src/resources/views/auth/register.blade.php
@extends('layouts.app')
@section('content')
<div class="container">
<div class="row">
<div class="col-md-8 col-md-offset-2">
<div class="panel panel-default">
<div class="panel-heading">Register</div>
<div class="panel-body">
<form class="form-horizontal" role="form" method="POST" action="{{ url('/register') }}">
{{ csrf_field() }}
<div class="form-group{{ $errors->has('first_name') ? ' has-error' : '' }}">
<label for="first_name" class="col-md-4 control-label">First Name</label>
<div class="col-md-6">
<input id="first_name" type="text" class="form-control" name="first_name" value="{{ old('first_name') }}">
@if ($errors->has('first_name'))
<span class="help-block">
<strong>{{ $errors->first('first_name') }}</strong>
</span>
@endif
</div>
</div>
<div class="form-group{{ $errors->has('last_name') ? ' has-error' : '' }}">
<label for="last_name" class="col-md-4 control-label">Last Name</label>
<div class="col-md-6">
<input id="last_name" type="text" class="form-control" name="last_name" value="{{ old('last_name') }}">
@if ($errors->has('last_name'))
<span class="help-block">
<strong>{{ $errors->first('last_name') }}</strong>
</span>
@endif
</div>
</div>
<div class="form-group{{ $errors->has('email') ? ' has-error' : '' }}">
<label for="email" class="col-md-4 control-label">E-Mail Address</label>
<div class="col-md-6">
<input id="email" type="email" class="form-control" name="email" value="{{ old('email') }}">
@if ($errors->has('email'))
<span class="help-block">
<strong>{{ $errors->first('email') }}</strong>
</span>
@endif
</div>
</div>
<div class="form-group{{ $errors->has('username') ? ' has-error' : '' }}">
<label for="username" class="col-md-4 control-label">Username</label>
<div class="col-md-6">
<input id="username" type="text" class="form-control" name="username" value="{{ old('username') }}">
@if ($errors->has('username'))
<span class="help-block">
<strong>{{ $errors->first('username') }}</strong>
</span>
@endif
</div>
</div>
<div class="form-group{{ $errors->has('password') ? ' has-error' : '' }}">
<label for="password" class="col-md-4 control-label">Password</label>
<div class="col-md-6">
<input id="password" type="password" class="form-control" name="password">
@if ($errors->has('password'))
<span class="help-block">
<strong>{{ $errors->first('password') }}</strong>
</span>
@endif
</div>
</div>
<div class="form-group{{ $errors->has('password_confirmation') ? ' has-error' : '' }}">
<label for="password-confirm" class="col-md-4 control-label">Confirm Password</label>
<div class="col-md-6">
<input id="password-confirm" type="password" class="form-control" name="password_confirmation">
@if ($errors->has('password_confirmation'))
<span class="help-block">
<strong>{{ $errors->first('password_confirmation') }}</strong>
</span>
@endif
</div>
</div>
<hr>
<div class="form-group{{ $errors->has('gender') ? ' has-error' : '' }}">
<label for="gender" class="col-md-4 control-label">Gender</label>
<div class="col-md-6">
<!-- <input id="gender" type="text" class="form-control" name="gender" value="{{ old('gender') }}"> -->
<select class="full-width" name="gender">
<option value="null">Please Select Birth Gender</option>
<option value="male">Male</option>
<option value="female">Female</option>
</select>
@if ($errors->has('gender'))
<span class="help-block">
<strong>{{ $errors->first('gender') }}</strong>
</span>
@endif
</div>
</div>
<div class="form-group{{ $errors->has('user_type') ? ' has-error' : '' }}">
<label for="user_type" class="col-md-4 control-label">User Type</label>
<div class="col-md-6">
<select class="full-width" name="user_type">
@foreach (include config('global.data').'/userTypes.php' as $userType)
<option value="{{ $userType }}"> {{ $userType }} </option>
@endforeach
</select>
@if ($errors->has('user_type'))
<span class="help-block">
<strong>{{ $errors->first('user_type') }}</strong>
</span>
@endif
</div>
</div>
<div class="form-group{{ $errors->has('age') ? ' has-error' : '' }}">
<label for="age" class="col-md-4 control-label">Age</label>
<div class="col-md-6">
<input id="age" type="number" class="form-control" name="age" value="{{ old('age') }}">
@if ($errors->has('age'))
<span class="help-block">
<strong>{{ $errors->first('age') }}</strong>
</span>
@endif
</div>
</div>
<div class="form-group{{ $errors->has('birth_country') ? ' has-error' : '' }}">
<label for="birth_country" class="col-md-4 control-label">Birth Country</label>
<div class="col-md-6">
<select class="full-width" name="birth_country">
<option value="NULL">Select Country</option>
<option value="AFG">Afghanistan</option>
<option value="ALA">Åland Islands</option>
<option value="ALB">Albania</option>
<option value="DZA">Algeria</option>
<option value="ASM">American Samoa</option>
<option value="AND">Andorra</option>
<option value="AGO">Angola</option>
<option value="AIA">Anguilla</option>
<option value="ATA">Antarctica</option>
<option value="ATG">Antigua and Barbuda</option>
<option value="ARG">Argentina</option>
<option value="ARM">Armenia</option>
<option value="ABW">Aruba</option>
<option value="AUS">Australia</option>
<option value="AUT">Austria</option>
<option value="AZE">Azerbaijan</option>
<option value="BHS">Bahamas</option>
<option value="BHR">Bahrain</option>
<option value="BGD">Bangladesh</option>
<option value="BRB">Barbados</option>
<option value="BLR">Belarus</option>
<option value="BEL">Belgium</option>
<option value="BLZ">Belize</option>
<option value="BEN">Benin</option>
<option value="BMU">Bermuda</option>
<option value="BTN">Bhutan</option>
<option value="BOL">Bolivia, Plurinational State of</option>
<option value="BES">Bonaire, Sint Eustatius and Saba</option>
<option value="BIH">Bosnia and Herzegovina</option>
<option value="BWA">Botswana</option>
<option value="BVT">Bouvet Island</option>
<option value="BRA">Brazil</option>
<option value="IOT">British Indian Ocean Territory</option>
<option value="BRN">Brunei Darussalam</option>
<option value="BGR">Bulgaria</option>
<option value="BFA">Burkina Faso</option>
<option value="BDI">Burundi</option>
<option value="KHM">Cambodia</option>
<option value="CMR">Cameroon</option>
<option value="CAN">Canada</option>
<option value="CPV">Cape Verde</option>
<option value="CYM">Cayman Islands</option>
<option value="CAF">Central African Republic</option>
<option value="TCD">Chad</option>
<option value="CHL">Chile</option>
<option value="CHN">China</option>
<option value="CXR">Christmas Island</option>
<option value="CCK">Cocos (Keeling) Islands</option>
<option value="COL">Colombia</option>
<option value="COM">Comoros</option>
<option value="COG">Congo</option>
<option value="COD">Congo, the Democratic Republic of the</option>
<option value="COK">Cook Islands</option>
<option value="CRI">Costa Rica</option>
<option value="CIV">Côte d'Ivoire</option>
<option value="HRV">Croatia</option>
<option value="CUB">Cuba</option>
<option value="CUW">Curaçao</option>
<option value="CYP">Cyprus</option>
<option value="CZE">Czech Republic</option>
<option value="DNK">Denmark</option>
<option value="DJI">Djibouti</option>
<option value="DMA">Dominica</option>
<option value="DOM">Dominican Republic</option>
<option value="ECU">Ecuador</option>
<option value="EGY">Egypt</option>
<option value="SLV">El Salvador</option>
<option value="GNQ">Equatorial Guinea</option>
<option value="ERI">Eritrea</option>
<option value="EST">Estonia</option>
<option value="ETH">Ethiopia</option>
<option value="FLK">Falkland Islands (Malvinas)</option>
<option value="FRO">Faroe Islands</option>
<option value="FJI">Fiji</option>
<option value="FIN">Finland</option>
<option value="FRA">France</option>
<option value="GUF">French Guiana</option>
<option value="PYF">French Polynesia</option>
<option value="ATF">French Southern Territories</option>
<option value="GAB">Gabon</option>
<option value="GMB">Gambia</option>
<option value="GEO">Georgia</option>
<option value="DEU">Germany</option>
<option value="GHA">Ghana</option>
<option value="GIB">Gibraltar</option>
<option value="GRC">Greece</option>
<option value="GRL">Greenland</option>
<option value="GRD">Grenada</option>
<option value="GLP">Guadeloupe</option>
<option value="GUM">Guam</option>
<option value="GTM">Guatemala</option>
<option value="GGY">Guernsey</option>
<option value="GIN">Guinea</option>
<option value="GNB">Guinea-Bissau</option>
<option value="GUY">Guyana</option>
<option value="HTI">Haiti</option>
<option value="HMD">Heard Island and McDonald Islands</option>
<option value="VAT">Holy See (Vatican City State)</option>
<option value="HND">Honduras</option>
<option value="HKG">Hong Kong</option>
<option value="HUN">Hungary</option>
<option value="ISL">Iceland</option>
<option value="IND">India</option>
<option value="IDN">Indonesia</option>
<option value="IRN">Iran, Islamic Republic of</option>
<option value="IRQ">Iraq</option>
<option value="IRL">Ireland</option>
<option value="IMN">Isle of Man</option>
<option value="ISR">Israel</option>
<option value="ITA">Italy</option>
<option value="JAM">Jamaica</option>
<option value="JPN">Japan</option>
<option value="JEY">Jersey</option>
<option value="JOR">Jordan</option>
<option value="KAZ">Kazakhstan</option>
<option value="KEN">Kenya</option>
<option value="KIR">Kiribati</option>
<option value="PRK">Korea, Democratic People's Republic of</option>
<option value="KOR">Korea, Republic of</option>
<option value="KWT">Kuwait</option>
<option value="KGZ">Kyrgyzstan</option>
<option value="LAO">Lao People's Democratic Republic</option>
<option value="LVA">Latvia</option>
<option value="LBN">Lebanon</option>
<option value="LSO">Lesotho</option>
<option value="LBR">Liberia</option>
<option value="LBY">Libya</option>
<option value="LIE">Liechtenstein</option>
<option value="LTU">Lithuania</option>
<option value="LUX">Luxembourg</option>
<option value="MAC">Macao</option>
<option value="MKD">Macedonia, the former Yugoslav Republic of</option>
<option value="MDG">Madagascar</option>
<option value="MWI">Malawi</option>
<option value="MYS">Malaysia</option>
<option value="MDV">Maldives</option>
<option value="MLI">Mali</option>
<option value="MLT">Malta</option>
<option value="MHL">Marshall Islands</option>
<option value="MTQ">Martinique</option>
<option value="MRT">Mauritania</option>
<option value="MUS">Mauritius</option>
<option value="MYT">Mayotte</option>
<option value="MEX">Mexico</option>
<option value="FSM">Micronesia, Federated States of</option>
<option value="MDA">Moldova, Republic of</option>
<option value="MCO">Monaco</option>
<option value="MNG">Mongolia</option>
<option value="MNE">Montenegro</option>
<option value="MSR">Montserrat</option>
<option value="MAR">Morocco</option>
<option value="MOZ">Mozambique</option>
<option value="MMR">Myanmar</option>
<option value="NAM">Namibia</option>
<option value="NRU">Nauru</option>
<option value="NPL">Nepal</option>
<option value="NLD">Netherlands</option>
<option value="NCL">New Caledonia</option>
<option value="NZL">New Zealand</option>
<option value="NIC">Nicaragua</option>
<option value="NER">Niger</option>
<option value="NGA">Nigeria</option>
<option value="NIU">Niue</option>
<option value="NFK">Norfolk Island</option>
<option value="MNP">Northern Mariana Islands</option>
<option value="NOR">Norway</option>
<option value="OMN">Oman</option>
<option value="PAK">Pakistan</option>
<option value="PLW">Palau</option>
<option value="PSE">Palestinian Territory, Occupied</option>
<option value="PAN">Panama</option>
<option value="PNG">Papua New Guinea</option>
<option value="PRY">Paraguay</option>
<option value="PER">Peru</option>
<option value="PHL">Philippines</option>
<option value="PCN">Pitcairn</option>
<option value="POL">Poland</option>
<option value="PRT">Portugal</option>
<option value="PRI">Puerto Rico</option>
<option value="QAT">Qatar</option>
<option value="REU">Réunion</option>
<option value="ROU">Romania</option>
<option value="RUS">Russian Federation</option>
<option value="RWA">Rwanda</option>
<option value="BLM">Saint Barthélemy</option>
<option value="SHN">Saint Helena, Ascension and Tristan da Cunha</option>
<option value="KNA">Saint Kitts and Nevis</option>
<option value="LCA">Saint Lucia</option>
<option value="MAF">Saint Martin (French part)</option>
<option value="SPM">Saint Pierre and Miquelon</option>
<option value="VCT">Saint Vincent and the Grenadines</option>
<option value="WSM">Samoa</option>
<option value="SMR">San Marino</option>
<option value="STP">Sao Tome and Principe</option>
<option value="SAU">Saudi Arabia</option>
<option value="SEN">Senegal</option>
<option value="SRB">Serbia</option>
<option value="SYC">Seychelles</option>
<option value="SLE">Sierra Leone</option>
<option value="SGP">Singapore</option>
<option value="SXM">Sint Maarten (Dutch part)</option>
<option value="SVK">Slovakia</option>
<option value="SVN">Slovenia</option>
<option value="SLB">Solomon Islands</option>
<option value="SOM">Somalia</option>
<option value="ZAF">South Africa</option>
<option value="SGS">South Georgia and the South Sandwich Islands</option>
<option value="SSD">South Sudan</option>
<option value="ESP">Spain</option>
<option value="LKA">Sri Lanka</option>
<option value="SDN">Sudan</option>
<option value="SUR">Suriname</option>
<option value="SJM">Svalbard and Jan Mayen</option>
<option value="SWZ">Swaziland</option>
<option value="SWE">Sweden</option>
<option value="CHE">Switzerland</option>
<option value="SYR">Syrian Arab Republic</option>
<option value="TWN">Taiwan, Province of China</option>
<option value="TJK">Tajikistan</option>
<option value="TZA">Tanzania, United Republic of</option>
<option value="THA">Thailand</option>
<option value="TLS">Timor-Leste</option>
<option value="TGO">Togo</option>
<option value="TKL">Tokelau</option>
<option value="TON">Tonga</option>
<option value="TTO">Trinidad and Tobago</option>
<option value="TUN">Tunisia</option>
<option value="TUR">Turkey</option>
<option value="TKM">Turkmenistan</option>
<option value="TCA">Turks and Caicos Islands</option>
<option value="TUV">Tuvalu</option>
<option value="UGA">Uganda</option>
<option value="UKR">Ukraine</option>
<option value="ARE">United Arab Emirates</option>
<option value="GBR">United Kingdom</option>
<option value="USA">United States</option>
<option value="UMI">United States Minor Outlying Islands</option>
<option value="URY">Uruguay</option>
<option value="UZB">Uzbekistan</option>
<option value="VUT">Vanuatu</option>
<option value="VEN">Venezuela, Bolivarian Republic of</option>
<option value="VNM">Viet Nam</option>
<option value="VGB">Virgin Islands, British</option>
<option value="VIR">Virgin Islands, U.S.</option>
<option value="WLF">Wallis and Futuna</option>
<option value="ESH">Western Sahara</option>
<option value="YEM">Yemen</option>
<option value="ZMB">Zambia</option>
<option value="ZWE">Zimbabwe</option>
</select>
@if ($errors->has('birth_country'))
<span class="help-block">
<strong>{{ $errors->first('birth_country') }}</strong>
</span>
@endif
</div>
</div>
<div class="form-group{{ $errors->has('ssn') ? ' has-error' : '' }}">
<label for="ssn" class="col-md-4 control-label">Social Security Number</label>
<div class="col-md-6">
<input id="ssn" type="text" class="form-control" name="ssn" value="{{ old('ssn') }}">
@if ($errors->has('ssn'))
<span class="help-block">
<strong>{{ $errors->first('ssn') }}</strong>
</span>
@endif
</div>
</div>
<div class="form-group">
<div class="col-md-6 col-md-offset-4">
<button type="submit" class="btn btn-primary" style="width:60%;margin-top:50px;">
<i class="fa fa-btn fa-user"></i> Register
</button>
</div>
</div>
</form>
</div>
</div>
</div>
</div>
</div>
@endsection