<?php include "includes/inc.header.php" ?>



<div class="col-lg-12 mx-auto">

  <!-- partial -->
  <div class="container-fluid page-body-wrapper">
    <p>&nbsp;</p>
    <h2 class="text-center mb-4">MyBooster Registration</h2>
    <div class="main-panel">
      <div class="content-wrapper">
        <div class="row">
          <div class="col-md-5 grid-margin" id="img_register">
            <div class="card">
              <img src="images/register.png">
            </div>
          </div>


          <div class="col-md-7">
            <div class="card">
              <div class="card-body">
                <h4 class="card-title">Become a Member</h4>
                <form id="frm_reg" action="" method="POST">
                  <div>
                    <h3>Account</h3>
                    <section>
                      <h6>Account</h6>
                      <div class="row">
                        <div class="form-group col-md-6">
                          <div class="form-radio form-radio-flat">
                            <label class="form-check-label">
                              <input type="radio" class="form-check-input" name="membershipRadios" id="membershipRadios1" value="1" checked="">
                              Individual
                              <i class="input-helper"></i></label>
                          </div>
                        </div>
                        <div class="form-group col-md-6">
                          <div class="form-radio form-radio-flat">
                            <label class="form-check-label">
                              <input type="radio" class="form-check-input" name="membershipRadios" id="membershipRadios2" value="2">
                              Company
                              <i class="input-helper"></i></label>
                          </div>
                        </div>
                      </div>
                      <div class="form-group col-md-8">
                        <label>Sponsor ID: *</label>
                        <input type="text" name="sponsorID" id="sponsorID" class="form-control" aria-describedby="sponsorName" placeholder="Enter Sponsor ID" maxlength="9">
                        <small name="sponsorName" id="sponsorName" class="form-text text-muted"></small>
                      </div>
                      <div class="form-group col-md-8">
                        <label>Placement ID:</label>
                        <input type="text" name="placementID" id="placementID" class="form-control" aria-describedby="placementName" placeholder="Enter Placement ID" maxlength="9">
                        <small name="placementName" id="placementName" class="form-text text-muted"></small>
                      </div>
                      <div class="form-group col-md-8">
                        <label>Select Leg:</label>
                        <select name="cmbPlacement" id="cmbPlacement" class="form-control" required>
                          <option value="left">Left</option>
                          <option value="right">Right</option>
                        </select>
                      </div>
                    </section>
                    <h3>Profile</h3>
                    <section>
                      <h6>Profile</h6>
                      <div class="row">
                        <div class="form-group col-md-6">
                          <label>First Name: *</label>
                          <input type="text" name="firstName" id="firstName" class="form-control" required aria-invalid="true" aria-describedby="firstNameHelp" placeholder="Enter First Name">
                          <small id="firstNameHelp" class="form-text text-muted"></small>
                        </div>
                        <div class="form-group col-md-6">
                          <label>Last Name: *</label>
                          <input type="text" name="lastName" id="lastName" class="form-control" aria-invalid="true" aria-describedby="lastNameHelp" placeholder="Last Name">
                          <small id="lastNameHelp" class="form-text text-muted"></small>
                        </div>
                      </div>
                      <div class="row">
                        <div class="form-group col-md-6">
                          <label>Email Address: *</label>
                          <input type="email" name="emailID" id="emailID" class="form-control" aria-invalid="true" aria-describedby="emailHelp" placeholder="Email Address" type="email">
                          <small id="emailHelp" class="form-text text-muted"></small>
                        </div>
                        <div class="form-group col-md-6">
                          <label>Mobile Number: *</label>
                          <input type="tel" name="mobileNumber" id="mobileNumber" class="form-control" placeholder="Mobile Number" maxlength="10">
                        </div>
                      </div>
                      <div class="row">
                        <div class="col-md-12">
                          <div class="form-group">
                            <div class="form-check form-check-flat">
                              <label class="form-check-label">
                                <input type="checkbox" class="form-check-input" checked><i class="input-helper"></i>
                                I accept <span><a href="https://mybooster.biz/pages/privacy-policy" target="_blank">Privacy Policy</a></span> & <span><a href="https://mybooster.biz/pages/code-of-ethics" target="_blank">Code of Ethics</a></span></label>
                            </div>
                          </div>
                        </div>
                        <input type="text" name="countryCode" id="countryCode" class="form-control" hidden>
                      </div>
                      <div class="dot-opacity-loader" id="loader_Registration">
                        <span></span>
                        <span></span>
                        <span></span>
                      </div>
                    </section>
                  </div>
                </form>
              </div>
            </div>
          </div>
        </div>

      </div>
      <!-- content-wrapper ends -->



      <?php include "includes/inc.footer.php" ?>