{Header}

  	<section class="inner-banner pattern-3">
        <div class="container text-center">
            <h2>REGISTRATION</h2>
            <p>We Offer Only Meditation</p>
        </div>
    </section>

	
	
	
	
	<section class="checkout-section section-padding cart-section">
        <div class="container">
            <div class="row clearfix">
				<div class="col-lg-9 col-xs-12">
                <!--Form Column-->
	<!--BeginFormmembers_recordHeader-->
	<!--EndFormmembers_recordHeader-->
	<!--BeginFormmembers_record-->	
                    <div class="section-title text-left">
                        <h1><span>MEMBER REGISTRATION</span></h1>
                    </div>
					<div class="col-md-12 col-sm-12 col-xs-12 column form-column"></div>
                    <div class="default-form billing-info-form">
						<div  style="margin-top:-32px;"><h5>Fields with <span class="txt-color-orng">' * '</span> are compulsory</h5></div>
                       <form method="POST" action="{FileName}" name="members_record">
					   <div class="col-md-12 col-sm-12 col-xs-12 column form-column">
					   <div class="row clearfix">
					   
					   <!--Beginmembers_recordError-->
					  <div class="form-group col-md-12 col-sm-12 col-xs-12">
					   	 <font color="#FF0000" size="-1">{smembers_recordErr}</font>
					   </div>
					   <!--Endmembers_recordError-->
					   
                			
								
									<div class="form-group col-md-6 col-sm-12 col-xs-12">
										<div class="field-label">First Name*</div>
										<input type="text" name="name" maxlength="50" value="{name}" size="25">
									</div>
									<div class="form-group col-md-6 col-sm-12 col-xs-12">
										<div class="field-label">Last Name*</div>
										<input type="text" name="surname" maxlength="50" value="{surname}" size="25">
									</div>
									<div class="form-group col-md-6 col-sm-12 col-xs-12">
										<div class="field-label">Email ID*</div>
										<input type="text" name="emailId" maxlength="50" value="{emailId}" size="25">
									</div>
									<div class="form-group col-md-6 col-sm-12 col-xs-12">
										<div class="field-label">Mobile No*</div>
										<input type="text" name="mobileNo" maxlength="50" value="{mobileNo}" size="25">
									</div>
									
									<div class="col-md-6 col-sm-12 col-xs-12">
									<div class="field-label">Gender*</div>
									<div class="radio">
										<!--Beginmembers_recordRLgender--><label><input type="radio" name="gender" value="{ID}" {Selected}>{Value}</label> <!--Endmembers_recordRLgender-->
									</div>
									</div>
									
									<div class="form-group col-md-6 col-sm-12 col-xs-12">
										<div class="field-label">Date of Birth</div>
										 <input type="text" name="dob" value="{dob}" id="mydate" data-lang="en" data-years="1915-2635"  data-format="DD-MM-YYYY" class="cal-icon"/>
									</div>
									<div class="form-group col-md-6 col-sm-12 col-xs-12">
										<div class="field-label">Password*</div>
										<input type="password" name="password" maxlength="50" value="{password}" size="25">
									</div>
									<div class="form-group col-md-6 col-sm-12 col-xs-12">
										<div class="field-label">Re-enter Password*</div>
										<input type="password" name="cpassword" maxlength="50" value="{cpassword}" size="25">
									</div>
									<div class="form-group col-md-6 col-sm-12 col-xs-12">
										<div class="field-label">Religion</div>
										<select name="seqReligionId" class="select">
										<!--Beginmembers_recordLBseqReligionId-->
										<option value="{ID}" {Selected}>{Value}</option>
										<!--Endmembers_recordLBseqReligionId-->
										</select>
									</div>
									<div class="form-group col-md-6 col-sm-12 col-xs-12">
										<div class="field-label">Category*</div>
										<select name="seqCaregoryId" class="select">
										<!--Beginmembers_recordLBseqCaregoryId-->
										<option value="{ID}" {Selected}>{Value}</option>
										<!--Endmembers_recordLBseqCaregoryId-->
										</select>
									</div>
									<!--Beginmembers_recordRLstatus-->
									<!--Endmembers_recordRLstatus-->


<div class="clearfix remember-box">
								 
								&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <input type="checkbox" name="terms" value="Y"/>
                              I Agree <a href="terms.php" target="_blank">Terms and Conditions</a>
								
								</div>	

									
							<div class="margin-top-40 text-right">



  <!--Beginmembers_recordInsert-->
				<input type="hidden" value="insert" name="FormAction">
				<button type="submit" class="thm-btn thm-blue-bg" onClick="document.members_record.FormAction.value = 'insert';">Register</button>
				                         <!--Endmembers_recordInsert-->


									<!--Beginmembers_recordCancel-->
							<button type="submit" class="thm-btn thm-blue-bg" onClick="document.members_record.FormAction.value = 'cancel';">Cancel</button>
							    <!--Endmembers_recordCancel-->
								
									   
								
							</div>
								</div>
							</div>
							
							
							<input type="hidden" name="FormName" value="members_record"/>
							<input type="hidden" name="Trn_dims" value="{Trn_dims}"/>
							<input type="hidden" name="Trn_Formmemberslist_grid_Sorting" value="{Trn_Formmemberslist_grid_Sorting}"/>
							<input type="hidden" name="Trn_Formmemberslist_grid_Sorted" value="{Trn_Formmemberslist_grid_Sorted}"/>
							<input type="hidden" name="Trn_s_seqMemberId" value="{Trn_s_seqMemberId}"/>
							<input type="hidden" name="Trn_s_name" value="{Trn_s_name}"/>
							<input type="hidden" name="Trn_s_surname" value="{Trn_s_surname}"/>
							<input type="hidden" name="Trn_s_emailId" value="{Trn_s_emailId}"/>
							<input type="hidden" name="Trn_s_gender" value="{Trn_s_gender}"/>
							<input type="hidden" name="Trn_s_seqReligionId" value="{Trn_s_seqReligionId}"/>
							<input type="hidden" name="Trn_s_seqCaregoryId" value="{Trn_s_seqCaregoryId}"/>
							<input type="hidden" name="Trn_s_registeredOn" value="{Trn_s_registeredOn}"/>
							<input type="hidden" name="Trn_s_status" value="{Trn_s_status}"/>
							<input type="hidden" name="PK_dims" value="{PK_dims}"/>
							<input type="hidden" name="dims" value="{dims}"/>
							
							
                        </form>
                    </div>
					
					
	<!--EndFormmembers_record-->
	<!--BeginFormmembers_recordFooter-->
	<!--EndFormmembers_recordFooter-->	
					
					
					
					
					
					
					
					
					
					
					
                <!--Form Column-->
				</div>
				<div class="col-lg-3 col-xs-12">
					<div class="single-sidebar package-slider-widget">
                            <div class="title">
                                <h3>CATEGORIES</h3>
                            </div>
                            <!-- /.title -->
                            <div id="package-slider-widget-wrapper" class="carousel slide offer-going-package-menu" data-ride="carousel">
                                <!-- Wrapper for slides -->
                                <div class="carousel-inner" role="listbox">
                                    
                                    <div class="item active">
                                        <div class="single-offer-going-pack">
                                            <div class="img-box">
                                                <img src="img/neophytes/student.jpg" alt="Students">
                                            </div>
                                            <div class="text-box">
                                                <div class="icon-box">
                                                    <div class="box">
                                                        <i class="fc-icon ftc-icon-running"></i>
                                                    </div>
                                                </div>
                                                <div class="content-box">
                                                    <a href="#"><h3>Students</h3></a>
                                                </div>
                                            </div>
                                        </div>
                                    </div>
                                    <div class="item">
                                        <div class="single-offer-going-pack">
                                            <div class="img-box">
                                                <img src="img/neophytes/working-pros.jpg" alt="Working Pros">
                                            </div>
                                            <div class="text-box">
                                                <div class="icon-box">
                                                    <div class="box">
                                                        <i class="fc-icon ftc-icon-running"></i>
                                                    </div>
                                                </div>
                                                <div class="content-box">
                                                    <a href="#"><h3>WORKING PROS</h3></a>
                                                </div>
                                            </div>
                                        </div>
                                    </div>
									
									<div class="item">
                                        <div class="single-offer-going-pack">
                                            <div class="img-box">
                                                <img src="img/neophytes/couple.jpg" alt="Couple">
                                            </div>
                                            <div class="text-box">
                                                <div class="icon-box">
                                                    <div class="box">
                                                        <i class="fc-icon ftc-icon-running"></i>
                                                    </div>
                                                </div>
                                                <div class="content-box">
                                                    <a href="#"><h3>Couple</h3></a>
                                                </div>
                                            </div>
                                        </div>
                                    </div>
                                </div>
								
								
								
								
								
                                <!-- Indicators -->
                                <ol class="carousel-indicators">
                                    <li data-target="#package-slider-widget-wrapper" data-slide-to="0" class="active"></li>
                                    <li data-target="#package-slider-widget-wrapper" data-slide-to="1" class=""></li>
                                    <li data-target="#package-slider-widget-wrapper" data-slide-to="2" class=""></li>
                                   
                                </ol>
                            </div>
                        </div>
				</div>
                </div>
            </div>
        </div>
    </section>
	<!--- Calendar css and js ----->
<link href="calendar/js/ion.calendar.css" rel="stylesheet" type="text/css">
<script src="calendar/jquery.min.js"></script> 
<script src="calendar/js/moment.min.js"></script> 
<script src="calendar/js/ion.calendar.js"></script> 
<script>
$(function(){
    $("#demo1").ionCalendar({
        lang: "en",
        years: "1915-2695",
        onClick: function(date){
            $("#result-1").html("onClick:<br/>" + date);
        }
    });


       $("#mydate").ionDatePicker();
	   $("#mydate2").ionDatePicker();
	    $("#mydate3").ionDatePicker();
		 $("#mydate4").ionDatePicker();
});
</script>
<script type="text/javascript">

  var _gaq = _gaq || [];
  _gaq.push(['_setAccount', 'UA-36251023-1']);
  _gaq.push(['_setDomainName', 'jqueryscript.net']);
  _gaq.push(['_trackPageview']);

  (function() {
    var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true;
    ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js';
    var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s);
  })();

</script>
<!--- Calendar css and js End----->
	
    
    
{Footer}