@extends('masterpage')

@section('newpagecontent')
   <section class="inner_header_back ">
        <div class="container pb-5 text-center padding-b-20">
            <div class="col-12 p-0 text-ali-left">
                <p class="animated zoomInDown h3 inner-banner-text" style=" " >Mentor/Instructor Registration<br>
                </p>
            </div>
            <!--<div class="col-12 mt-5-sm-3 p-0 text-ali-left">-->
            <!--    <a class="appao-btn" href="register"><span class="blink">Register Now</span></a>-->

            <!--</div>-->
             
        </div>
    </section>


<section class="workshop-section" style="padding-bottom: 120px;">
    <hr style="margin-top:0">
    <div class="container padding0 " style="padding: 0 5px;">
        <span style="font-weight:500;font-size:1.2em;">Register for Mentor/Instructor</span> <br> <br>
<!--	<span style="font-weight:400">Internship at Bennett University is offered free of cost. The fees charged is for Workshop / Hostel. </span>--> 	<span style="font-weight:400"> </span> <br> <br>


        <form action="{{ url('/membershipreg') }}" method="post" class="form-horizontal" onsubmit="return confirm('Please confirm All Details');" enctype="multipart/form-data">

            @if(!empty($errors->first()))
                <div class="row col-lg-12">
                    <div class="alert alert-danger">
                        <span>{{ $errors->first() }}</span>
                    </div>
                </div>
            @endif
            <input type="hidden" name="_token" value = "{{ csrf_token() }}" />
            <div class="col-sm-12 text-left padding0">
                <div class="row">
                    <div class="col-sm-6">
                        <div class="form-group">
                            <label class="control-label" for="fullname">Full Name<span class="required">*</span></label>
                            <input id="institue" name="institue" class="form-control input-md" type="text" value="{{ old('institue') }}">
                            @if ($errors->has('institue'))
                                <small class="text-danger">{{ $errors->first('institue') }}</small>
                            @endif
                        </div>
                    </div>
                    <div class="col-sm-6">
                        <div class="form-group">
                            <label class="control-label" for="fullname">Date of Birth<span class="required">*</span></label>
                            <input id="institue" name="institue" class="form-control input-md" type="date" value="{{ old('institue') }}">
                            @if ($errors->has('institue'))
                                <small class="text-danger">{{ $errors->first('institue') }}</small>
                            @endif
                        </div>
                    </div>
                </div>
            </div>
         
              <div class="col-sm-12 text-left padding0">
                    <div class="row">
                         <div class="col-sm-12">
                            <div class="form-group">
                                <label class="control-label" for="country">Education Qualification 1</label>
                            </div>
                        </div>
                        
                    </div>
                </div>

            <div class="col-sm-12 text-left padding0">
                    <div class="row">
                       
                       <div class="col-sm-4">
                        <div class="form-group">
                            <label class="control-label" for="fullname">Institution<span class="required">*</span></label>
                            <input id="institue" name="institue" class="form-control input-md" type="text" value="{{ old('institue') }}">
                            @if ($errors->has('institue'))
                                <small class="text-danger">{{ $errors->first('institue') }}</small>
                            @endif
                        </div>
                    </div>
                    <div class="col-sm-4">
                        <div class="form-group">
                            <label class="control-label" for="fullname">Name of the Degree<span class="required">*</span></label>
                            <input id="institue" name="institue" class="form-control input-md" type="text" value="{{ old('institue') }}">
                            @if ($errors->has('institue'))
                                <small class="text-danger">{{ $errors->first('institue') }}</small>
                            @endif
                        </div>
                    </div>
                        <div class="col-sm-4">
                            <div class="form-group">
                                <label class="control-label" for="mail">Year of Award<span class="required">*</span></label>
                                <input id="mail" name="email" class="form-control input-md" type="date"   value="{{ old('email') }}">
                                @if ($errors->has('email'))
                                    <small class="text-danger">{{ $errors->first('email') }}</small>

                                @endif
                                <span id="error_email"></span>
                            </div>
                        </div>
                    </div>
                </div>
                
              <div class="col-sm-12 text-left padding0">
                    <div class="row">
                         <div class="col-sm-12">
                            <div class="form-group">
                                <label class="control-label" for="country">Education Qualification 2</label>
                            </div>
                        </div>
                        
                    </div>
                </div>

            <div class="col-sm-12 text-left padding0">
                    <div class="row">
                       <div class="col-sm-4">
                        <div class="form-group">
                            <label class="control-label" for="fullname">Institution</label>
                            <input id="institue" name="institue" class="form-control input-md" type="text" value="{{ old('institue') }}">
                            @if ($errors->has('institue'))
                                <small class="text-danger">{{ $errors->first('institue') }}</small>
                            @endif
                        </div>
                    </div>
                     <div class="col-sm-4">
                        <div class="form-group">
                            <label class="control-label" for="fullname">Name of the Degree</label>
                            <input id="institue" name="institue" class="form-control input-md" type="text" value="{{ old('institue') }}">
                            @if ($errors->has('institue'))
                                <small class="text-danger">{{ $errors->first('institue') }}</small>
                            @endif
                        </div>
                    </div>
                        <div class="col-sm-4">
                            <div class="form-group">
                                <label class="control-label" for="mail">Year of Award</label>
                                <input id="mail" name="email" class="form-control input-md" type="date"   value="{{ old('email') }}">
                                @if ($errors->has('email'))
                                    <small class="text-danger">{{ $errors->first('email') }}</small>

                                @endif
                                <span id="error_email"></span>
                            </div>
                        </div>
                    </div>
                </div>
               
              <div class="col-sm-12 text-left padding0">
                    <div class="row">
                         <div class="col-sm-12">
                            <div class="form-group">
                                <label class="control-label" for="country">Education Qualification 3</label>
                            </div>
                        </div>
                        
                    </div>
                </div>

            <div class="col-sm-12 text-left padding0">
                    <div class="row">
                       
                       <div class="col-sm-4">
                        <div class="form-group">
                            <label class="control-label" for="fullname">Institution</label>
                            <input id="institue" name="institue" class="form-control input-md" type="text" value="{{ old('institue') }}">
                            @if ($errors->has('institue'))
                                <small class="text-danger">{{ $errors->first('institue') }}</small>
                            @endif
                        </div>
                    </div>
                     <div class="col-sm-4">
                        <div class="form-group">
                            <label class="control-label" for="fullname">Name of the Degree</label>
                            <input id="institue" name="institue" class="form-control input-md" type="text" value="{{ old('institue') }}">
                            @if ($errors->has('institue'))
                                <small class="text-danger">{{ $errors->first('institue') }}</small>
                            @endif
                        </div>
                    </div>
                        <div class="col-sm-4">
                            <div class="form-group">
                                <label class="control-label" for="mail">Year of Award</label>
                                <input id="mail" name="email" class="form-control input-md" type="date"   value="{{ old('email') }}">
                                @if ($errors->has('email'))
                                    <small class="text-danger">{{ $errors->first('email') }}</small>

                                @endif
                                <span id="error_email"></span>
                            </div>
                        </div>
                    </div>
                </div>
             
              <div class="col-sm-12 text-left padding0">
                    <div class="row">
                         <div class="col-sm-12">
                            <div class="form-group">
                                <label class="control-label" for="country">Certifications (If you have too many then only give important ones)</label>
                            </div>
                        </div>
                        
                    </div>
                </div>

            <div class="col-sm-12 text-left padding0">
                    <div class="row">
                       
                       <div class="col-sm-4">
                            <div class="form-group">
                                <label class="control-label" for="country">Name of the Certification 1</label>
                                <br style="margin-bottom: 25px;">
                                <input type="file" id="letter" name="letter">
                                @if ($errors->has('letter'))
                                    <small class="text-danger">{{ $errors->first('letter') }}</small>
                                @endif
                            </div>
                        </div>
                        
                        <div class="col-sm-4">
                            <div class="form-group">
                                <label class="control-label" for="country">Name of the Certification 2</label>
                                <br style="margin-bottom: 25px;">
                                <input type="file" id="letter" name="letter">
                               
                                @if ($errors->has('letter'))
                                    <small class="text-danger">{{ $errors->first('letter') }}</small>
                                @endif
                            </div>
                        </div>
                         <div class="col-sm-4">
                            <div class="form-group">
                                <label class="control-label" for="country">Name of the Certification 3</label>
                                <br style="margin-bottom: 25px;">
                                <input type="file" id="letter" name="letter" title = "Choose a video please">
                                 
                                @if ($errors->has('letter'))
                                    <small class="text-danger">{{ $errors->first('letter') }}</small>
                                @endif
                            </div>
                        </div>
                    </div>
                </div>
                
                <div class="col-sm-12 text-left padding0">
                    <div class="row">
                        <div class="col-sm-3">
                        <div class="form-group">
                            <label class="control-label" for="mobile">Address<span class="required">*</span></label>
                            <input id="country" name="country" class="form-control input-md" type="text" value="{{ old('country') }}">
                            @if ($errors->has('country'))
                                <small class="text-danger">{{ $errors->first('country') }}</small>

                            @endif
                            <span id="error_country"></span>
                        </div>
                    </div>
                    <div class="col-sm-3">
                        <div class="form-group">
                            <label class="control-label" for="mobile">Country<span class="required">*</span></label>
                            <input id="country" name="country" class="form-control input-md" type="text" value="{{ old('country') }}">
                            @if ($errors->has('country'))
                                <small class="text-danger">{{ $errors->first('country') }}</small>

                            @endif
                            <span id="error_country"></span>
                        </div>
                    </div>
                    
                    <div class="col-sm-3">
                            <div class="form-group">
                                <label class="control-label" for="altemail">State</label><span class="required"> *</span>
                                <input id="state" name="state" class="form-control input-md" type="text" value="{{ old('state') }}">
                                @if ($errors->has('state'))
                                    <small class="text-danger">{{ $errors->first('state') }}</small>
                                @endif
                                <span id="error_state"></span>

                            </div>
                        </div>
                        
                        <div class="col-sm-3">
                            <div class="form-group">
                                <label class="control-label" for="altemail">City</label><span class="required"> *</span>
                                <input id="city" name="city" class="form-control input-md" type="text" value="{{ old('city') }}">
                                @if ($errors->has('city'))
                                    <small class="text-danger">{{ $errors->first('city') }}</small>
                                @endif
                                <span id="error_city"></span>

                            </div>
                        </div>
                    
                        <div class="col-sm-3">
                            <div class="form-group">
                                <label class="control-label" for="email">District <span class="required">*</span></label>
                                <input id="district" name="district" class="form-control input-md" type="text" value="{{ old('district') }}">
                                 <span id="error_district"></span>
                                @if ($errors->has('district'))
                                    <small class="text-danger">{{ $errors->first('district') }}</small>
                                @endif
                                <span id="error_district"></span>
                            </div>
                        </div>
                        
                     <div class="col-sm-3">
                        <div class="form-group">
                            <label class="control-label" for="parentmobile">Pin Code<span class="required">*</span></label>
                            <input id="pin" name="pin" class="form-control input-md" type="text" maxlength="6" value="{{ old('pin') }}">
                            @if ($errors->has('pin'))
                                <small class="text-danger">{{ $errors->first('pin') }}</small>

                            @endif
                            <span id="error_pin"></span>
                        </div>
                    </div>
                        
                    </div>
                </div>

         <div class="col-sm-12 text-left padding0">
                    <div class="row">
                        
                          <div class="col-sm-3">
                            <div class="form-group">
                                <label class="control-label" for="email">Nearest Airport <span class="required">*</span></label>
                                <input id="district" name="district" class="form-control input-md" type="text" value="{{ old('district') }}">
                                 <span id="error_district"></span>
                                @if ($errors->has('district'))
                                    <small class="text-danger">{{ $errors->first('district') }}</small>
                                @endif
                                <span id="error_district"></span>
                            </div>
                        </div>
                         <div class="col-sm-3">
                            <div class="form-group">
                                <label class="control-label" for="email">Distance of your home from Airport <span class="required">*</span></label>
                                <input id="district" name="district" class="form-control input-md" type="text" value="{{ old('district') }}">
                                 <span id="error_district"></span>
                                @if ($errors->has('district'))
                                    <small class="text-danger">{{ $errors->first('district') }}</small>
                                @endif
                                <span id="error_district"></span>
                            </div>
                        </div>
                         <div class="col-sm-3">
                            <div class="form-group">
                                <label class="control-label" for="email">Time taken to reach nearest Airport<span class="required">*</span></label>
                                <input id="district" name="district" class="form-control input-md" type="text" value="{{ old('district') }}">
                                 <span id="error_district"></span>
                                @if ($errors->has('district'))
                                    <small class="text-danger">{{ $errors->first('district') }}</small>
                                @endif
                                <span id="error_district"></span>
                            </div>
                        </div>
                        <div class="col-sm-3">
                            <div class="form-group">
                                <label class="control-label" for="email">Nearest Railway Station<span class="required">*</span></label>
                                <input id="district" name="district" class="form-control input-md" type="text" value="{{ old('district') }}">
                                 <span id="error_district"></span>
                                @if ($errors->has('district'))
                                    <small class="text-danger">{{ $errors->first('district') }}</small>
                                @endif
                                <span id="error_district"></span>
                            </div>
                        </div>
                    </div>
                </div>
                
              <div class="col-sm-12 text-left padding0">
                    <div class="row">
                         <div class="col-sm-12">
                            <div class="form-group">
                                <label class="control-label" for="country">Experience 1</label>
                            </div>
                        </div>
                    </div>
                </div>

            <div class="col-sm-12 text-left padding0">
                    <div class="row">
                      <div class="col-sm-4">
                            <div class="form-group">
                                <label class="control-label" for="email">Name of the Institution/Industry<span class="required">*</span></label>
                                <input id="district" name="district" class="form-control input-md" type="text" value="{{ old('district') }}">
                                 <span id="error_district"></span>
                                @if ($errors->has('district'))
                                    <small class="text-danger">{{ $errors->first('district') }}</small>
                                @endif
                                <span id="error_district"></span>
                            </div>
                        </div>
                        
                         <div class="col-sm-4">
                            <div class="form-group">
                                <label class="control-label" for="email">Designation<span class="required">*</span></label>
                                <input id="district" name="district" class="form-control input-md" type="text" value="{{ old('district') }}">
                                 <span id="error_district"></span>
                                @if ($errors->has('district'))
                                    <small class="text-danger">{{ $errors->first('district') }}</small>
                                @endif
                                <span id="error_district"></span>
                            </div>
                        </div>
                         <div class="col-sm-2">
                            <div class="form-group">
                                <label class="control-label" for="email">Start Date <span class="required">*</span></label>
                                <input id="district" name="district" class="form-control input-md" type="date" value="{{ old('district') }}">
                                 <span id="error_district"></span>
                                @if ($errors->has('district'))
                                    <small class="text-danger">{{ $errors->first('district') }}</small>
                                @endif
                                <span id="error_district"></span>
                            </div>
                        </div>
                        <div class="col-sm-2">
                            <div class="form-group">
                                <label class="control-label" for="email">End Date<span class="required">*</span></label>
                                <input id="district" name="district" class="form-control input-md" type="date" value="{{ old('district') }}">
                                 <span id="error_district"></span>
                                @if ($errors->has('district'))
                                    <small class="text-danger">{{ $errors->first('district') }}</small>
                                @endif
                                <span id="error_district"></span>
                            </div>
                        </div>
                      
                    </div>
                </div>
                
              <div class="col-sm-12 text-left padding0">
                    <div class="row">
                         <div class="col-sm-12">
                            <div class="form-group">
                                <label class="control-label" for="country">Experience 2</label>
                            </div>
                        </div>
                        
                    </div>
                </div>

            <div class="col-sm-12 text-left padding0">
                    <div class="row">
                       
                      <div class="col-sm-4">
                            <div class="form-group">
                                <label class="control-label" for="email">Name of the Institution/Industry</label>
                                <input id="district" name="district" class="form-control input-md" type="text" value="{{ old('district') }}">
                                 <span id="error_district"></span>
                                @if ($errors->has('district'))
                                    <small class="text-danger">{{ $errors->first('district') }}</small>
                                @endif
                                <span id="error_district"></span>
                            </div>
                        </div>
                        
                         <div class="col-sm-4">
                            <div class="form-group">
                                <label class="control-label" for="email">Designation</label>
                                <input id="district" name="district" class="form-control input-md" type="text" value="{{ old('district') }}">
                                 <span id="error_district"></span>
                                @if ($errors->has('district'))
                                    <small class="text-danger">{{ $errors->first('district') }}</small>
                                @endif
                                <span id="error_district"></span>
                            </div>
                        </div>
                         <div class="col-sm-2">
                            <div class="form-group">
                                <label class="control-label" for="email">Start Date </label>
                                <input id="district" name="district" class="form-control input-md" type="date" value="{{ old('district') }}">
                                 <span id="error_district"></span>
                                @if ($errors->has('district'))
                                    <small class="text-danger">{{ $errors->first('district') }}</small>
                                @endif
                                <span id="error_district"></span>
                            </div>
                        </div>
                        <div class="col-sm-2">
                            <div class="form-group">
                                <label class="control-label" for="email">End Date</label>
                                <input id="district" name="district" class="form-control input-md" type="date" value="{{ old('district') }}">
                                 <span id="error_district"></span>
                                @if ($errors->has('district'))
                                    <small class="text-danger">{{ $errors->first('district') }}</small>
                                @endif
                                <span id="error_district"></span>
                            </div>
                        </div>
                      
                    </div>
                </div>
                
              <div class="col-sm-12 text-left padding0">
                    <div class="row">
                         <div class="col-sm-12">
                            <div class="form-group">
                                <label class="control-label" for="country">Experience 3</label>
                            </div>
                        </div>
                        
                    </div>
                </div>

            <div class="col-sm-12 text-left padding0">
                    <div class="row">
                       
                      <div class="col-sm-4">
                            <div class="form-group">
                                <label class="control-label" for="email">Name of the Institution/Industry</label>
                                <input id="district" name="district" class="form-control input-md" type="text" value="{{ old('district') }}">
                                 <span id="error_district"></span>
                                @if ($errors->has('district'))
                                    <small class="text-danger">{{ $errors->first('district') }}</small>
                                @endif
                                <span id="error_district"></span>
                            </div>
                        </div>
                        
                         <div class="col-sm-4">
                            <div class="form-group">
                                <label class="control-label" for="email">Designation</label>
                                <input id="district" name="district" class="form-control input-md" type="text" value="{{ old('district') }}">
                                 <span id="error_district"></span>
                                @if ($errors->has('district'))
                                    <small class="text-danger">{{ $errors->first('district') }}</small>
                                @endif
                                <span id="error_district"></span>
                            </div>
                        </div>
                         <div class="col-sm-2">
                            <div class="form-group">
                                <label class="control-label" for="email">Start Date </label>
                                <input id="district" name="district" class="form-control input-md" type="date" value="{{ old('district') }}">
                                 <span id="error_district"></span>
                                @if ($errors->has('district'))
                                    <small class="text-danger">{{ $errors->first('district') }}</small>
                                @endif
                                <span id="error_district"></span>
                            </div>
                        </div>
                        <div class="col-sm-2">
                            <div class="form-group">
                                <label class="control-label" for="email">End Date</label>
                                <input id="district" name="district" class="form-control input-md" type="date" value="{{ old('district') }}">
                                 <span id="error_district"></span>
                                @if ($errors->has('district'))
                                    <small class="text-danger">{{ $errors->first('district') }}</small>
                                @endif
                                <span id="error_district"></span>
                            </div>
                        </div>
                      
                    </div>
                </div>
                
              
            <div class="col-sm-12 text-left padding0">
                    <div class="row">
                       
                      <div class="col-sm-4">
                            <div class="form-group">
                                <label class="control-label" for="email">Broad Expertise that you can teach along with hands on lab at coding level involvement<span class="required">*</span></label>
                                <input id="district" name="district" class="form-control input-md" type="text" value="{{ old('district') }}">
                                 <span id="error_district"></span>
                                @if ($errors->has('district'))
                                    <small class="text-danger">{{ $errors->first('district') }}</small>
                                @endif
                                <span id="error_district"></span>
                            </div>
                        </div>
                        
                         <div class="col-sm-4">
                            <div class="form-group">
                                <label class="control-label" for="email">Specific topics that you can teach along with hands on lab at coding level involvement<span class="required">*</span></label>
                                <input id="district" name="district" class="form-control input-md" type="text" value="{{ old('district') }}">
                                 <span id="error_district"></span>
                                @if ($errors->has('district'))
                                    <small class="text-danger">{{ $errors->first('district') }}</small>
                                @endif
                                <span id="error_district"></span>
                            </div>
                        </div>
                         <div class="col-sm-4">
                            <div class="form-group">
                                <label class="control-label" for="email">Expertise areas is which you can mentor real life projects to teams with code level involvement<span class="required">*</span></label>
                                <input id="district" name="district" class="form-control input-md" type="text" value="{{ old('district') }}">
                                 <span id="error_district"></span>
                                @if ($errors->has('district'))
                                    <small class="text-danger">{{ $errors->first('district') }}</small>
                                @endif
                                <span id="error_district"></span>
                            </div>
                        </div>
                         <div class="col-sm-4">
                            <div class="form-group">
                                <label class="control-label" for="email">Any Video Link of at least 5 minute of your teaching</label>
                                <input id="district" name="district" class="form-control input-md" type="text" value="{{ old('district') }}">
                                 <span id="error_district"></span>
                                @if ($errors->has('district'))
                                    <small class="text-danger">{{ $errors->first('district') }}</small>
                                @endif
                                <span id="error_district"></span>
                            </div>
                        </div>
                        <div class="col-sm-4">
                            <div class="form-group">
                                <label class="control-label" for="email">How much days per month you can spare for this<span class="required">*</span></label>
                                <input id="district" name="district" class="form-control input-md" type="text" value="{{ old('district') }}">
                                 <span id="error_district"></span>
                                @if ($errors->has('district'))
                                    <small class="text-danger">{{ $errors->first('district') }}</small>
                                @endif
                                <span id="error_district"></span>
                            </div>
                        </div>
                         <div class="col-sm-4">
                            <div class="form-group">
                                <label class="control-label" for="email">Any other highlights of yours<span class="required">*</span></label>
                                <input id="district" name="district" class="form-control input-md" type="text" value="{{ old('district') }}">
                                 <span id="error_district"></span>
                                @if ($errors->has('district'))
                                    <small class="text-danger">{{ $errors->first('district') }}</small>
                                @endif
                                <span id="error_district"></span>
                            </div>
                        </div>
                         <div class="col-sm-4">
                            <div class="form-group">
                                <label class="control-label" for="email">Upload CV<span class="required">*</span></label>
                                <input id="district" name="district" class="form-control input-md" type="file" value="{{ old('district') }}">
                                 <span id="error_district"></span>
                                @if ($errors->has('district'))
                                    <small class="text-danger">{{ $errors->first('district') }}</small>
                                @endif
                                <span id="error_district"></span>
                            </div>
                        </div>
                         <div class="col-sm-4">
                            <div class="form-group">
                                <label class="control-label" for="email">Upload Photo<span class="required">*</span></label>
                                <input id="district" name="district" class="form-control input-md" type="file" value="{{ old('district') }}">
                                 <span id="error_district"></span>
                                @if ($errors->has('district'))
                                    <small class="text-danger">{{ $errors->first('district') }}</small>
                                @endif
                                <span id="error_district"></span>
                            </div>
                        </div>
                    </div>
                </div>

            
           {{-- <input type="hidden" name="otpverification" value="" id="otpverification">--}}

            <div class="row">

               <div class="container text-left padding0 text-center">
                   
                   <!-----------this button is false-------------------------------------------->  
                   
                    <!--<button id="register" name="" class="btn btn-info" style="" disabled>Register</button>-->
                  <!-----------this line is commented for payment-------------------------------------------->  
                  
                  <!--<button id="register" name="register" class="btn btn-info" style="" >Register</button>-->
                  <input type="submit" value="Submit" class="btn btn-info" id="submit">
                   
                </div> 

            </div>
            <!--{{ csrf_field() }}-->

        </form>
        
    </div>
    
    
    <div class="modal fade location-popup" id="getCodeModal" tabindex="-1" role="dialog" aria-labelledby="myModalLabel" aria-hidden="true" style="">
        <div class="modal-dialog modal-lg ">
            <div class="modal-content" style="border: none;">
                <div class="modal-header">

                    <h5 class="modal-title" id="myModalLabel"> Seat Avaibility </h5>
                    <button type="button" class="close" data-dismiss="modal" aria-label="Close"><span aria-hidden="true">&times;</span></button>
                </div>
                <div class="modal-body" id="getCode" style="min-height: 100px;">

                </div>
            </div>
        </div>
    </div>
</section>

@endsection