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Viewing File: /home/u403625155/domains/connecttogetherwith.com/public_html/charityworld/web/event.php

<?php 

require "../../mail.php";

?>



<!--Author: W3layouts
Author URL: http://w3layouts.com
License: Creative Commons Attribution 3.0 Unported
License URL: http://creativecommons.org/licenses/by/3.0/
-->
<!DOCTYPE HTML>
<html>
<head>
<title>App</title>
<!-- Custom Theme files -->
<link href="css/style.css" rel="stylesheet" type="text/css" media="all"/>
<!-- Custom Theme files -->
<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<meta name="viewport" content="width=device-width, initial-scale=1, maximum-scale=1">
<meta http-equiv="Content-Type" content="text/html; charset=utf-8" /> 
<meta name="keywords" content="Ensaluto Form Responsive,Login form web template, Sign up Web Templates, Flat Web Templates, Login signup Responsive web template, Smartphone Compatible web template, free webdesigns for Nokia, Samsung, LG, SonyErricsson, Motorola web design" />
<!--Google Fonts-->
<link href='http://fonts.googleapis.com/css?family=Open+Sans:300italic,400italic,600italic,700italic,800italic,400,300,600,700,800' rel='stylesheet' type='text/css'>
<!--Google Fonts-->
<script src="js/jquery.min.js"></script>
<script src="https://unpkg.com/sweetalert/dist/sweetalert.min.js"></script>
</head>

<style type="text/css">

	.app{
		padding: 20px;
	}
	.app input{
		background-color: #f2f2f2;
		border-top: 1px solid #fff;
	}
	select[name='persons']{
		background-color: #f2f2f2;
		border-top: 1px solid #fff;
		width: 72%;
		outline: none;
		padding: 10px;
	}
	.date{
		background-color: #f2f2f2;
		border-top: 1px solid #fff;
		outline: none;
		padding: 7px;
	}
	.app h1{
		padding: 10px;
		font-weight: bolder;
		font-size: 24px;
	}
	label{
		text-align: right;
	}
	::placeholder{
		font-size: 13px;
	}
	input[type='checkbox']{
		transform: scale(1.5);
		margin: 10px;
	}

	input[type='radio']{
		transform: scale(1.5);
		margin: 10px;
	}
	button{
		margin-top: 15px;
		padding: 10px 25px;
		background-color: black;
		color: white;
		border: none;
		border-radius: 4px;
		cursor: pointer;
	}


	@media screen and (max-width: 1024px) {
		.app{
			width: 60%;
		}

	}


	@media screen and (max-width: 600px) {
		.app{
			width: 85%;
		}

	}


</style>

<body>
<!--sign up form start here-->
<div class="app">
	
	<h1>Event Appearances</h1>
	<p style="color: white;font-size: 12px;">Book for an event appearance.</p><br>

	<form method="POST">

		<label><b>User Details:</b> </label><br>
		<input type="text" name="fname" placeholder="First Name">
		
		<input type="text" name="lname" placeholder="Last Name">
		
		<input type="text" name="email" placeholder="Email">

		<input type="text" name="phone" placeholder="Phone"><br>

		<label><b>Address Details: </b></label><br>
		<input type="text" name="address" placeholder="Address">

		<input type="text" name="street_address" placeholder="Street Address">
		
		<input type="text" name="city" placeholder="City">
		
		<input type="text" name="state" placeholder="State/Province/Region">
		
		<input type="text" name="country" placeholder="Country"><br>

		<label><b>Type Of Event: </b></label><br>
		<select name="persons">
			<option value="Birthday">Birthday</option>
			<option value="Musical performance">Musical Performance</option>
			<option value="speaking engagement">Speaking Engagement</option>
			<option value="wedding">Wedding</option>
			<option value="convention">Convention</option>
			<option value="others">Others</option>
		</select><br><br>

		<input type="text" name="location" placeholder="Event Location"><br>

		<label><br>Additional information about your event: </label><br>
		<input type="text" name="info" placeholder=""><br>

		<label><b>Date:</b></label><br>
		<select name="days" class="date">
		  <option value="1">Days</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>
		  <option value="13">13</option>
		  <option value="14">14</option>
		  <option value="15">15</option>
		  <option value="16">16</option>
		  <option value="17">17</option>
		  <option value="18">18</option>
		  <option value="19">19</option>
		  <option value="20">20</option>
		  <option value="21">21</option>
		  <option value="22">22</option>
		  <option value="23">23</option>
		  <option value="24">24</option>
		  <option value="25">25</option>
		  <option value="26">26</option>
		  <option value="27">27</option>
		  <option value="28">28</option>
		  <option value="29">29</option>
		  <option value="30">30</option>
		  <option value="31">31</option>
		</select>

		<select name="month" class="date">
		  <option value="">Month</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>

		<select name="year" class="date">
		  <option value="">Year</option>
		  <option value="1920">1920</option>
		  <option value="1921">1921</option>
		  <option value="1922">1922</option>
		  <option value="1923">1923</option>
		  <option value="1924">1924</option>
		  <option value="1925">1925</option>
		  <option value="1926">1926</option>
		  <option value="1927">1927</option>
		  <option value="1928">1928</option>
		  <option value="1929">1929</option>
		  <option value="1930">1930</option>
		  <option value="1931">1931</option>
		  <option value="1932">1932</option>
		  <option value="1933">1933</option>
		  <option value="1934">1934</option>
		  <option value="1935">1935</option>
		  <option value="1936">1936</option>
		  <option value="1937">1937</option>
		  <option value="1938">1938</option>
		  <option value="1939">1939</option>
		  <option value="1940">1940</option>
		  <option value="1941">1941</option>
		  <option value="1942">1942</option>
		  <option value="1943">1943</option>
		  <option value="1944">1944</option>
		  <option value="1945">1945</option>
		  <option value="1946">1946</option>
		  <option value="1947">1947</option>
		  <option value="1948">1948</option>
		  <option value="1949">1949</option>
		  <option value="1950">1950</option>
		  <option value="1951">1951</option>
		  <option value="1952">1952</option>
		  <option value="1953">1953</option>
		  <option value="1954">1954</option>
		  <option value="1955">1955</option>
		  <option value="1956">1956</option>
		  <option value="1957">1957</option>
		  <option value="1958">1958</option>
		  <option value="1959">1959</option>
		  <option value="1960">1960</option>
		  <option value="1961">1961</option>
		  <option value="1962">1962</option>
		  <option value="1963">1963</option>
		  <option value="1964">1964</option>
		  <option value="1965">1965</option>
		  <option value="1966">1966</option>
		  <option value="1967">1967</option>
		  <option value="1968">1968</option>
		  <option value="1969">1969</option>
		  <option value="1970">1970</option>
		  <option value="1971">1971</option>
		<option value="1972">1972</option>
		<option value="1973">1973</option>
		<option value="1974">1974</option>
		<option value="1975">1975</option>
		<option value="1976">1976</option>
		<option value="1977">1977</option>
		<option value="1978">1978</option>
		<option value="1979">1979</option>
		<option value="1980">1980</option>
		<option value="1981">1981</option>
		<option value="1982">1982</option>
		<option value="1983">1983</option>
		<option value="1984">1984</option>
		<option value="1985">1985</option>
		<option value="1986">1986</option>
		<option value="1987">1987</option>
		<option value="1988">1988</option>
		<option value="1989">1989</option>
		<option value="1990">1990</option>
		<option value="1991">1991</option>
		<option value="1992">1992</option>
		<option value="1993">1993</option>
		<option value="1994">1994</option>
		<option value="1995">1995</option>
		<option value="1996">1996</option>
		<option value="1997">1997</option>
		<option value="1998">1998</option>
		<option value="1999">1999</option>
		<option value="2000">2000</option>
		<option value="2001">2001</option>
		<option value="2002">2002</option>
		<option value="2003">2003</option>
		<option value="2004">2004</option>
		<option value="2005">2005</option>
		<option value="2006">2006</option>
		<option value="2007">2007</option>
		<option value="2008">2008</option>
		<option value="2009">2009</option>
		<option value="2010">2010</option>
		<option value="2011">2011</option>
		<option value="2012">2012</option>
		<option value="2013">2013</option>
		<option value="2014">2014</option>
		<option value="2015">2015</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>
		</select><br><br>

		<label><b>Time: </b></label><br>
		<input type="text" name="hour" placeholder="HH" style="width: 11%;"> <b>:</b>
		<input type="text" name="minute" placeholder="MM" style="width: 11%;">

		<select name="meridian" style="padding: 13px;outline: none;">
			<option value="AM">AM</option>
			<option value="PM">PM</option>
		</select><br>

		<label><b>Packages: </b></label><br>
		<input type="radio" name="package" value="1 Hour Appearance"><span style="font-size: 17px;">1 Hour Appearance</span>
		<input type="radio" name="package" value="3 Hours Appearance"><span style="font-size: 17px;">3 Hours Appearance</span>
		<input type="radio" name="package" value="5 Hours Appearance"><span style="font-size: 16px;">5 Hours Appearance</span><br><br>

		<label><b>Gender: </b></label><br>
		<span>Male</span><input type="radio" name="gender" value="male">
		<span>Female</span><input type="radio" name="gender" value="female">

		<p style="color: white;font-size: 12px;">NOTE: Your Payment has to be made in other for your application to be approved. Payment Validates Application.</p><br>

		<label><b>Consent*</b></label><br>
		<span>I Agree</span><input type="radio" name="choice" value="agree">
		<span>I Disagree</span><input type="radio" name="choice" value="disagree"><br>

		<button name="send">Submit</button>

	</form>





<?php

if($_POST){
	$fname=$_POST['fname'];
	$lname=$_POST['lname'];
	$email=$_POST['email'];
	$phone=$_POST['phone'];
	$address=$_POST['address'];
	$street_address=$_POST['street_address'];
	$city=$_POST['city'];
	$state=$_POST['state'];
	$country=$_POST['country'];
	$persons=$_POST['persons'];
	$location=$_POST['location'];
	$info=$_POST['info'];
	$days=$_POST['days'];
	$month=$_POST['month'];
	$year=$_POST['year'];
	$hour=$_POST['hour'];
	$minute=$_POST['minute'];
	$meridian=$_POST['meridian'];
	$package=$_POST['package'];
	$gender=$_POST['gender'];
	$choice=$_POST['choice'];
	
	$subject="New Permit Request";

$message = "<p>
	Name: $fname " . " " . $lname . " <br/>
	Email of Client: $email <br/>
	Phone Number: $phone <br/>
	Address: $address <br/>
	Street Address: $street_address <br/>
	City: $city <br/>
	State: $state <br/>
	Country: $country <br/>
	Persons: $persons <br/>
	Location: $location <br/>
	Info: $info <br/>
	Time: $days/$month/$year: $hour:$minute $meridian <br/>
	Package: $package <br/>
	Gender: $gender <br/>
	Choice: $choice <br/>
</p>";
	
	sendmail("support@connecttogetherwith.com","$subject","$message");
	
	echo"
	<script>
	swal('Great','We have received your request We Will Respond As Soon As Possible','success')
	</script>
	";
}

?>





<script src="https://unpkg.com/sweetalert/dist/sweetalert.min.js"></script>


</div>
<!--sign up form end here-->
</body>
</html>
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