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Path : /hermes/bosweb/b1705/trinix19.ipage.com/Backup/notebk/
File Upload :
Current < : /hermes/bosweb/b1705/trinix19.ipage.com/Backup/notebk/submitter_registration.php

<!DOCTYPE html>
<html>
    <head>
        <title>STUDENTSNOTEBOOKS</title>
        <meta charset=utf-"8" />
        <meta name="viewport" content="width=device-width, initial-scale=1">
        <link href="/notebook/css/bootstrap.min.css" rel="stylesheet" type="text/css">
        <link href="/notebook/css/main.css" rel="stylesheet" type="text/css">
        <link href="/notebook/css/font-awesome.css" rel="stylesheet" type="text/css">
        <link href="/notebook/css/font-awesome.min.css" rel="stylesheet" type="text/css">
        <link href="/notebook/css/datepicker.css" rel="stylesheet">
        <script src="/notebook/js/jquery-1.8.1.min.js" async="" type="text/javascript"></script>
        <script src="/notebook/js/jquery-1.11.0.js"></script>
        <script src="/notebook/js/bootstrap.min.js"></script>
        <script src="/notebooks/js/jQuery.js" type="text/javascript"></script>
        <script type="text/javascript">
			$(document).ready(function () {
				$("#chtr_name").click(function(){
					$("#chtr_div").show();
					if($("#chapter_name option[value='other']").length == 0)
					{
						$("#chtr_div").show();
						$('#chapter_name').append('<option value="other" selected="selected">Other</option>');
					}
				});
				$("#add_sub").click(function(){
					$("#sub_div").show();
					if($("#subject option[value='other']").length == 0)
					{
						$('#subject').append('<option value="other" selected="selected">Other</option>');
					}
				});
				$("#nof_csc").click(function(){
					$("#nof_csc_div").show();
					if($("#name_of option[value='other']").length == 0)
					{
						$('#name_of').append('<option value="other" selected="selected">Other</option>');
					}
				});
				$("#ctgry").click(function(){
					$("#ctgry_div").show();
					if($("#category option[value='other']").length == 0)
					{
						$('#category').append('<option value="other" selected="selected">Other</option>');
					}
				});
				$("#strm").click(function(){
					$("#strm_div").show();
					if($("#stream option[value='other']").length == 0)
					{
						$('#stream').append('<option value="other" selected="selected">Other</option>');
					}
				});
			});
			$(document).ready(function () {
				$("#chapter_name").change(function(){
					($('#chapter_name').val()!="other")
					{
						$("#chapter_name option[value='other']").remove();
						$("#chtr_div").hide();
					}
				});
				$("#subject").change(function(){
					($('#subject').val()!="other")
					{
						$("#subject option[value='other']").remove();
						$("#sub_div").hide();
					}
				});
				$("#name_of").change(function(){
					($('#name_of').val()!="other")
					{
						$("#name_of option[value='other']").remove();
						$("#nof_csc_div").hide();
					}
				});
				$("#category").change(function(){
					($('#category').val()!="other")
					{
						$("#category option[value='other']").remove();
						$("#ctgry_div").hide();
					}
				});
				$("#stream").change(function(){	
					($('#stream').val()!="other")
					{
						$("#stream option[value='other']").remove();
						$("#strm_div").hide();
					}
				});
			});
			
			$(document).ready(function () {
				$('#datefor').datepicker();
            });
            // Change Your home URL..
            home_url = 'http://securecamp.co/notebooks/';
            /* *
             *     fileName - ajax file name to be called by ajax method.
             *     data - pass the infromation(like location-id , location-type) via data variable.
             *     loadDataToDiv - id of the div to which the ajax responce is to be loaded.
             * */
            function ajax_call(fileName,data, loadDataToDiv) {
                jQuery("#"+loadDataToDiv).html('<option selected="selected">-- -- -- Loding Data -- -- --</option>');

                //  If you are changing counrty, make the state and city fields blank
                if(loadDataToDiv=='state'){
                    jQuery('#city').html('');
                    jQuery('#state').html('');                    
                }
                //  If you are changing state, make the city fields blank
                if(loadDataToDiv=='city'){
                    jQuery('#city').html('');
                }
                jQuery.post(home_url + '/' + fileName + '.php', data, function(result) {
                    jQuery('#' + loadDataToDiv).html(result);
                });
            }
			function getStream(catId)
			{
				var xhttp = new XMLHttpRequest();
				xhttp.onreadystatechange = function() {
					if (xhttp.readyState == 4 && xhttp.status == 200) {
						document.getElementById("strmDiv").innerHTML = xhttp.responseText;
					}
				};
				xhttp.open("GET", "http://securecamp.co/notebooks/getStrem.php?cat="+catId, true);
				xhttp.send();
			}
			function validate()
			{
				var formIsValid = true;
				if(document.getElementById('stud_name').value=="")
				{
					document.getElementById("error_student").innerHTML="\n Please Enter Student Name";
                    document.getElementById("stud_name").style.borderColor = "#D9534F";
                    formIsValid = false;
				}
				if(document.getElementById('teacher_name').value=="")
				{
					document.getElementById("error_teacher").innerHTML="\n Please Enter Teacher Name";
                    document.getElementById("teacher_name").style.borderColor = "#D9534F";
                    formIsValid = false;
				}
				if(document.getElementById('profile_pic').value=="")
				{
					document.getElementById("error_profile").innerHTML="\n Please Select Profile Picture";
                    formIsValid = false;
				}
				if(document.getElementById('chapter_name').value=="")
				{
					document.getElementById("error_chapter").innerHTML="\n Please Select Chapter Name";
                    document.getElementById("chapter_name").style.borderColor = "#D9534F";
                    formIsValid = false;
				}
				else if(document.getElementById('chapter_name').value=="other")
				{
					if(document.getElementById('addchtr').value=="")
					{
						document.getElementById("error_addchapter").innerHTML="\n Please Enter Notebook Title";
						document.getElementById("addchtr").style.borderColor = "#D9534F";
						formIsValid = false;
					}
				}
				if(document.getElementById('subject').value=="")
				{
					document.getElementById("error_subject").innerHTML="\n Please Enter Student Name";
                    document.getElementById("subject").style.borderColor = "#D9534F";
                    formIsValid = false;
				}
				else if(document.getElementById('subject').value=="other")
				{
					if(document.getElementById('addSub').value=="")
					{
						document.getElementById("error_addsub").innerHTML="\n Please Enter Subject";
						document.getElementById("addSub").style.borderColor = "#D9534F";
						formIsValid = false;
					}
				}
				if(document.getElementById('name_of').value=="")
				{
					document.getElementById("error_nameof").innerHTML="\n Please Select Name of Collage/School/Coaching";
                    document.getElementById("name_of").style.borderColor = "#D9534F";
                    formIsValid = false;
				}
				else if(document.getElementById('name_of').value=="other")
				{
					if(document.getElementById('addnof_csc').value=="")
					{
						document.getElementById("error_addnameof").innerHTML="\n Please Enter Name of Collage/School/Coaching";
						document.getElementById("addnof_csc").style.borderColor = "#D9534F";
						formIsValid = false;
					}
				}
				if(document.getElementById('category').value=="")
				{
					document.getElementById("error_category").innerHTML="\n Please Select Category";
                    document.getElementById("category").style.borderColor = "#D9534F";
                    formIsValid = false;
				}
				else if(document.getElementById('category').value=="other")
				{
					if(document.getElementById('addctgry').value=="")
					{
						document.getElementById("error_addcategory").innerHTML="\n Please Enter other Category";
						document.getElementById("addctgry").style.borderColor = "#D9534F";
						formIsValid = false;
					}
				}
				if(document.getElementById('stream').value=="")
				{
					document.getElementById("error_stream").innerHTML="\n Please Select Stream";
                    document.getElementById("stream").style.borderColor = "#D9534F";
                    formIsValid = false;
				}
				else if(document.getElementById('stream').value=="other")
				{
					if(document.getElementById('addstrm').value=="")
					{
						document.getElementById("error_addstream").innerHTML="\n Please Enter other Stream";
						document.getElementById("addstrm").style.borderColor = "#D9534F";
						formIsValid = false;
					}
				}
				if(document.getElementById('country').value=="")
				{
					document.getElementById("error_country").innerHTML="\n Please Select Country";
                    document.getElementById("country").style.borderColor = "#D9534F";
                    formIsValid = false;
				}
				if(document.getElementById('state').value=="")
				{
					document.getElementById("error_state").innerHTML="\n Please Select State";
                    document.getElementById("state").style.borderColor = "#D9534F";
                    formIsValid = false;
				}
				if(document.getElementById('city').value=="")
				{
					document.getElementById("error_city").innerHTML="\n Please Select City";
                    document.getElementById("city").style.borderColor = "#D9534F";
                    formIsValid = false;
				}
				if(document.getElementById('notebook_cover_file').value=="")
				{
					document.getElementById("error_coverfile").innerHTML="\n Please Upload Text/Photo for Notebook Cover";
                    document.getElementById("notebook_cover_file").style.borderColor = "#D9534F";
                    formIsValid = false;
				}
				if(document.getElementById('datefor').value=="")
				{
					document.getElementById("error_datefor").innerHTML="\n Please Select Date";
                    document.getElementById("datefor").style.borderColor = "#D9534F";
                    formIsValid = false;
				}
				if(document.getElementById('cardholder_name').value=="")
				{
					document.getElementById("error_cardholder").innerHTML="\n Please Enter Cardholder Name";
                    document.getElementById("cardholder_name").style.borderColor = "#D9534F";
                    formIsValid = false;
				}
				if(document.getElementById('card_no').value=="")
				{
					document.getElementById("error_cardno").innerHTML="\n Please Enter Card Number";
                    document.getElementById("card_no").style.borderColor = "#D9534F";
                    formIsValid = false;
				}
				if(document.getElementById('exp_date_mm').value=="")
				{
					document.getElementById("error_exdatemm").innerHTML="\n Please Select Expiration Month";
                    document.getElementById("exp_date_mm").style.borderColor = "#D9534F";
                    formIsValid = false;
				}
				if(document.getElementById('exp_date_yy').value=="")
				{
					document.getElementById("error_exdateyy").innerHTML="\n Please Select Expiration Year";
                    document.getElementById("exp_date_yy").style.borderColor = "#D9534F";
                    formIsValid = false;
				}
				if(document.getElementById('security_code').value=="")
				{
					document.getElementById("error_security").innerHTML="\n Please Enter Security Code";
                    document.getElementById("security_code").style.borderColor = "#D9534F";
                    formIsValid = false;
				}
				if(document.getElementById('mo_no').value=="")
				{
					document.getElementById("error_mobile").innerHTML="\n Please Enter Mobile Number";
                    document.getElementById("mo_no").style.borderColor = "#D9534F";
                    formIsValid = false;
				}
				if(isNaN(document.getElementById('mo_no').value))
				{
					document.getElementById("error_mobile").innerHTML="\n Please Enter Valid Mobile Number";
                    document.getElementById("mo_no").style.borderColor = "#D9534F";
                    formIsValid = false;
				}
				if(document.getElementById('otp').value=="")
				{
					document.getElementById("error_otp").innerHTML="\n Please Enter One Time Password";
                    document.getElementById("otp").style.borderColor = "#D9534F";
                    formIsValid = false;
				}
				if(document.getElementById('email').value=="")
				{
					document.getElementById("error_email").innerHTML="\n Please Enter Email";
                    document.getElementById("email").style.borderColor = "#D9534F";
                    formIsValid = false;
				}
				else if(document.getElementById('email').value!="")
				{
					var reg = /^([A-Za-z0-9_\-\.])+\@([A-Za-z0-9_\-\.])+\.([A-Za-z]{2,4})$/;
					var address = document.getElementById("email").value;
					if(reg.test(address) == false)
					{
						document.getElementById("error_email").innerHTML="\n Please Enter Valid Email";
						document.getElementById("email").style.borderColor = "#D9534F";
						formIsValid = false;
					}
				}
				if(document.getElementById('password').value=="")
				{
					document.getElementById("error_pass").innerHTML="\n Please Enter Password";
                    document.getElementById("password").style.borderColor = "#D9534F";
                    formIsValid = false;
				}
				 return formIsValid;
			}
			function autoTab(current,next)
			{
				if (current.getAttribute&&current.value.length==current.getAttribute("maxlength"))
				next.focus()
			}
        </script>
    </head>
    <body>
        		<section class="navigation">
            <div class="container-fluid">
                <div class="row">
                    <nav>
                        <div class="navbar-header">
                            <button type="button" class="navbar-toggle collapsed" data-toggle="collapse" data-target="#bs-example-navbar-collapse-1" aria-expanded="false">
                                <span class="sr-only">Toggle navigation</span>
                                <span class="icon-bar"></span>
                                <span class="icon-bar"></span>
                                <span class="icon-bar"></span>
                            </button>
                            <a class="navbar-brand" href="http://securecamp.co/notebooks/"><p class="logo"><img src="http://securecamp.co/notebooks/images/logo2.png" class="img-responsive"></p></a>
                        </div>
                        <div class="collapse navbar-collapse" id="bs-example-navbar-collapse-1">
                            <ul class="nav navbar-nav navbar-right">
								                                <li><a href="http://securecamp.co/notebooks/login.php">Log In </a></li>
                                <li><a href="http://securecamp.co/notebooks/reader_registration.php">Sign Up</a></li>
                                <li><button onclick="window.location.href='http://securecamp.co/notebooks/submitter_registration.php'" type="button" class="btn btn-info submit-btn">Submit your Notebook</button></li>
                                                            </ul>
                        </div>
                    </nav>
                </div>
            </div>
        </section>        <section class="category">
            <div class=" container-fluid" style="margin-top:20px;">
                <div class="row">
                    <div class="col-md-12">
                        <form class="form-horizontal" enctype="multipart/form-data" name="sumbitter_regis_form" method="post" onSubmit="return validate();">
                              <div class="form-group">
                               <label class="col-sm-4 control-label">Student Name</label>
                                <div class="col-sm-5">
                                  <input type="text" class="form-control" id="stud_name" placeholder="Student Name" name="stud_name">
                                  <div id="error_student" class="text-danger"></div>
                                </div>
                              </div>
                              <div class="form-group">
                                <label class="col-sm-4 control-label">Profile Picture<br/>(if not affixed)</label>
                                <div class="col-sm-5">
                                  <input type="file"  id="profile_pic" name="profile_pic">
                                  <div id="error_profile" class="text-danger"></div>
                                </div>
                              </div>
                               <div class="form-group">
                               <label class="col-sm-4 control-label">Teacher Name</label>
                                <div class="col-sm-5">
                                  <input type="text" class="form-control" id="teacher_name" placeholder="Teacher Name" name="teacher_name">
                                  <div id="error_teacher" class="text-danger"></div>
                                </div>
                              </div>
                             <div class="form-group">
                               <label class="col-sm-4 control-label">Chapter Name</label>
                                <div class="col-sm-5">
                                  <select class="form-control" id="chapter_name" name="chapter_name" >
                                  	<option value="">Select</option>
                                                                        		<option value="1">Applied Physics</option>
                                                                                		<option value="2">Applied Physics</option>
                                                                                		<option value="3">Applied Physics</option>
                                                                                		<option value="4">fit</option>
                                                                                		<option value="5">Applied Physics</option>
                                                                                		<option value="6">fit</option>
                                                                                		<option value="7">Applied Physics</option>
                                                                                		<option value="8">thermodynamics</option>
                                                                                		<option value="9">Applied Physics</option>
                                                                                		<option value="10">thermodynamics</option>
                                                                                		<option value="11">thermodynamics</option>
                                                                                		<option value="12">matrix</option>
                                                                                		<option value="13">chemistry</option>
                                                                                		<option value="14">HYDROCARBENS IN ORGANIC CHEMISTRY</option>
                                                                                		<option value="15">HYDROCARBENS IN ORGANIC CHEMISTRYy</option>
                                                                              </select>
                                  <div id="error_chapter" class="text-danger"></div>
                                </div>
                                <div class="col-sm-1">
                                	<a href="javascript:void(0);" class="btn btn-primary" id="chtr_name"><i class="fa fa-plus"></i></a>
                                </div>
                              </div>
                              <div class="form-group" style="display:none;" id="chtr_div">
                                  <div class="col-sm-offset-4 col-sm-5">
                              		 <input type="text" name="addchtr" id="addchtr" class="form-control">
                                     <div id="error_addchapter" class="text-danger"></div>
                                   </div>
                              </div>
                              <div class="form-group">
                                <label class="col-sm-4 control-label">Subject</label>
                                <div class="col-sm-5">
                                  <select class="form-control" id="subject" name="subject">
                                  	<option value="">Select</option>
                                                                        		<option value="1">Physics</option>
                                                                                		<option value="2">cs</option>
                                                                                		<option value="3">basic electronics</option>
                                                                                		<option value="4">mathematics</option>
                                                                                		<option value="5">chemistry</option>
                                                                              </select>
                                  <div id="error_subject" class="text-danger"></div>
                                </div>
                                <div class="col-sm-1"><a href="javascript:void(0);" class="btn btn-primary" id="add_sub"><i class="fa fa-plus"></i></a></div>
                              </div>
                              <div class="form-group" style="display:none;" id="sub_div">
                                  <div class="col-sm-offset-4 col-sm-5">
                              		 <input type="text" name="addSub" id="addSub" class="form-control">
                                     <div id="error_addSub" class="text-danger"></div>
                                   </div>
                              </div>
                            <div class="form-group">
                               <label  class="col-sm-4 control-label">Name of (Coaching/College/School)</label>
                                <div class="col-sm-5">
                                   <select class="form-control" id="name_of" name="name_of">
                                  	<option value="">Select</option>
                                                                        		<option value="1">A.N. Institute of Engineering</option>
                                                                                		<option value="2">hbti</option>
                                                                                		<option value="3">mpec</option>
                                                                                		<option value="4">gic</option>
                                                                              </select>
                                  <div id="error_nameof" class="text-danger"></div>
                                </div>
                                <div class="col-sm-1"><a href="javascript:void(0);" class="btn btn-primary" id="nof_csc"><i class="fa fa-plus"></i></a></div>
                              </div>
                              <div class="form-group" style="display:none;" id="nof_csc_div">
                                  <div class="col-sm-offset-4 col-sm-5">
                              		 <input type="text" name="addnof_csc" id="addnof_csc" class="form-control">
                                     <div id="error_addnameof" class="text-danger"></div>
                                   </div>
                              </div>
                              <div class="form-group">
                                <label class="col-sm-4 control-label">Category</label>
                                <div class="col-sm-5">
                                   <select class="form-control" id="category" name="category">
                                  	<option value="">Select</option>
                                                                        		<option value="1">College</option>
                                                                                		<option value="2">engg coll</option>
                                                                                		<option value="3">coaching</option>
                                                                              </select>
                                  <div id="error_category" class="text-danger"></div>
                                </div>
                                <div class="col-sm-1"><a href="javascript:void(0);" class="btn btn-primary" id="ctgry"><i class="fa fa-plus"></i></a></div>
                              </div>
                              <div class="form-group" style="display:none;" id="ctgry_div">
                                  <div class="col-sm-offset-4 col-sm-5">
                              		 <input type="text" name="addctgry" id="addctgry" class="form-control">
                                     <div id="error_addcategory" class="text-danger"></div>
                                   </div>
                              </div>
                              <div class="form-group">
                                <label class="col-sm-4 control-label">Stream</label>
                                <div class="col-sm-5">
                                  <select class="form-control" id="stream" name="stream">
                                  	<option value="">Select</option>
                                                                        		<option value="1">Engineering</option>
                                                                                		<option value="2">btech</option>
                                                                                		<option value="3">engineering</option>
                                                                              </select>
                                  <div id="error_stream" class="text-danger"></div>
                                </div>
                                <div class="col-sm-1"><a href="javascript:void(0);" class="btn btn-primary" id="strm"><i class="fa fa-plus"></i></a></div>
                              </div>
                              <div class="form-group" style="display:none;" id="strm_div">
                                  <div class="col-sm-offset-4 col-sm-5">
                              		 <input type="text" name="addstrm" id="addstrm" class="form-control">
                                     <div id="error_addstream" class="text-danger"></div>
                                   </div>
                              </div>
                              <div class="form-group">
                                <label class="col-sm-4 control-label">Country</label>
                                <div class="col-sm-5">
                                   <select class="form-control" id="country" name="country" onChange="ajax_call('ajaxCall',{location_id:this.value,location_type:1}, 'state')">
                                  	<option value="">Select</option>
                                                                        		<option value="1">Aruba</option>
                                                                                		<option value="2">Afghanistan</option>
                                                                                		<option value="3">Angola</option>
                                                                                		<option value="4">Anguilla</option>
                                                                                		<option value="5">Albania</option>
                                                                                		<option value="6">Andorra</option>
                                                                                		<option value="7">Netherlands Antilles</option>
                                                                                		<option value="8">United Arab Emirates</option>
                                                                                		<option value="9">Argentina</option>
                                                                                		<option value="10">Armenia</option>
                                                                                		<option value="11">American Samoa</option>
                                                                                		<option value="12">Antarctica</option>
                                                                                		<option value="13">French Southern territories</option>
                                                                                		<option value="14">Antigua and Barbuda</option>
                                                                                		<option value="15">Australia</option>
                                                                                		<option value="16">Austria</option>
                                                                                		<option value="17">Azerbaijan</option>
                                                                                		<option value="18">Burundi</option>
                                                                                		<option value="19">Belgium</option>
                                                                                		<option value="20">Benin</option>
                                                                                		<option value="21">Burkina Faso</option>
                                                                                		<option value="22">Bangladesh</option>
                                                                                		<option value="23">Bulgaria</option>
                                                                                		<option value="24">Bahrain</option>
                                                                                		<option value="25">Bahamas</option>
                                                                                		<option value="26">Bosnia and Herzegovina</option>
                                                                                		<option value="27">Belarus</option>
                                                                                		<option value="28">Belize</option>
                                                                                		<option value="29">Bermuda</option>
                                                                                		<option value="30">Bolivia</option>
                                                                                		<option value="31">Brazil</option>
                                                                                		<option value="32">Barbados</option>
                                                                                		<option value="33">Brunei</option>
                                                                                		<option value="34">Bhutan</option>
                                                                                		<option value="35">Bouvet Island</option>
                                                                                		<option value="36">Botswana</option>
                                                                                		<option value="37">Central African Republic</option>
                                                                                		<option value="38">Canada</option>
                                                                                		<option value="39">Cocos (Keeling) Islands</option>
                                                                                		<option value="40">Switzerland</option>
                                                                                		<option value="41">Chile</option>
                                                                                		<option value="42">China</option>
                                                                                		<option value="43">Côte d’Ivoire</option>
                                                                                		<option value="44">Cameroon</option>
                                                                                		<option value="45">Congo, The Democratic Republic</option>
                                                                                		<option value="46">Congo</option>
                                                                                		<option value="47">Cook Islands</option>
                                                                                		<option value="48">Colombia</option>
                                                                                		<option value="49">Comoros</option>
                                                                                		<option value="50">Cape Verde</option>
                                                                                		<option value="51">Costa Rica</option>
                                                                                		<option value="52">Cuba</option>
                                                                                		<option value="53">Christmas Island</option>
                                                                                		<option value="54">Cayman Islands</option>
                                                                                		<option value="55">Cyprus</option>
                                                                                		<option value="56">Czech Republic</option>
                                                                                		<option value="57">Germany</option>
                                                                                		<option value="58">Djibouti</option>
                                                                                		<option value="59">Dominica</option>
                                                                                		<option value="60">Denmark</option>
                                                                                		<option value="61">Dominican Republic</option>
                                                                                		<option value="62">Algeria</option>
                                                                                		<option value="63">Ecuador</option>
                                                                                		<option value="64">Egypt</option>
                                                                                		<option value="65">Eritrea</option>
                                                                                		<option value="66">Western Sahara</option>
                                                                                		<option value="67">Spain</option>
                                                                                		<option value="68">Estonia</option>
                                                                                		<option value="69">Ethiopia</option>
                                                                                		<option value="70">Finland</option>
                                                                                		<option value="71">Fiji Islands</option>
                                                                                		<option value="72">Falkland Islands</option>
                                                                                		<option value="73">France</option>
                                                                                		<option value="74">Faroe Islands</option>
                                                                                		<option value="75">Micronesia, Federated States o</option>
                                                                                		<option value="76">Gabon</option>
                                                                                		<option value="77">United Kingdom</option>
                                                                                		<option value="78">Georgia</option>
                                                                                		<option value="79">Ghana</option>
                                                                                		<option value="80">Gibraltar</option>
                                                                                		<option value="81">Guinea</option>
                                                                                		<option value="82">Guadeloupe</option>
                                                                                		<option value="83">Gambia</option>
                                                                                		<option value="84">Guinea-Bissau</option>
                                                                                		<option value="85">Equatorial Guinea</option>
                                                                                		<option value="86">Greece</option>
                                                                                		<option value="87">Grenada</option>
                                                                                		<option value="88">Greenland</option>
                                                                                		<option value="89">Guatemala</option>
                                                                                		<option value="90">French Guiana</option>
                                                                                		<option value="91">Guam</option>
                                                                                		<option value="92">Guyana</option>
                                                                                		<option value="93">Hong Kong</option>
                                                                                		<option value="94">Heard Island and McDonald Isla</option>
                                                                                		<option value="95">Honduras</option>
                                                                                		<option value="96">Croatia</option>
                                                                                		<option value="97">Haiti</option>
                                                                                		<option value="98">Hungary</option>
                                                                                		<option value="99">Indonesia</option>
                                                                                		<option value="100">India</option>
                                                                                		<option value="101">British Indian Ocean Territory</option>
                                                                                		<option value="102">Ireland</option>
                                                                                		<option value="103">Iran</option>
                                                                                		<option value="104">Iraq</option>
                                                                                		<option value="105">Iceland</option>
                                                                                		<option value="106">Israel</option>
                                                                                		<option value="107">Italy</option>
                                                                                		<option value="108">Jamaica</option>
                                                                                		<option value="109">Jordan</option>
                                                                                		<option value="110">Japan</option>
                                                                                		<option value="111">Kazakstan</option>
                                                                                		<option value="112">Kenya</option>
                                                                                		<option value="113">Kyrgyzstan</option>
                                                                                		<option value="114">Cambodia</option>
                                                                                		<option value="115">Kiribati</option>
                                                                                		<option value="116">Saint Kitts and Nevis</option>
                                                                                		<option value="117">South Korea</option>
                                                                                		<option value="118">Kuwait</option>
                                                                                		<option value="119">Laos</option>
                                                                                		<option value="120">Lebanon</option>
                                                                                		<option value="121">Liberia</option>
                                                                                		<option value="122">Libyan Arab Jamahiriya</option>
                                                                                		<option value="123">Saint Lucia</option>
                                                                                		<option value="124">Liechtenstein</option>
                                                                                		<option value="125">Sri Lanka</option>
                                                                                		<option value="126">Lesotho</option>
                                                                                		<option value="127">Lithuania</option>
                                                                                		<option value="128">Luxembourg</option>
                                                                                		<option value="129">Latvia</option>
                                                                                		<option value="130">Macao</option>
                                                                                		<option value="131">Morocco</option>
                                                                                		<option value="132">Monaco</option>
                                                                                		<option value="133">Moldova</option>
                                                                                		<option value="134">Madagascar</option>
                                                                                		<option value="135">Maldives</option>
                                                                                		<option value="136">Mexico</option>
                                                                                		<option value="137">Marshall Islands</option>
                                                                                		<option value="138">Macedonia</option>
                                                                                		<option value="139">Mali</option>
                                                                                		<option value="140">Malta</option>
                                                                                		<option value="141">Myanmar</option>
                                                                                		<option value="142">Mongolia</option>
                                                                                		<option value="143">Northern Mariana Islands</option>
                                                                                		<option value="144">Mozambique</option>
                                                                                		<option value="145">Mauritania</option>
                                                                                		<option value="146">Montserrat</option>
                                                                                		<option value="147">Martinique</option>
                                                                                		<option value="148">Mauritius</option>
                                                                                		<option value="149">Malawi</option>
                                                                                		<option value="150">Malaysia</option>
                                                                                		<option value="151">Mayotte</option>
                                                                                		<option value="152">Namibia</option>
                                                                                		<option value="153">New Caledonia</option>
                                                                                		<option value="154">Niger</option>
                                                                                		<option value="155">Norfolk Island</option>
                                                                                		<option value="156">Nigeria</option>
                                                                                		<option value="157">Nicaragua</option>
                                                                                		<option value="158">Niue</option>
                                                                                		<option value="159">Netherlands</option>
                                                                                		<option value="160">Norway</option>
                                                                                		<option value="161">Nepal</option>
                                                                                		<option value="162">Nauru</option>
                                                                                		<option value="163">New Zealand</option>
                                                                                		<option value="164">Oman</option>
                                                                                		<option value="165">Pakistan</option>
                                                                                		<option value="166">Panama</option>
                                                                                		<option value="167">Pitcairn</option>
                                                                                		<option value="168">Peru</option>
                                                                                		<option value="169">Philippines</option>
                                                                                		<option value="170">Palau</option>
                                                                                		<option value="171">Papua New Guinea</option>
                                                                                		<option value="172">Poland</option>
                                                                                		<option value="173">Puerto Rico</option>
                                                                                		<option value="174">North Korea</option>
                                                                                		<option value="175">Portugal</option>
                                                                                		<option value="176">Paraguay</option>
                                                                                		<option value="177">Palestine</option>
                                                                                		<option value="178">French Polynesia</option>
                                                                                		<option value="179">Qatar</option>
                                                                                		<option value="180">Réunion</option>
                                                                                		<option value="181">Romania</option>
                                                                                		<option value="182">Russian Federation</option>
                                                                                		<option value="183">Rwanda</option>
                                                                                		<option value="184">Saudi Arabia</option>
                                                                                		<option value="185">Sudan</option>
                                                                                		<option value="186">Senegal</option>
                                                                                		<option value="187">Singapore</option>
                                                                                		<option value="188">South Georgia and the South Sa</option>
                                                                                		<option value="189">Saint Helena</option>
                                                                                		<option value="190">Svalbard and Jan Mayen</option>
                                                                                		<option value="191">Solomon Islands</option>
                                                                                		<option value="192">Sierra Leone</option>
                                                                                		<option value="193">El Salvador</option>
                                                                                		<option value="194">San Marino</option>
                                                                                		<option value="195">Somalia</option>
                                                                                		<option value="196">Saint Pierre and Miquelon</option>
                                                                                		<option value="197">Sao Tome and Principe</option>
                                                                                		<option value="198">Suriname</option>
                                                                                		<option value="199">Slovakia</option>
                                                                                		<option value="200">Slovenia</option>
                                                                                		<option value="201">Sweden</option>
                                                                                		<option value="202">Swaziland</option>
                                                                                		<option value="203">Seychelles</option>
                                                                                		<option value="204">Syria</option>
                                                                                		<option value="205">Turks and Caicos Islands</option>
                                                                                		<option value="206">Chad</option>
                                                                                		<option value="207">Togo</option>
                                                                                		<option value="208">Thailand</option>
                                                                                		<option value="209">Tajikistan</option>
                                                                                		<option value="210">Tokelau</option>
                                                                                		<option value="211">Turkmenistan</option>
                                                                                		<option value="212">East Timor</option>
                                                                                		<option value="213">Tonga</option>
                                                                                		<option value="214">Trinidad and Tobago</option>
                                                                                		<option value="215">Tunisia</option>
                                                                                		<option value="216">Turkey</option>
                                                                                		<option value="217">Tuvalu</option>
                                                                                		<option value="218">Taiwan</option>
                                                                                		<option value="219">Tanzania</option>
                                                                                		<option value="220">Uganda</option>
                                                                                		<option value="221">Ukraine</option>
                                                                                		<option value="222">United States Minor Outlying I</option>
                                                                                		<option value="223">Uruguay</option>
                                                                                		<option value="224">United States</option>
                                                                                		<option value="225">Uzbekistan</option>
                                                                                		<option value="226">Holy See (Vatican City State)</option>
                                                                                		<option value="227">Saint Vincent and the Grenadin</option>
                                                                                		<option value="228">Venezuela</option>
                                                                                		<option value="229">Virgin Islands, British</option>
                                                                                		<option value="230">Virgin Islands, U.S.</option>
                                                                                		<option value="231">Vietnam</option>
                                                                                		<option value="232">Vanuatu</option>
                                                                                		<option value="233">Wallis and Futuna</option>
                                                                                		<option value="234">Samoa</option>
                                                                                		<option value="235">Yemen</option>
                                                                                		<option value="236">Yugoslavia</option>
                                                                                		<option value="237">South Africa</option>
                                                                                		<option value="238">Zambia</option>
                                                                                		<option value="239">Zimbabwe</option>
                                                                              </select>
                                  <div id="error_country" class="text-danger"></div>
                                </div>
                              </div>
                              <div class="form-group">
                                <label class="col-sm-4 control-label">State</label>
                                <div class="col-sm-5">
                                  <select class="form-control" id="state" name="state" onChange="ajax_call('ajaxCall',{location_id:this.value,location_type:2}, 'city')">
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                                  <div id="error_state" class="text-danger"></div>
                                </div>
                              </div>
                              <div class="form-group">
                                <label class="col-sm-4 control-label">City</label>
                                <div class="col-sm-5">
                                 	<select name="city" id="city" class="form-control">
            						</select>
                                    <div id="error_city" class="text-danger"></div>
                                </div>
                              </div>
                               <div class="form-group">
                                <label class="col-sm-4 control-label">Text/Photo for Notebook Cover</label>
                                <div class="col-sm-5">
                                  <input type="file" id="notebook_cover_file" name="notebook_cover_file">
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                               <div class="form-group">
                                <label class="col-sm-4 control-label">Date</label>
                                <div class="col-sm-5">
                                  <input type="text" class="form-control" id="datefor" name="datefor">
                                  <div id="error_datefor" class="text-danger"></div>
                                </div>
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                               <div class="form-group">
                                <label class="col-sm-4 control-label">Cardholder Name</label>
                                <div class="col-sm-5">
                                  <input type="text" class="form-control" id="cardholder_name" name="cardholder_name">
                                  <div id="error_cardholder" class="text-danger"></div>
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                              <div class="form-group">
                                <label class="col-sm-4 control-label">Card Number</label>
                                <div class="col-sm-5">
                                  <input type="text" class="form-control" id="card_no" name="card_no" maxlength="16" onKeyUp="autoTab(this, document.sumbitter_regis_form.exp_date_mm)">
                                  <div id="error_cardno" class="text-danger"></div>
                                </div>
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                              <div class="form-group">
                                <label class="col-sm-4 control-label">Expiration Date</label>
                                <div class="col-sm-2">
                                  <select class="form-control" id="exp_date_mm" name="exp_date_mm">
                                  	<option value="">MM</option>
                                                                        	<option value="1">1</option>
                                                                        	<option value="2">2</option>
                                                                        	<option value="3">3</option>
                                                                        	<option value="4">4</option>
                                                                        	<option value="5">5</option>
                                                                        	<option value="6">6</option>
                                                                        	<option value="7">7</option>
                                                                        	<option value="8">8</option>
                                                                        	<option value="9">9</option>
                                                                        	<option value="10">10</option>
                                                                        	<option value="11">11</option>
                                                                        	<option value="12">12</option>
                                                                      </select>
                                  <div id="error_exdatemm" class="text-danger"></div>
                                </div>
                                <div class="col-sm-2">
                                  <select class="form-control" id="exp_date_yy" name="exp_date_yy">
                                  	<option value="">YY</option>
                                                                          	<option value="2016">2016</option>
                                                                        	<option value="2017">2017</option>
                                                                        	<option value="2018">2018</option>
                                                                        	<option value="2019">2019</option>
                                                                        	<option value="2020">2020</option>
                                                                        	<option value="2021">2021</option>
                                                                        	<option value="2022">2022</option>
                                                                        	<option value="2023">2023</option>
                                                                        	<option value="2024">2024</option>
                                                                        	<option value="2025">2025</option>
                                                                        	<option value="2026">2026</option>
                                                                        	<option value="2027">2027</option>
                                                                        	<option value="2028">2028</option>
                                                                        	<option value="2029">2029</option>
                                                                        	<option value="2030">2030</option>
                                                                        	<option value="2031">2031</option>
                                                                        	<option value="2032">2032</option>
                                                                        	<option value="2033">2033</option>
                                                                        	<option value="2034">2034</option>
                                                                        	<option value="2035">2035</option>
                                                                        	<option value="2036">2036</option>
                                                                        	<option value="2037">2037</option>
                                                                        	<option value="2038">2038</option>
                                                                        	<option value="2039">2039</option>
                                                                        	<option value="2040">2040</option>
                                                                        	<option value="2041">2041</option>
                                                                        	<option value="2042">2042</option>
                                                                        	<option value="2043">2043</option>
                                                                        	<option value="2044">2044</option>
                                                                        	<option value="2045">2045</option>
                                                                      </select>
                                  <div id="error_exdateyy" class="text-danger"></div>
                                </div>
                              </div>
                               <div class="form-group">
                                <label class="col-sm-4 control-label">Security Code(of CCV or CVV)</label>
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                                  <input type="text" class="form-control" id="security_code" name="security_code">
                                  <div id="error_security" class="text-danger"></div>
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                                  <div id="error_mobile" class="text-danger"></div>
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                                  <div id="error_otp" class="text-danger"></div>
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                              </div>
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                                <label class="col-sm-4 control-label">Email</label>
                                <div class="col-sm-5">
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                                  <div id="error_email" class="text-danger"></div>
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