139 lines
6.4 KiB
PHP
139 lines
6.4 KiB
PHP
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<div class="form-box">
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<div class="boximage">
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<img src="<?php echo site_url(SITEVARS->Campaigns[0]->cover_photo);?>" class="img-fluid" />
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</div>
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<!-- <div class="infotext">
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<h1> <?php //echo SITEVARS->Campaigns[0]->title;?></h1>
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</div> -->
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<form method="post" action="#" id="enquiry-form">
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@csrf
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<input type="hidden" name="sources_id" value="3" />
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<input type="hidden" name="campaigns_id" value="<?php echo SITEVARS->Campaigns[0]->campaign_id; ?>" />
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<div class="form-row">
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<div class="col-12 col-sm-12 col-md-12 col-lg-12">
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<div class="form-group"><label for="from-name">Name</label><span class="required-input">*</span>
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<input class="form-control" type="text" id="from-name" name="name" required="">
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</div>
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</div>
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</div>
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<div class="form-row">
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<div class="col-12 col-sm-6 col-md-12 col-lg-6">
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<div class="form-group"><label for="from-email">Email</label><span class="required-input">*</span>
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<input class="form-control" type="email" id="from-email" name="email" required="">
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</div>
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</div>
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<div class="col-12 col-sm-6 col-md-12 col-lg-6">
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<div class="form-group"><label for="from-phone">Mobile Number</label><span class="required-input">*</span>
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<div class="input-group">
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<input class="form-control" type="text" id="from-phone" name="mobile" required="">
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</div>
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</div>
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</div>
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</div>
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<div class="form-row">
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<div class="col-12 col-sm-6 col-md-12 col-lg-6">
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<div class="form-group"><label for="from-qualifications">Highest Qualification</label><span class="required-input">*</span>
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<select class="form-control" id="from-qualifications" type="text" name="qualification" required="">
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<option value="">Select Qualification</option>
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<option value="SEE/SLC">SEE/SLC</option>
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<option value="A levels">A levels</option>
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<option value="10+2/PCL">10+2/PCL</option>
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<option value="Bachelors (3 years)">Bachelors (3 Years)</option>
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<option value="Bachelors (4 years)">Bachelors (4 Years)</option>
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<option value="Master's and Above">Master's and Above</option>
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</select>
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</div>
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</div>
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<div class="col-12 col-sm-6 col-md-12 col-lg-6">
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<div class="form-group"><label for="board">University / Board:</label><span class="required-input">*</span>
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<div class="input-group">
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<input class="form-control" type="text" id="board" name="board" required="" autocomplete="off">
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</div>
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</div>
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</div>
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</div>
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<div class="form-row">
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<div class="col-md-12">
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<div class="form-group"><label for="preferred_destination">Preferred Study Destination:</label><span class="required-input">*</span>
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<div class="select-group">
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<select name="preferred_destination" class="form-control field-info" required="">
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<option value="" selected="" disabled="">Preferred Study Destination *</option>
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<option value="study-in-australia">Study in Australia</option>
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<option value="study-in-new-zealand">Study in New Zealand</option>
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<option value="study-in-canada">Study in Canada</option>
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<option value="study-in-uk">Study in UK</option>
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<option value="study-in-usa">Study in USA</option>
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<option value="other">Others</option>
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</select>
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</div>
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</div>
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</div>
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</div>
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<div class="form-row">
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<div class="col-12 col-sm-12 col-md-12 col-lg-12">
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<div class="form-group"><label for="from-calltime">Message / Enquiry</label><span class="required-input">*</span>
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<textarea name="message" class="form-control" rows="5" re></textarea>
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</div>
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</div>
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</div>
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<div class="form-group">
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<div class="form-row">
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<input type="hidden" name="g-recaptcha-response" value="">
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<div class="col"><button class="btn btn-success btn-block" type="submit" id="submitButton">Submit <i class="fa fa-chevron-circle-right"></i></button></div>
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</div>
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</div>
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</div>
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</form>
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<?php //pre(SITEVARS->Campaigns[0]); ?>
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<div class="modal fade" id="success-modal" tabindex="-1" role="dialog" aria-labelledby="success-modal-label" aria-hidden="true">
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<div class="modal-dialog" role="document">
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<div class="modal-content">
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<div class="modal-header" style="display: none;">
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<h5 class="modal-title" id="success-modal-label">Success</h5>
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<button type="button" class="close" data-dismiss="modal" aria-label="Close">
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<span aria-hidden="true">×</span>
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</button>
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</div>
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<div class="modal-body">
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<div id="modal-text-area">
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</div>
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<div id="success-modal-qr">
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</div>
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<div id="canvas-area">
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</div>
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</div>
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<div class="modal-footer">
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<button type="button" id="downloadButton" class="btn btn-success full-width" style="width: 100%;">Download : Presidential Pass</button>
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</div>
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</div>
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</div>
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</div>
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<div class="modal fade" id="error-modal" tabindex="-1" role="dialog" aria-labelledby="error-modal-label" aria-hidden="true">
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<div class="modal-dialog" role="document">
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<div class="modal-content">
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<div class="modal-header">
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<h5 class="modal-title" id="error-modal-label">Form Validation Errors</h5>
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<button type="button" class="close" data-dismiss="modal" aria-label="Close">
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<span aria-hidden="true">×</span>
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</button>
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</div>
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<div class="modal-body">
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<!-- Error messages will be displayed here -->
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</div>
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<div class="modal-footer">
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<button type="button" class="btn btn-secondary" data-dismiss="modal">Close</button>
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</div>
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</div>
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</div>
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</div>
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</div>
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