags($_POST['EMAILconfirm']); //$_SESSION['Photo1'] = $row['Photo1']; $_SESSION['ConfirmPassword']= md5($_POST['txtcp']); /// Socio Religious Attributes $_SESSION['Gothra']= strip_tags($_POST['txtGothra']); $_SESSION['Star']= strip_tags($_POST['txtStar']); $_SESSION['Moonsign']= strip_tags($_POST['txtMoon']); $_SESSION['HoroscopeMatch']= strip_tags($_POST['txtHorosMatch']); $_SESSION['Manglik']= strip_tags($_POST['txtManglik']); $_SESSION['Placeofbirth']= strip_tags($_POST['txtPb']); $_SESSION['Timeofbirth']= strip_tags($_POST['txtTb']); $email =$_POST['email']; $password1 =$_POST['password']; $password =md5 ($_POST['password']); $mobile =$_POST['mobile']; $name =$_POST['name']; $gender =$_POST['gender']; $Dob =$_POST['year']; $month =$_POST['month']; $day =$_POST['day']; $txtregdate = strip_tags(date('d-M-Y')); $DOB =$Dob.'-'.$month.'-'.$day; $religion =$_POST['religion']; //$mothertounge =$_POST['mothertounge']; //$residence =$_POST['country']; $terms="true"; $status ="InActive"; $strorderstatus = "No"; $_SESSION['Accept']= strip_tags($_POST['txtAccept']); //msg5.text = Request.ServerVariables("REMOTE_ADDR") if($_POST['name']) { $duplicate=mysql_query("SELECT * from register where ConfirmEmail='$email' "); $countduplicate=mysql_num_rows($duplicate); if($countduplicate!=0) { echo '<script>alert("User With Same Email Id Already Exists"); window.location="http://balajilagan.com/registrationnew_1.php"; </script>'; } else { $sql=mysql_query("insert into register (`ID`,`ConfirmEmail`,`ConfirmPassword`,`Mobile`,`Name`,`Gender`,`DOB`,`Religion`,`status`,`Regdate`,`Orderstatus`) values ('null','".$_POST['email']."','$password','$mobile','$name','$gender','$DOB','$religion','$status','$txtregdate','$strorderstatus')"); } $select=mysql_query("SELECT ID from register order by ID desc limit 1 "); $fetch=mysql_fetch_array($select); $id=$fetch['ID']; $_SESSION['matriid']=$id; $update2 = mysql_query("update register set matriid=concat(prefix,id),age=(YEAR(CURDATE())-YEAR(dob)) - (RIGHT(CURDATE(),5)<RIGHT(dob,5))") or die("Could not update data because ".mysql_error()); $update1 = mysql_query("update register set Maritalstatus='".$_SESSION['MaritalStatus']."',childrenlivingstatus='".$_SESSION['ChildrenLivingStatus']."',Handicap='".$_SESSION['hand']."',Religion='".$_SESSION['Religion']."',Caste='".$_SESSION['Caste']."',Subcaste='".$_SESSION['SubCaste']."',Gothram='".$_SESSION['Gothra']."',Star='".$_SESSION['Star']."',Moonsign='".$_SESSION['Moonsign']."',Horosmatch='".$_SESSION['HoroscopeMatch']."',Manglik='".$_SESSION['Manglik']."',TOB='".$_SESSION['Timeofbirth']."',POB='".$_SESSION['Placeofbirth']."' WHERE ID= '$id' "); } ?> <html> <head> <meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1" /> <meta charset="utf-8"> <meta name="viewport" content="width=device-width, initial-scale=1"> <link rel="stylesheet" href="http://maxcdn.bootstrapcdn.com/bootstrap/3.3.6/css/bootstrap.min.css"> <script src="https://ajax.googleapis.com/ajax/libs/jquery/1.12.4/jquery.min.js"></script> <script src="http://maxcdn.bootstrapcdn.com/bootstrap/3.3.6/js/bootstrap.min.js"></script> <title>Free Online Registration</title> <link href="style.css" rel="stylesheet" type="text/css"> </head> <script language="javascript" src="Country_States_Cities.js" type="text/javascript"> </script> <script language="javascript" type="text/javascript"> function loadvalues() { enb('country'); select_field('country',''); select_field('state',''); enb('state'); select_field('city',''); } function Validate() { /* -------- city part ends here ------- */ } //checks the fields that are compulsory namely state, city, terms of use function CheckFields() { var i = Validate(); if(i==0) return false; return true; } </script> <script language="javascript"> function ValidateNo( NumStr, String ) { for( var Idx = 0; Idx < NumStr.length; Idx ++ ) { var Char = NumStr.charAt( Idx ); var Match = false; for( var Idx1 = 0; Idx1 < String.length; Idx1 ++) { if( Char == String.charAt( Idx1 ) ) Match = true; } if ( !Match ) return false; } return true; } function ResetValues( ) { var formn = this.document.formn; formn.txtEdu.value = ""; formn.txtEdudetails = ""; formn.txOccu.value = ""; formn.txtEmp.value = ""; formn.txtHeight.value = ""; formn.txtWeight.value = ""; formn.txtBlood.value = ""; formn.txtBody.value = ""; formn.txtComplexion.value = ""; formn.txtAddress.value = ""; formn.txtCity.value = ""; formn.txtState.value = ""; formn.txtPhone.value = ""; return true; } // Function to validate all the inputs function Validate( ) { var formn = this.document.formn; // Check Education if ( formn.txtEdu.selectedIndex == 0 ) { alert( "Please Select your Education." ); formn.txtEdu.focus( ); return false; } // Check Edu details // Check Occupation if ( formn.txtOccu.value == "" ) { alert( "Please Select your Occupation." ); formn.txtOccu.focus( ); return false; } // Check Employed in if ( formn.txtEmp.selectedIndex == 0 ) { alert( "Please Select your Employed in status." ); formn.txtEmp.focus( ); return false; } // Check Height // if ( formn.txtHeight1.selectedIndex == 0 ) // { // alert( "Please Select your Height." ); // formn.txtHeight1.focus( ); // return false; // } // // // // Check Weight // if ( formn.txtWeight.selectedIndex == 0 ) // { // alert( "Please Select your Weight." ); // formn.txtWeight.focus( ); // return false; // } // // // // Check Blood Group // if ( formn.txtBlood.selectedIndex == 0 ) // { // alert( "Please Select your Blood Group." ); // formn.txtBlood.focus( ); // return false; // } // Check BodyType if ( formn.txtBody.selectedIndex == 0 ) { alert( "Please Select your Body type." ); formn.txtBody.focus( ); return false; } // Check Complexion if ( formn.txtComplexion.selectedIndex == 0 ) { alert( "Please Select your Complexion." ); formn.txtComplexion.focus( ); return false; } // Check Address if ( formn.txtAddress.value == "" ) { alert( "Please enter your Address." ); formn.txtAddress.focus( ); return false; } if ( formn.txtCountry.value == "" ) { alert( "Please select your country." ); formn.cboCountry.focus( ); return false; } if ( formn.txtState.value == "" ) { alert( "Please select your state." ); formn.cboState.focus( ); return false; } if ( formn.city.value == "" ) { alert( "Please enter your city." ); formn.city.focus( ); return false; } // Check any Phone number // Check Area Code if ( formn.txtAC.value == "" ) { alert( "Please enter your Area Code." ); formn.txtAC.focus( ); return false; } if ((document.formn.txtMobile.value == "") && (document.formn.txtPhone.value == "")){ alert("One contact information is compulsory.\n Kindly enter your any contact number."); document.formn.txtPhone.focus( ); return false; } if ((document.formn.txtMobile.value == "") && (document.formn.txtPhone.value.length < 6 )) { alert( "Phone number must be atleast 6 numbers." ); document.formn.txtPhone.focus( ); return false; } if ((document.formn.txtPhone.value == "") && (document.formn.txtMobile.value.length < 10 )) { alert( "Mobile number must be minimum 10 numbers." ); document.formn.txtMobile.focus( ); return false; } return true; } </script> <script> function check_phone(field_name) { var i, max, field_info field_info = eval("document.formn." + field_name); max = field_info.value.length; for (i = 0; i < max; i++) { if(isNaN(field_info.value.charAt(i))) { alert("You Must Enter A Number."); field_info.value = ""; field_info.focus(); return false; } } return true; } </script> <script> <!-- function clearform() { // formn.txtEdu.value = "1" //formn.txtAddress.value = "" //formn.txtAddress.value = "" // formn.txtAddress.value = "" //formn.txtAddress.value = "" ////formn.txtAddress.value = "" // formn.txtAddress.value = "" formn.txtEdudetails.value = "" formn.txtAddress.value = "" formn.txtCity.value = "" formn.txtState.value = "" formn.txtPhone.value = "" } //--> </script> <style> .tabpadding{padding:10px;height:25px;} </style> <body> <nav class="navbar navbar-default"> <div class="container-fluid" style="background:#BC1003;color:white"> <div class="navbar-header"> <a class="navbar-brand" href="#" style="color:white">Balaji Lagan Services</a> </div> <!-- <ul class="nav navbar-nav" style="float:right"> <li style="background:#680303;color:white"><a href="index.php" class="active" style="color:white;font-weight:bold;font-size:15px"><i class="fa fa-home"></i> Home</a></li> <li><a href="registration1.php"><i class="fa fa-pencil"></i> Register</a> </li> <li> </li> <li style="background:#680303;color:white"><a href="membership.php" style="color:white;font-weight:bold;font-size:15px"><i class="fa fa-group"></i> Membership</a> </li> <li> </li> <li style="background:#680303;color:white"><a href="paymentoptions.php" style="color:white;font-weight:bold;font-size:15px"><i class="fa fa-money"> Payment Option</i></a> </li> <li> </li> <li style="background:#680303;color:white"><a href="contactus.php" style="color:white;font-weight:bold;font-size:15px"><i class="fa fa-phone"></i> Contact us</a> </li> </ul>--> </div> </nav> <div class="container_full"> <div class="container"> <div class="row"> <div class="col-md-12"> <form action="registrationnew3.php" method="post" name="formn" onSubmit="return Validate()"> </TD> <table width="780" align="center"border="0" cellpadding="0" cellspacing="0" class=""> <!--DWLayoutTable--> <tr> <td width="780" height="164"> <table width="780" border="0" align="center" cellpadding="0" cellspacing="0" bgcolor="#FFFFFF" > <!--DWLayoutTable--> <table style="border:1px solid #E8E3CD;width:780px;"> <tr valign="top"> <td height="206" colspan="2"><table width="746" border="0" align="center"> <tr > <td><div align="left"><span class="LgHeading">Registration Continue </span></div></td> </tr> <tr> <td width="716"><div align="left" style="color:#808080">All Fields marks <span class="bodysg"><span class="Alert">*</span></span> are compulsory.<br> Please mention accurate information in this form or your profile may be declined. </div></td> </tr> </table> <br> <TABLE width=746 border=0 align="center" cellPadding=0 cellSpacing=0> <TR> <TD class=grebg vAlign=top colSpan=3 height=12><IMG src="pics/trans.gif"></TD> </TR> <TR> <TD class=grebg width=12><IMG height=1 src="pics/trans.gif"></TD> <TD class=lastnull vAlign=top width=722><TABLE cellSpacing=3 cellPadding=3 width=722 border=0> <TR height=28> <TD class=smalltxt align=right colSpan=2><div align="left"></div></TD> </TR> <!---- --> <TR> <TD class=grebg colSpan=2><IMG height=1 src="pics/trans.gif"></TD> </TR> <TR class=tabpadding> <TD colspan="2" class=grtxtbold1><div align="left"><span class="bodysg">Education and Occupation </span></div></TD> </TR> <!---- --> <TR> <TD class=grebg colSpan=2><IMG height=1 src="pics/blank(1).gif"></TD> </TR> <TR class=tabpadding> <TD class=grtxtbold1><div align="left">Education <span class="Alert">* </span></div></TD> <TD width="500"><div align="left"> <select name="txtEdu" class="selectfield" id="txtEdu" style="width:215px;"> <option value="" selected>- Select -</option> <option value="Associates degree">Associates degree</option> <option value="Bachelors">Bachelors</option> <option value="B-TECH">B-TECH</option> <option value="BCA">BCA</option> <option value="B-ARCH">B-ARCH</option> <option value="B-PLAN">B-PLAN</option> <option value="BBA">BBA</option> <option value="BE">BE</option> <option value="B-PHILL">B-PHILL</option> <option value="B.COM">B.COM</option> <option value="BA">BA</option> <option value="BHM">BHM</option> <option value="BED">BED</option> <option value="BDS">BDS</option> <option value="BHMS">BHMS</option> <option value="BAMS">BAMS</option> <option value="BSc">BSc</option> <option value="B-PHARMA">B-PHARMA</option> <option value="BGL/BL/LLB">BGL/BL/LLB</option> <option value="C.A">C.A.</option> <option value="CS">CS</option> <option value="Doctorate">Doctorate</option> <option value="Diploma">Diploma</option> <option value="High school">High school</option> <option value="Honours degree">Honours degree</option> <option value="Intermediate">Intermediate</option> <option value="Masters"><b>Masters</b></option> <option value="MBA">MBA</option> <option value="MSc">MSc</option> <option value="MCA/PGDCA">MCA/PGDCA</option> <option value="ME/M TECH">ME/M TECH</option> <option value="MS(ENGINEERING)">MS(ENGINEERING)</option> <option value="PG">PG</option> <option value="M-ARCH">M-ARCH</option> <option value="MBA/PGDM">MBA/PGDM</option> <option value="MD/MS(MEDICAL)">MD/MS(MEDICAL)</option> <option value="MBBS">MBBS</option> <option value="MDS">MDS</option> <option value="MVSE">MVSE</option> <option value="MPT">MPT</option> <option value="M-PHARMA">M-PHARMA</option> <option value="Trade school">Trade school</option> <option value="Undergraduate">Undergraduate</option> <option value="Less than high school">Less than high school</option> </select> </div></TD> </TR> <!-- --> <TR> <TD class=grebg colSpan=2><IMG height=1 src="pics/trans.gif"></TD> </TR> <TR> <TD class=grebg colSpan=2><IMG height=1 src="pics/trans.gif"></TD> </TR> <TR class=tabpadding> <TD class=grtxtbold1><div align="left">Edu Description </div></TD> <TD><div align="left"> <textarea name="Edudesc" rows="4" id="Edudesc" style="width:210px;height:70px" class="textfield"></textarea> </div></TD> </TR> <!-- --> <TR> <TD class=grebg colSpan=2><IMG height=1 src="pics/trans.gif"></TD> </TR> <TR class=tabpadding> <TD class=grtxtbold1><div align="left">Annual income <span class="Alert"> </span></div></TD> <TD class=smalltxt><div align="left"> <select name="txtIncome" class="selectfield" id="txtIncome" style="width:215px;"> <option value="" selected="selected">[Select Annual Income Range]</option> <optgroup label=""></optgroup> <optgroup label="Income in Indian Rupees"> <option value="Under - Rs.50,000">Under Rs.50,000</option> <option value="Under - Rs.50,000">Under Rs.50,000</option> <option value="Rs.50,001 - 1,00,000">Rs.50,001 - 1,00,000</option> <option value="Rs.1,00,001 - 2,00,000">Rs.1,00,001 - 2,00,000</option> <option value="Rs.2,00,001 - 3,00,000">Rs.2,00,001 - 3,00,000</option> <option value="Rs.3,00,001 - 4,00,000">Rs.3,00,001 - 4,00,000</option> <option value="Rs.4,00,001 - 5,00,000">Rs.4,00,001 - 5,00,000</option> <option value="Rs.5,00,001 - 7,50,000">Rs.5,00,001 - 7,50,000</option> <option value="Rs.7,50,001 - 10,00,000">Rs.7,50,001 - 10,00,000</option> <option value="Rs.10,00,001 - 12,00,000">10,00,001 to 12,00,000</option> <option value="Rs.12,00,001 - 15,00,000">12,00,001 to 15,00,000</option> <option value="Rs.15,00,001 - 20,00,000">15,00,001 to 20,00,000</option> <option value="Rs.20,00,001 - 25,00,000">20,00,001 to 25,00,000</option> <option value="Rs.25,00,001 - 30,00,000">25,00,001 to 30,00,000</option> <option value="Rs.30,00,001 - 35,00,000">30,00,001 to 35,00,000</option> <option value="Rs.35,00,001 - 40,00,000">35,00,001 to 40,00,000</option> <option value="Rs.40,00,001 - 45,00,000">40,00,001 to 45,00,000</option> <option value="Rs.45,00,001 - 50,00,000">45,00,001 to 50,00,000</option> <option value="Rs.50,00,001 - 55,00,000">50,00,001 to 55,00,000</option> <option value="Rs.55,00,001 - 60,00,000">55,00,001 to 60,00,000</option> <option value="Rs.60,00,001 - 65,00,000">60,00,001 to 65,00,000</option> <option value="Rs.60,00,001 - 65,00,000">65,00,001 to 70,00,000</option> <option value="Rs.70,00,001 - 75,00,000">70,00,001 to 75,00,000</option> <option value="Rs.75,00,001 - 80,00,000">75,00,001 to 80,00,000</option> <option value="Rs.80,00,001 - 85,00,000">80,00,001 to 85,00,000</option> <option value="Rs.85,00,001 - 90,00,000">85,00,001 to 90,00,000</option> <option value="Rs.90,00,001 - 95,00,000">85,00,001 to 90,00,000</option> <option value="Rs.95,00,001 - 1 Crore">95,00,001 to 1 Crore</option> </optgroup> <optgroup label=""></optgroup> <optgroup label="Income in US Dollars"> <option value="Under $25,000">Under $25,000</option> <option value="$25,001 - 50,000">$25,001 - 50,000</option> <option value="$50,001 - 75,000">$50,001 - 75,000</option> <option value="$75,001 - 100,000">$75,001 - 100,000</option> <option value="$100,001 - 150,000">$100,001 - 150,000</option> <option value="$150,001 - 200,000">$150,001 - 200,000</option> <option value="$200,001 and above">$200,001 and above</option> </optgroup> <optgroup label=""></optgroup> <option value="No Income">No Income</option> </select> </div></TD> </TR> <TR> <TD class=grebg colSpan=2><IMG height=1 src="pics/trans.gif"></TD> </TR> <TR class=tabpadding> <TD class=grtxtbold1><div align="left">Salary </div></TD> <TD><div align="left"> <input type="text" name="salary" class="textfield" style="width:215px" id="salary"> </div></TD> </TR> <TR> <TD class=grebg colSpan=2><IMG height=1 src="pics/trans.gif"></TD> </TR> <TR class=tabpadding> <TD class=grtxtbold1 valign=center><div align="left">Occupation <span class="Alert"> </span></div></TD> <TD class=smalltxt><div align="left"> <select name="txtOccu" class="selectfield" id="txtOccu" style="width:215px;"> <option value="" selected>- Select -</option> <option value="Not working">Not working</option> <option value="Non-mainstream professional">Non-mainstream professional</option> <option value="Accountant">Accountant</option> <option value="Acting Professional">Acting Professional</option> <option value="Actor">Actor</option> <option value="Administration Professional">Administration Professional</option> <option value="Advertising Professional">Advertising Professional</option> <option value="Air Hostess">Air Hostess</option> <option value="Analyst">Analyst</option> <option value="Architect">Architect</option> <option value="Artisan">Artisan</option> <option value="Audiologist">Audiologist</option> <option value="Banker">Banker</option> <option value="Beautician">Beautician</option> <option value="Biologist / Botanist">Biologist / Botanist</option> <option value="Business Person">Business Person</option> <option value="Chartered Accountant">Chartered Accountant</option> <option value="Civil Engineer">Civil Engineer</option> <option value="Clerical Official">Clerical Official</option> <option value="Commercial Pilot">Commercial Pilot</option> <option value="Company Secretary">Company Secretary</option> <option value="Computer Professional">Computer Professional</option> <option value="Consultant">Consultant</option> <option value="Contractor">Contractor</option> <option value="Co-Ordinator">Co-Ordinator</option> <option value="Cost Accountant">Cost Accountant</option> <option value="Creative Person">Creative Person</option> <option value="Customer Support Professional">Customer Support Professional</option> <option value="Defense Employee">Defense Employee</option> <option value="Dentist">Dentist</option> <option value="Designer">Designer</option> <option value="Doctor">Doctor</option> <option value="Economist">Economist</option> <option value="Engineer">Engineer</option> <option value="Engineer (Mechanical)">Engineer (Mechanical)</option> <option value="Engineer (Project)">Engineer (Project)</option> <option value="Entertainment Professional">Entertainment Professional</option> <option value="Event Manager">Event Manager</option> <option value="Executive">Executive</option> <option value="Factory worker">Factory worker</option> <option value="Farmer">Farmer</option> <option value="Fashion Designer">Fashion Designer</option> <option value="Finance Professional">Finance Professional</option> <option value="Flight Attendant">Flight Attendant</option> <option value="Government Employee">Government Employee</option> <option value="Health Care Professional">Health Care Professional</option> <option value="Home Maker">Home Maker</option> <option value="Hotel & Restaurant Professional">Hotel & Restaurant Professional</option> <option value="Human Resources Professional">Human Resources Professional</option> <option value="Interior Designer">Interior Designer</option> <option value="Investment Professional">Investment Professional</option> <option value="IT / Telecom Professional">IT / Telecom Professional</option> <option value="Journalist">Journalist</option> <option value="Lawyer">Lawyer</option> <option value="Lecturer">Lecturer</option> <option value="Legal Professional">Legal Professional</option> <option value="Manager">Manager</option> <option value="Marketing Professional">Marketing Professional</option> <option value="Media Professional">Media Professional</option> <option value="Medical Professional">Medical Professional</option> <option value="Medical Transcriptionist">Medical Transcriptionist</option> <option value="Merchant Naval Officer">Merchant Naval Officer</option> <option value="Nurse">Nurse</option> <option value="Occupational Therapist">Occupational Therapist</option> <option value="Optician">Optician</option> <option value="Pharmacist">Pharmacist</option> <option value="Physician Assistant">Physician Assistant</option> <option value="Physicist">Physicist</option> <option value="Physiotherapist">Physiotherapist</option> <option value="Pilot">Pilot</option> <option value="Politician">Politician</option> <option value="Production professional">Production professional</option> <option value="Professor">Professor</option> <option value="Psychologist">Psychologist</option> <option value="Public Relations Professional">Public Relations Professional</option> <option value="Real Estate Professional">Real Estate Professional</option> <option value="Research Scholar">Research Scholar</option> <option value="Retired Person">Retired Person</option> <option value="Retail Professional">Retail Professional</option> <option value="Sales Professional">Sales Professional</option> <option value="Scientist">Scientist</option> <option value="Self-employed Person">Self-employed Person</option> <option value="Social Worker">Social Worker</option> <option value="Software Consultant">Software Consultant</option> <option value="Sportsman">Sportsman</option> <option value="Student">Student</option> <option value="Teacher">Teacher</option> <option value="Teamleader">Team Leader</option> <option value="Technician">Technician</option> <option value="Training Professional">Training Professional</option> <option value="Transportation Professional">Transportation Professional</option> <option value="Veterinary Doctor">Veterinary Doctor</option> <option value="Volunteer">Volunteer</option> <option value="Writer">Writer</option> <option value="Zoologist">Zoologist</option> <option value="Other">Other</option> </select> </div></TD> </TR> <TR> <TD class=grebg colSpan=2><IMG height=1 src="pics/trans.gif"></TD> </TR> <TR class=tabpadding> <TD class=grtxtbold1 width=210><div align="left">Employed in <span class="Alert"> </span></div></TD> <TD vAlign=top><div align="left"> <select name="txtEmp" class="selectfield" id="txtEmp" style="width:215px;"> <option value="" selected>- Select -</option> <option value="Business">Business</option> <option value="Defence">Defence</option> <option value="Government">Government</option> <option value="Not Employed in">Not Employed in</option> <option value="Private">Private</option> <option value="Others">Others</option> </select> </div></TD> </TR> <TR> <TD class=grebg colSpan=2><IMG height=1 src="pics/trans.gif"></TD> </TR> <TR class=tabpadding> <TD class=grtxtbold1 style="width:115px"><div align="left">Occ City </div></TD> <TD><div align="left"> <input type="text" name="oc" class="textfield" style="width:215px" id="oc"> </div></TD> <TD class=grtxtbold1><div align="left">Occ State </div></TD> <TD><div align="left"> <input type="text" name="os" class="textfield" style="width:215px" id="os"> </div></TD> </TR> <TR> <TD class=grebg colSpan=2><IMG height=1 src="pics/trans.gif"></TD> </TR> <TR class=tabpadding> </TR> <TR> <TD class=grebg colSpan=2><IMG height=1 src="pics/trans.gif"></TD> </TR> <TR class=tabpadding> <TD class=grtxtbold1><div align="left">Work Description </div></TD> <TD><div align="left"> <textarea name="wd" class="textfield" style="width:215px" id="wd"></textarea> </div></TD> </TR> <TR> <TD class=greendot colSpan=2></TD> </TR> <TR class=tabpadding> <TD colspan="2" class=grtxtbold1><div align="left">Physical Attributes</div></TD> </TR> <TR> <TD class=grebg colSpan=2><IMG height=1 src="pics/trans.gif"></TD> </TR> <TR class=tabpadding> <TD class=grtxtbold1><div align="left"> Height </div></TD> <TD class=grtxt><div align="left"> <select name="txtHeight1" class="selectfield" id="txtHeight1" style="width:215px;"> <option value="" selected>- Select -</option> <option value="1">Below 4ft</option> <option value="2">4ft 6in</option> <option value="3">4ft 7in</option> <option value="4">4ft 8in</option> <option value="5">4ft 9in</option> <option value="6">4ft 10in</option> <option value="7">4ft 11in</option> <option value="8">5ft</option> <option value="9">5ft 1in</option> <option value="10">5ft 2in</option> <option value="11">5ft 3in</option> <option value="12">5ft 4in</option> <option value="13">5ft 5in</option> <option value="14">5ft 6in</option> <option value="15">5ft 7in</option> <option value="16">5ft 8in</option> <option value="17">5ft 9in</option> <option value="18">5ft 10in</option> <option value="19">5ft 11in</option> <option value="20">6ft</option> <option value="21">6ft 1in</option> <option value="22">6ft 2in</option> <option value="23">6ft 3in</option> <option value="24">6ft 4in</option> <option value="25">6ft 5in</option> <option value="26">6ft 6in</option> <option value="27">6ft 7in</option> <option value="28">6ft 8in</option> <option value="29">6ft 9in</option> <option value="30">6ft 10in</option> <option value="31">6ft 11in</option> <option value="32">7ft</option> <option value="33">Above 7ft</option> </select></div></TD> </TR> <TR> <TD class=grebg colSpan=2><IMG height=1 src="pics/trans.gif"></TD> </TR> <TR class=tabpadding> <TD class=grtxtbold1><div align="left">Weight </div></TD> <TD class=grtxt><div align="left"> <select name="txtWeight" class="selectfield" id="txtWeight" style="width:215px;"> <option value="0" selected="selected">- Select -</option> <option value="41 kg">41 kg</option> <option value="42 kg">42 kg</option> <option value="43 kg">43 kg</option> <option value="44 kg">44 kg</option> <option value="45 kg">45 kg</option> <option value="46 kg">46 kg</option> <option value="47 kg">47 kg</option> <option value="48 kg">48 kg</option> <option value="49 kg">49 kg</option> <option value="50 kg">50 kg</option> <option value="51 kg">51 kg</option> <option value="52 kg">52 kg</option> <option value="53 kg">53 kg</option> <option value="54 kg">54 kg</option> <option value="55 kg">55 kg</option> <option value="56 kg">56 kg</option> <option value="57 kg">57 kg</option> <option value="58 kg">58 kg</option> <option value="59 kg">59 kg</option> <option value="60 kg">60 kg</option> <option value="61 kg">61 kg</option> <option value="62 kg">62 kg</option> <option value="63 kg">63 kg</option> <option value="64 kg">64 kg</option> <option value="65 kg">65 kg</option> <option value="66 kg">66 kg</option> <option value="67 kg">67 kg</option> <option value="68 kg">68 kg</option> <option value="69 kg">69 kg</option> <option value="70 kg">70 kg</option> <option value="71 kg">71 kg</option> <option value="72 kg">72 kg</option> <option value="73 kg">73 kg</option> <option value="74 kg">74 kg</option> <option value="75 kg">75 kg</option> <option value="76 kg">76 kg</option> <option value="77 kg">77 kg</option> <option value="78 kg">78 kg</option> <option value="79 kg">79 kg</option> <option value="80 kg">80 kg</option> <option value="81 kg">81 kg</option> <option value="82 kg">82 kg</option> <option value="83 kg">83 kg</option> <option value="84 kg">84 kg</option> <option value="85 kg">85 kg</option> <option value="86 kg">86 kg</option> <option value="87 kg">87 kg</option> <option value="88 kg">88 kg</option> <option value="89 kg">89 kg</option> <option value="90 kg">90 kg</option> <option value="91 kg">91 kg</option> <option value="92 kg">92 kg</option> <option value="93 kg">93 kg</option> <option value="94 kg">94 kg</option> <option value="95 kg">95 kg</option> <option value="96 kg">96 kg</option> <option value="97 kg">97 kg</option> <option value="98 kg">98 kg</option> <option value="99 kg">99 kg</option> <option value="100 kg">100 kg</option> <option value="101 kg">101 kg</option> <option value="102 kg">102 kg</option> <option value="103 kg">103 kg</option> <option value="104 kg">104 kg</option> <option value="105 kg">105 kg</option> <option value="106 kg">106 kg</option> <option value="107 kg">107 kg</option> <option value="108 kg">108 kg</option> <option value="109 kg">109 kg</option> <option value="110 kg">110 kg</option> <option value="111 kg">111 kg</option> <option value="112 kg">112 kg</option> <option value="113 kg">113 kg</option> <option value="114 kg">114 kg</option> <option value="115 kg">115 kg</option> <option value="116 kg">116 kg</option> <option value="117 kg">117 kg</option> <option value="118 kg">118 kg</option> <option value="119 kg">119 kg</option> <option value="120 kg">120 kg</option> <option value="121 kg">121 kg</option> <option value="122 kg">122 kg</option> <option value="123 kg">123 kg</option> <option value="124 kg">124 kg</option> <option value="125 kg">125 kg</option> <option value="126 kg">126 kg</option> <option value="127 kg">127 kg</option> <option value="128 kg">128 kg</option> <option value="129 kg">129 kg</option> <option value="130 kg">139 kg</option> <option value="132 kg">130 kg</option> <option value="131 kg">131 kg</option> <option value="132 kg">132 kg</option> <option value="133 kg">133 kg</option> <option value="134 kg">134 kg</option> <option value="135 kg">135 kg</option> <option value="136 kg">136 kg</option> <option value="137 kg">137 kg</option> <option value="138 kg">138 kg</option> <option value="139 kg">139 kg</option> <option value="140 kg">140 kg</option> </select> </div></TD> </TR> <TR> <TD class=grebg colSpan=2><IMG height=1 src="pics/trans.gif"></TD> </TR> <TR> <TD class=grebg colSpan=2><IMG height=1 src="pics/trans.gif"></TD> </TR> <TR class=tabpadding> <TD class=grtxtbold1><div align="left">Complexion<span class="Alert">*</span> </div></TD> <TD class=grtxt><div align="left"> <select name="txtComplexion" class="selectfield" id="txtComplexion" style="width:215px;"> <option value="" selected>- Select -</option> <option value="Very Fair">Very Fair</option> <option value="Fair">Fair</option> <option value="Wheatish">Wheatish</option> <option value="Wheatish Medium">Wheatish Medium</option> <option value="Wheatish Brown">Wheatish Brown</option> <option value="Dark">Dark</option> </select> </div> <div align="left"></div></TD> </TR> <TR> <TD class=grebg colSpan=2><IMG height=1 src="pics/trans.gif"></TD> </TR> <TR class=tabpadding> <TD class=grtxtbold1><div align="left">Body type <span class="Alert">*</span> </div></TD> <TD><div align="left"> <input name="txtBody" type="radio" value="Slim"> Slim <input name="txtBody" type="radio" value="Average" checked> Average <input name="txtBody" type="radio" value="Athletic"> Athletic <input name="txtBody" type="radio" value="Heavy"> Heavy</div></TD> </TR> <TR> <TD class=grebg colSpan=2><IMG height=1 src="pics/trans.gif"></TD> </TR> <TR> <TD class=grebg colSpan=2><IMG height=1 src="pics/trans.gif"></TD> </TR> <TR> <TD class=grebg colSpan=2><IMG height=1 src="pics/trans.gif"></TD> </TR> <TR> <TD class=grebg colSpan=2><IMG height=1 src="pics/trans.gif"></TD> </TR> <TR> <TD class=greendot colSpan=2></TD> </TR> <TR class=tabpadding> <TD colspan="2" class=grtxtbold1><div align="left"><span class="bodysg">Contact Details </span></div> <div align="left"></div></TD> </TR> <TR> <TD class=grebg colSpan=2><IMG height=1 src="pics/trans.gif"></TD> </TR> <TR class=tabpadding> <TD class=grtxtbold1><div align="left">Address <span class="Alert">*</span></div></TD> <TD class=grtxt><div align="left"> <textarea name="txtAddress" rows="4" id="txtAddress" style="width:210px;height:100px;" class="textfield"></textarea> <br> <span class="style2">The contact address is only for Official purpose and will not be disclosed to others</span></div></TD> </TR> <TR> <TD class=grebg colSpan=2><IMG height=1 src="pics/trans.gif"></TD> </TR> <tr class=tabpadding> <td>Country</td><td> <script src="country.js" type="text/javascript"></script> <select name="cboCountry" id="cboCountry" onChange="Fill_States();" style="width:215px;" class="selectfield"> </select> <input disabled="disabled" name="txtNumCountries" type="hidden" /> <input disabled="disabled" name="txtSelectedCountry" type="hidden" /> <input disabled="disabled" name="txtNumStates" type="hidden" /> <input disabled="disabled" name="txtSelectedState" type="hidden" /> <input disabled="disabled" name="txtStateLength" type="hidden" /> <input disabled="disabled" name="txtCountryLength" type="hidden" /> <input name="txtCountry" id="txtCountry" type="hidden" /> <input name="txtState" id="txtState" type="hidden" /></td></tr> <tr class=tabpadding><td>State / Province</td><td><select class="selectfield" name="cboState" id="cboState" onchange="Update_Globals();" style="width:215px;" > </select> <script type="text/javascript"> Fill_Country();Fill_States();Clear_Form();</script></td></tr> <tr class=tabpadding><td>City</td><td><input type="text" name="city" class="textfield" style="width:215px;"/></td></tr> <TR> <TD class=grebg colSpan=2><IMG height=1 src="pics/trans.gif"></TD> </TR> <TR class=tabpadding> <TD class=grtxtbold1><div align="left">Phone</div></TD> <TD class=grtxt><div align="left"> <input name="txtCC" type="text" class="textfield" id="txtCC" style="width:30px;" onFocus="if (this.value == '91') this.value = '';" onKeyUp="check_phone('txtCC')" value="+91" size="10" maxlength="10"> - <input name="txtAC" type="text" class="textfield" id="txtAC" size="10" maxlength="10" style="width:40px;" onFocus="if (this.value == 'Area Code') this.value = '';" value="Area Code" onKeyUp="check_phone('txtAC')"> - <input name="txtPhone" type="text" class="textfield" id="txtPhone" size="10" maxlength="10" style="width:110px;" onKeyUp="check_phone('txtPhone')"> </div></TD> </TR> <TR> <TD class=grebg colSpan=2><IMG height=1 src="pics/trans.gif"></TD> </TR> <TR class=tabpadding> <TD class=grtxtbold1><div align="left">Mobile </div></TD> <TD class=grtxt><div align="left"> <input name="txtMobile" type="text" class="textfield" id="txtMobile" size="40" maxlength="40" style="width:210px;" onKeyUp="check_phone('txtMobile')"> </div></TD> </TR> <TR> <TD class=grebg colSpan=2><IMG height=1 src="pics/trans.gif"></TD> </TR> <TR class=tabpadding> <TD class=grtxtbold1><div align="left">Residence in</div></TD> <TD class=grtxt><div align="left"> <select name="txtRes" class="selectfield" id="txtCitizen" style="width:215px;"> <option value="Citizen">Citizen</option> <option value="Permanent Resident">Permanent Resident</option> <option value="Student Visa">Student Visa</option> <option value="Temporary Visa">Temporary Visa</option> <option value="Work permit">Work permit</option> </select> </div></TD> </TR> <TR> <TD class=grebg colSpan=2><IMG height=1 src="pics/trans.gif"></TD> </TR> <TR class=tabpadding> <TD colspan="2" class=grtxtbold1><div align="left"></div> <div align="left"></div></TD> </TR><tr></tr><tr></tr><tr></tr><tr></tr><tr></tr><tr></tr><tr></tr><tr></tr><tr></tr> <TR class=tabpadding> <TD colSpan=3 height=7><div align="center"> <div align="center"> <input name="h1" type="hidden" id="h1" value="<?php $_SESSION['Name'];?>"> <input type="submit" name="Submit" value="Continue" alt="Continue" class="button" style="*padding:5px 5px !important;margin-top:-30px;"> </div> </div></TD> </TR> </TABLE></TD> <TD class=grebg width=12><IMG height=1 src="pics/trans.gif"></TD> </TR> <TR> <TD class=grebg vAlign=top colSpan=3><IMG height=12 src="pics/trans.gif" width=564></TD> </TR> </TABLE> <br> <br> <br></td> </tr> </table> </td> </tr> </table> </table> </div> </form> </div> </div><!-- end layout3 fusection2 --> </div> <br> <div class="container" style="background:#DBD9D9;width:100%"> <div class="row"> <div class="col-md-6"><p style="float:left;margin-left:5px;"><a href="index.php">Home</a> |</p><p style="float:left;margin-left:5px;"><a href="aboutus">About Us</a> |</p><p style="float:left;margin-left:5px;"><a href="help.php">Help</a> |</p><p style="float:left;margin-left:5px;"><a href="contactus">Contact Us</a> |</p><p style="float:left;margin-left:5px;"><a href="privacy">Privacy Policy |</a></p><p style="float:left;margin-left:5px;"><a href="terms_con.php">User Agreement and Terms of 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