File: /var/www/html/sarvodayahospital/resources/views/pages/nursing-event-registration.blade.php
<!DOCTYPE html>
<html>
<head>
<title>National Nursing Conclave - Registration Form</title>
<meta charset="utf-8">
<meta name="viewport" content="width=device-width, initial-scale=1">
<link href="https://cdn.jsdelivr.net/npm/bootstrap@5.0.2/dist/css/bootstrap.min.css" rel="stylesheet">
<link rel="stylesheet" href="https://cdnjs.cloudflare.com/ajax/libs/font-awesome/4.7.0/css/font-awesome.css" integrity="sha512-5A8nwdMOWrSz20fDsjczgUidUBR8liPYU+WymTZP1lmY9G6Oc7HlZv156XqnsgNUzTyMefFTcsFH/tnJE/+xBg==" crossorigin="anonymous" referrerpolicy="no-referrer" />
<style>
@import url('https://fonts.googleapis.com/css2?family=Roboto:wght@400;500;700&display=swap');*{box-sizing: border-box;}body{margin: 0;padding: 0;font-size: 16px;line-height: 26px;color: #7E7E7E;font-family: 'Roboto', sans-serif;}img{max-width: 100%;}h2{font-size: 35px;line-height: 45px;font-weight: 700;color: #555555;}h3{font-size: 22px;line-height: 32px;}section{padding: 50px 0;}.fw-700{font-weight: 700;}.pdm-form-box {padding: 30px;margin-top: 30px;border: 1px solid #B8B8B8;border-radius: 10px;box-shadow: 0 6px 11px #4f4f4f19;}.pdm-form-content-wrapper {max-width: 900px;margin: auto;}.form-control {padding: 10px 15px;box-shadow: none !important;outline: none;}input[type="submit"] {border-radius: 5px;background: #008FC5;border: none;color: #fff;padding: 7px 40px;font-size: 18px;font-weight: 500;}
.f-6 {font-size: 8px}
.error {
color: red;
}
</style>
</head>
<body>
<section class="pdm-form-sec">
<div class="container">
<div class="pdm-form-content-wrapper">
<div class="pdm-form-content-box">
<img src="https://sdk-image2.s3.ap-south-1.amazonaws.com/nursing_conclave_bg_4ad546fe92.jpeg" class="w-100 banner-img mt-3 rounded-2"/>
<div class="pdm-form-box mt-3">
<form class="mt-4" method="POST" action="{{ route('nursing-event.registration') }}" enctype="multipart/form-data" id="nursing_reg_form">
@csrf
<input type="hidden" name="amount" value="" class="amount">
<input type="hidden" name="event_name" value="Nursing Conclave">
<div class="row">
<div class="col-sm-2">
<div class="form-group mb-4">
<label class="fw-700 mb-1">Title</label>
<select class="form-control form-select" name="title">
<option value="" disabled></option>
<option value="Dr" selected>Dr</option>
<option value="Mr">Mr</option>
<option value="Ms">Ms</option>
</select>
@error('title')
<span class="text-danger">{{ $message }}</span>
@enderror
</div>
</div>
<div class="col-sm-4">
<div class="form-group mb-4">
<label class="fw-700 mb-1">Name *</label>
<input type="text" class="w-100 form-control" placeholder="" name="name" value="{{ old('name') }}"/>
@error('name')
<span class="text-danger">{{ $message }}</span>
@enderror
</div>
</div>
<div class="col-sm-6">
<div class="form-group mb-4">
<label class="fw-700 mb-1">Profession *</label>
<select class="form-control form-select" name="profession" id="profession">
<option value="Choose Profession" selected disabled></option>
<option value="Student" {{ old('profession') === 'Student' ? 'selected' : '' }}>Student</option>
<option value="Nurse" {{ old('profession') === 'Nurse' ? 'selected' : '' }}>Nurse</option>
<option value="Nurse Admin" {{ old('profession') === 'Nurse Admin' ? 'selected' : '' }}>Nurse Admin</option>
<option value="Other" {{ old('profession') === 'Other' ? 'selected' : '' }}>Other</option>
</select>
@error('profession')
<span class="text-danger">{{ $message }}</span>
@enderror
</div>
</div>
</div>
<div class="row">
<div class="col-md-12">
<div class="form-group mb-4" id="prof_input">
<label class="fw-700 mb-1">Enter Nursing Registration Number *</label>
<input type="text" class="w-100 form-control" placeholder="" name="other_profession" value="{{ old('other_profession') }}" />
@error('other_profession')
<span class="text-danger">{{ $message }}</span>
@enderror
</div>
</div>
<div class="col-md-12">
<div class="form-group mb-4" id="id_card">
<label class="fw-700 mb-1">Upload Image of Your ID Card * <span class="f-6">(Upload file upto 2 MB)</span></label>
<input type="file" class="w-100 form-control" name="id_card" value="{{ old('id_card') }}" />
@error('id_card')
<span class="text-danger">{{ $message }}</span>
@enderror
</div>
</div>
<div class="col-sm-6">
<div class="form-group mb-4">
<label class="fw-700 mb-1">Email</label>
<input type="text" class="w-100 form-control" placeholder="" name="email"/>
@error('email')
<span class="text-danger">{{ $message }}</span>
@enderror
</div>
</div>
<div class="col-sm-6">
<div class="form-group mb-4">
<label class="fw-700 mb-1">Contact Number *</label>
<input type="text" class="w-100 form-control" placeholder="" name="phone" value="{{ old('phone') }}"/>
@error('phone')
<span class="text-danger">{{ $message }}</span>
@enderror
</div>
</div>
</div>
<div class="row">
<div class="col-sm-6">
<div class="form-group mb-4">
<label class="fw-700 mb-1">Organization/Institution *</label>
<input type="text" class="w-100 form-control" placeholder="" name="organization" value="{{ old('organization') }}"/>
@error('organization')
<span class="text-danger">{{ $message }}</span>
@enderror
</div>
</div>
<div class="col-sm-6">
<div class="form-group mb-4">
<label class="fw-700 mb-1">Designation</label>
<input type="text" class="w-100 form-control" placeholder="" name="qualification" value="{{ old('qualification') }}"/>
@error('qualification')
<span class="text-danger">{{ $message }}</span>
@enderror
</div>
</div>
</div>
<div class="row">
{{-- <div class="col-sm-6">
<div class="form-group mb-4">
<label class="fw-700 mb-1">MCI/RCI Registration ID</label>
<input type="text" class="w-100 form-control" placeholder="" name="registration_id"/>
</div>
</div> --}}
<div class="col-sm-6">
<div class="form-group mb-4">
<label class="fw-700 mb-1">City *</label>
<input type="text" class="w-100 form-control" placeholder="" name="city" value="{{ old('city') }}"/>
@error('city')
<span class="text-danger">{{ $message }}</span>
@enderror
</div>
</div>
<div class="col-md-12 fee_box">
<p> <i class="fa fa-info-circle" aria-hidden="true"></i> A payment of Rs <span class="charge"></span> as registration fee will be charged for this event. </p>
</div>
</div>
<div class="form-group mb-4 text-center">
<input type="submit" value="Proceed to Pay"/>
</div>
</form>
</div>
{{-- @if (\Session::has('event'))
@dump(\Session::get('event')->Name)
@endif --}}
</div>
</div>
</div>
@if (\Session::has('event'))
<form id="myForm" action="https://www.sarvodayahospital.com/paymentgatway/ccavRequestHandler.php" method="post">
<input type="hidden" name="mobile_number" value="{{ \Session::get('event')->Phone }}">
<input type="hidden" name="billing_name" value="{{ \Session::get('event')->Name }}">
<input type="hidden" name="billing_email" value="{{ \Session::get('event')->Email }}">
<input type="hidden" name="billing_country" value="India">
<input type="hidden" name="language" value="EN">
<input type="hidden" name="cancel_url" value="{{ route('nursing-event.payment-status') }}">
<input type="hidden" name="redirect_url" value="{{ route('nursing-event.payment-status') }}">
{{-- <input type="hidden" name="cancel_url" value="https://www.sarvodayahospital.com/order/success/online">
<input type="hidden" name="redirect_url" value="https://www.sarvodayahospital.com/order/success/online"> --}}
<input type="hidden" name="currency" value="INR">
<input type="hidden" name="amount" value="{{ \Session::get('event')->Amount }}">
<input type="hidden" name="order_id" value="{{ \Session::get('event')->TxnNumber }}">
<input type="hidden" id="tid" name="tid" value="{{ \Carbon\Carbon::now()->valueOf() }}">
<input type="hidden" name="merchant_id" value="{{ config('sarvodaya.ccAvenueMerchantId') }}">
{{-- <input type="submit" name="submit" value="Confirm"> --}}
</form>
@endif
</section>
<script src="https://ajax.googleapis.com/ajax/libs/jquery/3.6.4/jquery.min.js"></script>
<script src="https://cdn.jsdelivr.net/npm/jquery-validation@1.19.5/dist/jquery.validate.min.js"></script>
<script src="https://cdnjs.cloudflare.com/ajax/libs/jquery-validate/1.19.5/additional-methods.min.js"></script>
<script>
$('#myForm').submit();
$('#prof_input').hide();
$('#id_card').hide();
$('.fee_box').hide();
const expireDate = '2024-04-25';
if($('#profession').val() == 'Other' || $('#profession').val() == 'Student') {
$('#id_card').show();
$('#prof_input').hide();
}
if($('#profession').val() == 'Nurse' || $('#profession').val() == 'Nurse Admin') {
$('#prof_input').show();
$('#id_card').hide();
}
function GetTodayDate() {
var tdate = new Date();
return tdate.toISOString().slice(0, 10);
}
function getEventChargeAmount(profession) {
if (GetTodayDate() <= expireDate) {
switch (profession) {
case 'Student':
$('.fee_box').show();
$('.charge').text('1000');
$('.amount').val('1000');
break;
default:
$('.fee_box').show();
$('.charge').text('1500');
$('.amount').val('1500');
break;
}
} else {
switch (profession) {
case 'Student':
$('.fee_box').show();
$('.charge').text('1000');
$('.amount').val('1000');
break;
default:
$('.fee_box').show();
$('.charge').text('2000');
$('.amount').val('2000');
break;
}
}
}
$(document).ready(function () {
$('#profession').change(function(event) {
let professionVal = $(this).val();
getEventChargeAmount(professionVal)
if(professionVal == 'Other' || professionVal == 'Student') {
$('#id_card').show();
$('#prof_input').hide();
}else {
$('#id_card').hide();
$('#prof_input').show();
}
})
$('#nursing_reg_form').validate({
rules: {
name: {
required: true
},
email: {
required: true,
email: true
},
phone: {
required: true
},
profession: {
required: true
},
other_profession: {
required: true
},
id_card: {
required: true,
accept: "image/*,application/pdf"
},
organization: {
required: true
},
city: {
required: true
}
}
});
});
</script>
</body>
</html>