Current File : /home/inlingua/www/sensoriumpsychologists.com/diagnostics/school_registration.php
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<head>
    <title>School Registration</title>
    <?php include("common/head_links.php");?>

</head>
<body class="theme_skin_kinder">
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<div id="box_wrapper">

    <?php include("common/header.php");?>


    <section id="topOfPage" class="topTabsWrap color_section">
        <div class="container">
            <div class="row">
                <div class="col-sm-12">
                    
                    <h3 class="pageTitle h3">School Registration</h3>
                </div>
            </div>
        </div>
    </section>
    
    
    
    <section class="mainWrap">
        <div class="container">
                  
                    <div class="row">
                    	
                        <div class="col-sm-12">
                        
                        <h3 class="title">Registration Now</h3>
                        
                        <div class="sc_contact_form sc_contact_form_contact" style="border:1px solid #00F; padding:25px;">
                        
                        <form data-formtype="contact" method="post" action="">
                            <div class="columnsWrap">
                                <div class="col-md-4">
                                    <label class="required" for="">Name</label>
                                    <input id="" type="text" name="name">
                                </div>
                                <div class="col-md-4">
                                    <label class="required" for="">E-mail</label>
                                    <input id="" type="text" name="email">
                                </div>
                                <div class="col-md-4">
                                    <label class="required" for="">Mobile No.</label>
                                    <input id="" type="text" name="mobile">
                                </div>
                            </div>
                            <div class="columnsWrap">
                                <div class="col-md-4">
                                    <label class="required" for="">Office No.</label>
                                    <input id="" type="text" name="office_no">
                                </div>
                                <div class="col-md-8">
                                    <label class="required" for="">Address</label>
                                    <input id="" type="text" name="address">
                                </div>
                                
                            </div>
                            <div class="message">
                                <label class="required" for="">Educational Qualification Promoter/Partner/Individual</label>
                                <textarea id="" class="textAreaSize" name="educational_qualification"></textarea>
                            </div>
                            <div class="message">
                                <label class="required" for="">School</label>
                                <textarea id="" class="textAreaSize" name="school"></textarea>
                            </div>
                            <div class="columnsWrap">
                                <div class="col-md-4">
                                    <label class="required" for="">PAN No.</label>
                                    <input id="" type="text" name="pan_no">
                                </div>
                                <div class="col-md-4">
                                    <label class="required" for="">Occupation</label>
                                    <input id="" type="text" name="occupation">
                                </div>
                                <div class="col-md-4">
                                    <label class="required" for="">Nature of Work</label>
                                    <input id="" type="text" name="nature_of_work">
                                </div>
                            </div>
                            
                            <div class="columnsWrap">
                            	<h3>For Persons In Business</h3>
                                <div class="col-md-4">
                                    <label class="required" for="">Company Name(s)</label>
                                    <input id="" type="text" name="">
                                </div>
                                <div class="col-md-4">
                                    <label class="required" for="">Ownership Prop./Pvt. Partner</label>
                                    <input id="" type="text" name="">
                                </div>
                                <div class="col-md-4">
                                    <label class="required" for="">Nature of Business</label>
                                    <input id="" type="text" name="">
                                </div>
                            </div>
                            <div class="columnsWrap">
                            	<h3></h3>
                                <div class="col-md-4">
                                    <label class="required" for="">Principal Product/Brand</label>
                                    <input id="" type="text" name="">
                                </div>
                                <div class="col-md-4">
                                    <label class="required" for="">Years in Business</label>
                                    <input id="" type="text" name="">
                                </div>
                                <div class="col-md-4">
                                    <label class="required" for="">Annual Turnover (Current Fiscal YR)</label>
                                    <input id="" type="text" name="">
                                </div>
                            </div>
                            
                            <div class="columnsWrap">
                            	<h3>For Persons In Service</h3>
                                <div class="col-md-4">
                                    <label class="required" for="">Name of Current Employer</label>
                                    <input id="" type="text" name="">
                                </div>
                                <div class="col-md-4">
                                    <label class="required" for="">Designation</label>
                                    <input id="" type="text" name="">
                                </div>
                                <div class="col-md-4">
                                    <label class="required" for="">Job Profile</label>
                                    <input id="" type="text" name="">
                                </div>
                            </div>
                            
                            <div class="columnsWrap">
                            	<h3>Franchise Details</h3>
                                <h4>Existing Franchise Details</h4>
                                <div class="col-md-2">
                                    <label class="required" for="">City for Franchise</label>
                                    <input id="" type="text" name="">
                                </div>
                                <div class="col-md-2">
                                    <label class="required" for="">Location</label>
                                    <input id="" type="text" name="">
                                </div>
                                <div class="col-md-2">
                                    <label class="required" for="">Area (In Square Feets)</label>
                                    <input id="" type="text" name="">
                                </div>
                                <div class="col-md-3">
                                    <label class="required" for="">Area on Hire/Lease/Loan</label>
                                    <input id="" type="text" name="">
                                </div>
                                <div class="col-md-3">
                                    <label class="required" for="">Prop. / Partnership / Pvt. Ltd.</label>
                                    <input id="" type="text" name="">
                                </div>
                            </div>
                            
                            <div class="columnsWrap">
                                <h4>Proposed Franchise Details</h4>
                                <div class="col-md-2">
                                    <label class="required" for="">Intersted City for Franchise</label>
                                    <input id="" type="text" name="">
                                </div>
                                <div class="col-md-2">
                                    <label class="required" for="">Proposed Location</label>
                                    <input id="" type="text" name="">
                                </div>
                                <div class="col-md-2">
                                    <label class="required" for="">Area (In Square Feets)</label>
                                    <input id="" type="text" name="">
                                </div>
                                <div class="col-md-3">
                                    <label class="required" for="">Area on Hire/Lease/Loan</label>
                                    <input id="" type="text" name="">
                                </div>
                                <div class="col-md-3">
                                    <label class="required" for="">Prop. / Partnership / Pvt. Ltd.</label>
                                    <input id="" type="text" name="">
                                </div>
                            </div>
                            
                            <div class="columnsWrap">
                            	<h4>How soon you can start the project</h4>
                                <div class="col-md-3">
                                    <label class="required" for="">One Month/Two Months/Three Months</label>
                                </div>
                                <div class="col-md-3">
                                    <input id="" type="text" name="">
                                </div>
                                <div class="col-md-3">
                                    <label class="required" for="">Amount</label>
                                </div>
                                <div class="col-md-3">
                                    <input id="" type="text" name="">
                                </div>
                                
                            </div>
                            
                            
                            
                            
                            <div class="sc_contact_form_button">
                                <div class="squareButton ico">
                                    <a href="#" class="sc_contact_form_submit icon-comment">Next</a>
                                </div>
                            </div>
                            <div class="result sc_infobox"></div>
                        </form>
                    </div>
                        
                       <!-- <form>
                          <div class="form-group">
                            <input type="text" class="form-control" id="name" placeholder="Your Name">
                          </div>
                          <div class="form-group">
                            <label for="mobile">Mobile Number:</label>
                            <input type="text" class="form-control" id="mobile">
                          </div>
                          <div class="form-group">
                            <label for="email">Email ID:</label>
                            <input type="email" class="form-control" id="email">
                          </div>
                          
                          <div class="form-group">
                            <label for="pwd">Password:</label>
                            <input type="password" class="form-control" id="pwd">
                          </div>
                          <div class="form-group">
                            <label for="pwd">Retype Password:</label>
                            <input type="password" class="form-control" id="pwd">
                          </div>
                          <div>
                            <span><img src="captcha.php" alt="Captcha" /> </span><br /><br />
                          </div>
                           <div class="form-group">
                            <label for="mobile">Enter Captcha Code</label>
                            <input type="text" class="form-control" id="mobile">
                          </div>
                          <div class="checkbox">
                            <label><input type="checkbox"> </i>I accept all <a class="terms" href="#">terms and conditions</a></label>
                          </div>
                          <button type="submit" class="btn btn-success pull-right">Create an Account</button>
                        </form>-->
                        
                    </div>
                </div>
                </div>


                    
                    
                
                  
            
            
        
    </section>




    
    <?php include("common/footer.php");?>

</div><!-- eof #box_wrapper -->

<div class="preloader">
    <div class="preloader_image"></div>
</div>

       <?php include("common/footer_links.php");?>


    </body>
</html>