-
Notifications
You must be signed in to change notification settings - Fork 0
/
index.html
199 lines (160 loc) · 8.66 KB
/
index.html
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8" />
<meta name="viewport" content="width=device-width, initial-scale=1.0" />
<link rel="stylesheet" href="style.css" />
<link rel="=stylesheet" href="https://unicons.iconscout.com/release/v4.0.0/css/line.css">
<title>Registration Page</title>
<!-- Start VWO Async SmartCode -->
<script type='text/javascript' id='vwoCode'>
window._vwo_code=window._vwo_code || (function() {
var account_id=673315,
version=1.4,
settings_tolerance=2000,
library_tolerance=2500,
use_existing_jquery=false,
is_spa=1,
hide_element='body',
/* DO NOT EDIT BELOW THIS LINE */
f=false,d=document,vwoCodeEl=document.querySelector('#vwoCode'),code={use_existing_jquery:function(){return use_existing_jquery},library_tolerance:function(){return library_tolerance},finish:function(){if(!f){f=true;var e=d.getElementById('_vis_opt_path_hides');if(e)e.parentNode.removeChild(e)}},finished:function(){return f},load:function(e){var t=d.createElement('script');t.fetchPriority='high';t.src=e;t.type='text/javascript';t.innerText;t.onerror=function(){_vwo_code.finish()};d.getElementsByTagName('head')[0].appendChild(t)},getVersion:function(){return version},getMatchedCookies:function(e){var t=[];if(document.cookie){t=document.cookie.match(e)||[]}return t},getCombinationCookie:function(){var e=code.getMatchedCookies(/(?:^|;)\s?(_vis_opt_exp_\d+_combi=[^;$]*)/gi);e=e.map(function(e){try{var t=decodeURIComponent(e);if(!/_vis_opt_exp_\d+_combi=(?:\d+,?)+\s*$/.test(t)){return''}return t}catch(e){return''}});var i=[];e.forEach(function(e){var t=e.match(/([\d,]+)/g);t&&i.push(t.join('-'))});return i.join('|')},init:function(){window.settings_timer=setTimeout(function(){_vwo_code.finish()},settings_tolerance);var e=d.createElement('style'),t=hide_element?hide_element+'{opacity:0 !important;filter:alpha(opacity=0) !important;background:none !important;}':'',i=d.getElementsByTagName('head')[0];e.setAttribute('id','_vis_opt_path_hides');vwoCodeEl&&e.setAttribute('nonce',vwoCodeEl.nonce);e.setAttribute('type','text/css');if(e.styleSheet)e.styleSheet.cssText=t;else e.appendChild(d.createTextNode(t));i.appendChild(e);var n=this.getCombinationCookie();this.load('https://dev.visualwebsiteoptimizer.com/j.php?a='+account_id+'&u='+encodeURIComponent(d.URL)+'&f='+ +is_spa+'&vn='+version+(n?'&c='+n:''));return settings_timer}};window._vwo_settings_timer = code.init();return code;}());
</script>
<!-- End VWO Async SmartCode -->
</head>
<body>
<div class="container">
<header>Registration Form</header>
<form action="#" >
<div class="form-first">
<div class="details personal">
<span class="title">Personal Details</span>
<div class="fields">
<div class="input field">
<label>First Name</label>
<input type="text" placeholder="Enter Your First Name" required>
</div>
<div class="input field">
<label>Last Name</label>
<input type="text" placeholder="Enter Your Last Name" required>
</div>
<div class="input field">
<label>Date Of Birth</label>
<input type="date" placeholder="Enter Your Date of Birth" required>
</div>
<div class="input field">
<label>Email</label>
<input type="text" placeholder="Enter Your Email" required>
</div>
<div class="input field">
<label>Mobile Number</label>
<input type="number" placeholder="Enter Your Mobile Number" required>
</div>
<div class="input field">
<label>Gender</label>
<input type="text" placeholder="Enter Your Gender" required>
</div>
<div class="input field">
<label>Occupation</label>
<input type="text" placeholder="Enter Your Occupation" required>
</div>
<div class="input field">
<label>Address</label>
<input type="text" placeholder="Enter Your Address" required>
</div>
</div>
</div>
<div class="details ID">
<span class="title">Identity Details</span>
<div class="fields">
<div class="input field">
<label>Id Type</label>
<input type="text" placeholder="Enter ID Type" required>
</div>
<div class="input field">
<label>Id Number</label>
<input type="number" placeholder="Enter ID Number" required>
</div>
<div class="input field">
<label>Issued Date</label>
<input type="date" placeholder="Enter Your Date of Birth" required>
</div>
<div class="input field">
<label>Issued State</label>
<input type="text" placeholder="Enter Issued State" required>
</div>
<div class="input field">
<label>Expiry Date</label>
<input type="date" placeholder="Enter Your Mobile Number" required>
</div>
<div class="input field">
<label>Issued Authority</label>
<input type="text" placeholder="Enter Your Gender" required>
</div>
</div>
<button class="nextbtn">
<span class="btnText">Next</span>
<i class="uil uil navigator"></i>
</button>
</div>
</div>
<div class="form-Second">
<div class="Address details">
<span class="title">Address Details</span>
<div class="fields">
<div class="input field">
<label>Address Type</label>
<input type="text" placeholder="Enter Address type" required>
</div>
<div class="input field">
<label>Nationality</label>
<input type="text" placeholder="Enter Your Nationality" required>
</div>
<div class="input field">
<label>State</label>
<input type="text" placeholder="Enter Your State" required>
</div>
<div class="input field">
<label>District</label>
<input type="text" placeholder="Enter Your District" required>
</div>
<div class="input field">
<label>Block Number</label>
<input type="number" placeholder="Enter Block No." required>
</div>
<div class="input field">
<label>Ward Number</label>
<input type="number" placeholder="Enter Your Ward No." required>
</div>
</div>
</div>
<div class="Family details">
<span class="title">Family Details</span>
<div class="fields">
<div class="input field">
<label>Father's Name</label>
<input type="text" placeholder="Enter Father's Name" required>
</div>
<div class="input field">
<label>Mother's Name</label>
<input type="number" placeholder="Enter Mother Nmae" required>
</div>
<div class="input field">
<label>Grand-Father Name</label>
<input type="date" placeholder="Enter Your Grand-Father Name" required>
</div>
<div class="input field">
<label>Grand-Mother Name</label>
<input type="text" placeholder="Enter Grand-Mother Name" required>
</div>
</div>
<button class="nextbtn">
<span class="btnText">Next</span>
<i class="uil uil navigator"></i>
</button>
</div>
</div>
</form>
</div>
<!-- Code injected by live-server -->
</body>
</html>