<div class="col-sm-6">
<div class="form-group">
<label for="p_number">Phone Number <span class="red-star">*</span></label>
<input type="tel" class="form-control" required="" name="runner_phonenumber" id="runner_phonenumber" placeholder="(770 493-3934)" value="<?php
echo $runner_phonenumber;
?>
">
</div>
</div>
<div class="col-sm-6">
<div class="form-group">
<label for="city">Country <span class="red-star">*</span></label>
<select name="runner_country" class="form-control" id="runner_country">
<option value="Please Select">Select Your Country</option>
<?php
$runner_country_select = runner_add_country_select();
foreach ($runner_country_select as $each_country) {
$selected = $runner_country == $each_country ? 'selected="selected"' : '';
echo '<option ' . $selected . ' value="' . $each_country . '">' . $each_country . '</option>';
}
?>
</select>
</div>
</div>
</div>
<div class="row">
<div class="col-sm-4">
<div class="form-group">
<label for="p_number">Gender <span class="red-star">*</span></label>
<div>
<label class="radio-inline">
function pippin_registration_form_fields()
{
ob_start();
?>
<h3 class="pippin_header">
<?php
//_e('Register New Account');
?>
</h3>
<?php
// show any error messages after form submission
pippin_show_error_messages();
?>
<form id="marathon_registration_form" class="registration_form" action="" method="POST">
<!--form fields here-->
<div class="row">
<div class="col-sm-12 text-center mb-30">
<h3 data-text-color="#219b48"><strong>ALEH Ascend Marathon Registarion</strong></h3>
</div>
<div class="col-sm-6">
<div class="form-group">
<label for="f_name">First Name <span class="red-star">*</span></label>
<input type="text" class="form-control" required="" name="runner_first_name" id="runner_first_name" placeholder="John">
</div>
</div>
</div>
<div class="row">
<div class="col-sm-6">
<div class="form-group">
<label for="l_name">Last Name <span class="red-star">*</span></label>
<input type="text" class="form-control" required="" name="runner_last_name" id="runner_last_name" placeholder="Smith">
</div>
</div>
</div>
<div class="row">
<div class="col-sm-6">
<div class="form-group">
<label for="address">Address <span class="red-star">*</span></label>
<input type="text" class="form-control" required="" name="runner_address1" id="runner_address1" placeholder="9009 Woodwerd Way">
</div>
</div>
<div class="col-sm-6">
<div class="form-group">
<label for="address">.</label>
<input type="text" class="form-control" name="runner_address2" id="runner_address2" placeholder="Address Line #2">
</div>
</div>
</div>
<div class="row">
<div class="col-sm-6">
<div class="form-group">
<label for="city">City <span class="red-star">*</span></label>
<input type="tel" class="form-control" required="" name="runner_city" id="runner_city" placeholder="">
<!--<select name="runner_city" class="form-control" id="runner_city">
<option value="Please Select">Please Select Your City</option>
<option value="">city 1</option>
<option value="">city 2</option>
</select>-->
</div>
</div>
<div class="col-sm-3 col-md-offset-3">
<div class="form-group">
<label for="zipcode">Zipcode <span class="red-star">*</span></label>
<input type="text" class="form-control" required="" name="runner_zipcode" id="runner_zipcode" placeholder="33483">
</div>
</div>
</div>
<div class="row">
<div class="col-sm-6">
<div class="form-group">
<label for="p_number">Phone Number <span class="red-star">*</span></label>
<input type="tel" class="form-control" required="" name="runner_phonenumber" id="runner_phonenumber" placeholder="(770 493-3934)">
</div>
</div>
<div class="col-sm-6">
<div class="form-group">
<label for="city">Country <span class="red-star">*</span></label>
<select name="runner_country" class="form-control" id="runner_country">
<option value="Please Select">Select Your Country</option>
<?php
$runner_country_select = runner_add_country_select();
foreach ($runner_country_select as $each_country) {
echo '<option value="' . $each_country . '">' . $each_country . '</option>';
}
?>
</select>
</div>
</div>
</div>
<div class="row">
<div class="col-sm-6">
<div class="form-group">
<label for="p_number">Email Address <span class="red-star">*</span></label>
<input type="email" class="form-control" required="" name="user_email" id="user_email" placeholder="*****@*****.**">
</div>
</div>
</div>
<div class="row">
<div class="col-sm-4">
<div class="form-group">
<label for="p_number">Gender <span class="red-star">*</span></label>
<div>
<label class="radio-inline">
<input type="radio" value="Male" name="runner_gender">
Male </label>
<label class="radio-inline">
<input type="radio" value="Female" name="runner_gender">
Female </label>
</div>
</div>
</div>
<div class="col-sm-8">
<div class="form-group">
<label for="birthday">Birthday <span class="red-star">*</span></label>
<div class="row">
<div class="col-xs-4">
<div class="form-group">
<select name="birth_month" class="form-control">
<option value="Please Select">Select Month</option>
<?php
// lowest year wanted
$cutoff = 1910;
// current year
$now = date('Y');
for ($m = 1; $m <= 12; $m++) {
echo ' <option value="' . $m . '">' . date('M', mktime(0, 0, 0, $m)) . '</option>' . PHP_EOL;
}
?>
</select>
</div>
</div>
<div class="col-xs-4">
<div class="form-group">
<select name="birth_day" class="form-control">
<option value="Please Select">Select Date</option>
<?php
for ($d = 1; $d <= 31; $d++) {
echo ' <option value="' . $d . '">' . $d . '</option>' . PHP_EOL;
}
?>
</select>
</div>
</div>
<div class="col-xs-4">
<div class="form-group">
<select name="birth_year" class="form-control">
<option value="Please Select">Select year</option>
<?php
for ($y = $now; $y >= $cutoff; $y--) {
echo ' <option value="' . $y . '">' . $y . '</option>' . PHP_EOL;
}
?>
</select>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="row">
<div class="col-sm-6">
<div class="form-group">
<label for="f_name"> Passport or Israeli ID (Teudat Zehut) number: <span class="red-star">*</span></label>
<input type="text" class="form-control" required="" name="passport_or_israeli_id" id="passport_or_israeli_id" placeholder="">
</div>
</div>
</div>
<div class="row">
<div class="col-sm-10 col-sm-offset-1 mt-30 mb-30">
<hr>
</div>
</div>
<div class="row">
<div class="col-sm-12 text-center mt-30 mb-30">
<h3 data-text-color="#219b48"><strong>Emergency Contact Information</strong></h3>
</div>
</div>
<div class="row">
<div class="col-sm-6">
<div class="form-group">
<label for="f_name">Full Name <span class="red-star">*</span></label>
<input type="text" class="form-control" required="" name="emergency_contact_name" id="emergency_contact_name" placeholder="John">
</div>
</div>
<div class="col-sm-6">
<div class="form-group">
<label for="p_">Phone Number <span class="red-star">*</span></label>
<input type="tel" class="form-control" required="" name="emergency_contact_phone_number" id="emergency_contact_phone_number" placeholder="(770) 493-3934">
</div>
</div>
</div>
<div class="row">
<div class="col-sm-6">
<div class="form-group">
<label for="f_name">Relationship <span class="red-star">*</span></label>
<input type="text" class="form-control" required="" name="emergency_contact_relationship" id="emergency_contact_relationship" placeholder="Type">
</div>
</div>
</div>
<div class="row">
<div class="col-sm-10 col-sm-offset-1 mt-30 mb-30">
<hr>
</div>
</div>
<div class="row">
<div class="col-sm-12 text-center mt-30 mb-30">
<h3 data-text-color="#219b48"><strong>General Marathon Information</strong></h3>
</div>
</div>
<div class="row">
<div class="col-sm-6">
<h4><strong>What Marathon would you like to participate in:</strong> </h4>
<div class="radio">
<label>
<input type="radio" name="what_marathon_like_to_participate" value="Jerusalem Marathon">
Jerusalem Marathon</label>
</div>
<div class="radio">
<label>
<input type="radio" name="what_marathon_like_to_participate" value="Berlin Marathon">
Berlin Marathon</label>
</div>
<div class="radio">
<label>
<input type="radio" name="what_marathon_like_to_participate" value="Chicago Marathon">
Chicago Marathon</label>
</div>
<div class="radio">
<label>
<input type="radio" name="what_marathon_like_to_participate" value="NYC Marathon">
NYC Marathon</label>
</div>
</div>
</div>
<div class="row">
<div class="col-sm-6">
<h4><strong>Are you participating in (choose one):</strong></h4>
<div class="radio">
<label>
<input type="radio" name="are_you_participating_in_range" value="10k" >
10k</label>
</div>
<div class="radio">
<label>
<input type="radio" name="are_you_participating_in_range" value="1/2 marathon">
1/2 marathon</label>
</div>
<div class="radio">
<label>
<input type="radio" name="are_you_participating_in_range" value="Full Marathon">
Full Marathon</label>
</div>
</div>
</div>
<div class="row">
<div class="col-sm-6">
<h4><strong>What is your average race time?</strong></h4>
<div class="radio">
<label>
<input type="radio" name="what_is_your_average_race_time" value="1-1.5 hours" >
1-1.5 hours</label>
</div>
<div class="radio">
<label>
<input type="radio" name="what_is_your_average_race_time" value="1.5-2 hours">
1.5-2 hours</label>
</div>
<div class="radio">
<label>
<input type="radio" name="what_is_your_average_race_time" value="2.5-3 hours">
2.5-3 hours</label>
</div>
<div class="radio">
<label>
<input type="radio" name="what_is_your_average_race_time" value="3.5-4 hours">
3.5-4 hours</label>
</div>
</div>
</div>
<div class="row">
<div class="col-sm-12">
<h4><strong>ALEH Ascend T-shirt order:</strong></h4>
</div>
<div class="col-sm-4">
<p>Your size <span class="red-star">*</span></p>
<div class="radio">
<label>
<input type="radio" name="tshirt_order_your_size" value="XS">
XS</label>
</div>
<div class="radio">
<label>
<input type="radio" name="tshirt_order_your_size" value="Small">
Small</label>
</div>
<div class="radio">
<label>
<input type="radio" name="tshirt_order_your_size" value="Medium">
Medium</label>
</div>
<div class="radio">
<label>
<input type="radio" name="tshirt_order_your_size" value="Large">
Large</label>
</div>
<div class="radio">
<label>
<input type="radio" name="tshirt_order_your_size" value="Xlarge">
Xlarge</label>
</div>
</div>
<div class="col-sm-4">
<p>Gender <span class="red-star">*</span></p>
<div class="radio">
<label>
<input type="radio" name="tshirt_order_gender" value="Male">
Male</label>
</div>
<div class="radio">
<label>
<input type="radio" name="tshirt_order_gender" value="Female">
Female</label>
</div>
</div>
<div class="col-sm-4">
<p>Sleeves <span class="red-star">*</span></p>
<div class="radio">
<label>
<input type="radio" name="tshirt_order_sleeves" value="Short sleeve">
Short sleeve </label>
</div>
<div class="radio">
<label>
<input type="radio" name="tshirt_order_sleeves" value="Long sleeve">
Long sleeve </label>
</div>
</div>
</div>
<div class="row">
<div class="col-sm-10 col-sm-offset-1 mt-30 mb-30">
<hr>
</div>
</div>
<div class="row">
<div class="col-sm-12 text-center mt-30 mb-30">
<h3 data-text-color="#219b48"><strong>Create your own personal login page</strong></h3>
</div>
</div>
<div class="row">
<div class="col-sm-10 col-sm-offset-1">
<div class="row">
<div class="col-sm-4">
<div class="form-group">
<label for="p_number">Username <span class="red-star">*</span></label>
<input type="text" class="form-control" required="" name="runner_username" id="runner_username" placeholder="ddonov9342">
</div>
</div>
<div class="col-sm-4">
<div class="form-group">
<label for="city">Password <span class="red-star">*</span></label>
<input type="password" class="form-control" required="" name="runner_password" id="runner_password" placeholder="******">
</div>
</div>
<div class="col-sm-4">
<div class="form-group">
<label for="city">Retype Password <span class="red-star">*</span></label>
<input type="password" class="form-control" required="" name="runner_retype_password" id="runner_retype_password" placeholder="******">
</div>
</div>
</div>
<div class="row">
<div class="col-sm-12">
<div class="form-group">
<div class="checkbox">
<label>
<input type="checkbox" name="agree_terms" id="agree_terms" value="agree">
By Registering your agreeing to <a target="_blank" href="<?php
echo home_url('/terms-of-service/');
?>
">Your Website Here Terms of Service </a> </label>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="row">
<div class="col-sm-12 text-center mt-30 mb-30">
<input type="hidden" name="pippin_register_nonce" value="<?php
echo wp_create_nonce('pippin-register-nonce');
?>
"/>
<input type="submit" value="<?php
_e('REGISTER');
?>
"/>
</div>
</div>
</form>
<script>
jQuery("#marathon_registration_form").submit(function(e) {
if(!jQuery('#agree_terms:checked').length) {
alert("Please select Terms of Service.");
//stop the form from submitting
return false;
}
return true;
});
</script>
<?php
return ob_get_clean();
}