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<!doctype html> <!--[if lt IE 7]> <html class="no-js lt-ie9 lt-ie8 lt-ie7" lang=""> <![endif]--> <!--[if IE 7]> <html class="no-js lt-ie9 lt-ie8" lang=""> <![endif]--> <!--[if IE 8]> <html class="no-js lt-ie9" lang=""> <![endif]--> <!--[if gt IE 8]><!--> <html class="no-js" lang="en"> <!--<![endif]--> <head> <meta charset="utf-8"> <meta name="viewport" content="width=device-width, initial-scale=1"> <meta name="description" content=""> <meta name="author" content="DynamicLayers"> <title>Dominican Institute | Registration </title> <link rel="shortcut icon" type="image/x-icon" href="img/logo.png"> <!-- Font Awesome Icons CSS --> <link rel="stylesheet" href="css/font-awesome.min.css"> <!-- Themify Icons CSS --> <link rel="stylesheet" href="css/themify-icons.css"> <!-- Elegant Font Icons CSS --> <link rel="stylesheet" href="css/elegant-font-icons.css"> <!-- Elegant Line Icons CSS --> <link rel="stylesheet" href="css/elegant-line-icons.css"> <!-- Bootstrap CSS --> <link rel="stylesheet" href="css/bootstrap.min.css"> <!-- Venobox CSS --> <link rel="stylesheet" href="css/venobox/venobox.css"> <!-- OWL-Carousel CSS --> <link rel="stylesheet" href="css/owl.carousel.css"> <!-- Slick Nav CSS --> <link rel="stylesheet" href="css/slicknav.min.css"> <!-- Css Animation CSS --> <link rel="stylesheet" href="css/css-animation.min.css"> <!-- Nivo Slider CSS --> <link rel="stylesheet" href="css/nivo-slider.css"> <!-- Main CSS --> <link rel="stylesheet" href="css/main.css"> <!-- Responsive CSS --> <link rel="stylesheet" href="css/responsive.css"> <style> select option { background-color: red; color: #333333 !important; } </style> <script src="js/vendor/modernizr-2.8.3-respond-1.4.2.min.js"></script> </head> <body> <!--[if lt IE 8]> <p class="browserupgrade">You are using an <strong>outdated</strong> browser. Please <a href="http://browsehappy.com/">upgrade your browser</a> to improve your experience.</p> <![endif]--> <div class="site-preloader-wrap"> <div class="spinner"></div> </div><!-- Preloader --> <?php include("includes/navigation.php"); ?> <div class="header-height"></div> <div class="pager-header"> <div class="container"> <div class="page-content text-center"> <h2>Alumni Registration</h2> <!-- <p>Nobody is bothered about an institution more than <br> its alumni</p> <ol class="breadcrumb"> <li class="breadcrumb-item"><a href="./">Home</a></li> <li class="breadcrumb-item active">Alumni Registration</li> </ol> --> </div> </div> </div><!-- /Page Header --> <!-- /Page Header --> <div style="background-color: #FFFFFF;padding: 47px;"> <div class="row"> <div class="col-lg-9"> <?php if(isset($_POST['g-recaptcha-response'])){ // recaptcha version 2 $captcha = $_POST['g-recaptcha-response']; if(empty($captcha)){ echo "<div class='alert alert-danger'> An error occured, please try again! </div>"; exit(); } else{ $title =$surname = $middle_name =$first_name =$nationality = $country_of_residence= $date_of_birth= $affiliation= $current_address= $phone_number=$alternate_phone_number=$alternate_phone_number = $current_profession =$program_of_study =$year_of_entry = $year_of_graduation =$email_assignment =$email_update =$agreement =""; if ($_SERVER["REQUEST_METHOD"] == "POST" && isset($_POST["submit"]) && $_POST["submit"] ==="Register as Alumni") { // recaptcha version 3 $url = "https://www.google.com/recaptcha/api/siteverify"; $secret = "6LfTgrYgAAAAABNDnxujH42IJQ0uy5_U5GQ1vi9P"; $response = $_POST['token_generate']; $remote_ip = $_SERVER['REMOTE_ADDR']; $request = file_get_contents($url.'?secret='.$secret.'&response='.$response); $result = json_decode($request); function args($data) { //include_once("includes/config.php"); require("includes/config.php"); $data = trim($data); $data = stripslashes($data); $data = strip_tags($data); $data = htmlspecialchars($data); $data = mysqli_real_escape_string($con, $data); return $data; } $title = args($_POST['title']); $surname = args($_POST['surname']); $middle_name = args($_POST['middle_name']); $first_name = args($_POST['first_name']); $nationality = args($_POST['nationality']); $email = args($_POST['email']); $country_of_residence = args($_POST['country_of_residence']); $date_of_birth = args($_POST['date_of_birth']); $affiliation = args($_POST['affiliation']); $current_address = args($_POST['current_address']); $phone_number = args($_POST['phone_number']); $alternate_phone_number = args($_POST['alternate_phone_number']); $current_profession = args($_POST['current_profession']); $program_of_study = args($_POST['program_of_study']); $year_of_entry = args($_POST['year_of_entry']); $year_of_graduation = args($_POST['year_of_graduation']); $email_assignment = args($_POST['email_assignment']); $email_update = args($_POST['email_update']); $agreement = args($_POST['agreement']); $archived = "No"; $date_registered=date("F j, Y"); $insert = "INSERT INTO alumni (title,surname, middle_name, first_name, email, nationality, country_of_residence, date_of_birth, affiliation, current_address, phone_number, alternate_phone_number, current_profession, program_of_study, year_of_entry, year_of_graduation, email_assignment, email_update, agreement, archived, date_registered ) VALUES ('$title','$surname', '$middle_name','$first_name','$email','$nationality','$country_of_residence','$date_of_birth','$affiliation', '$current_address','$phone_number', '$alternate_phone_number', ' $current_profession','$program_of_study', '$year_of_entry',' $year_of_graduation','$email_assignment', '$email_update','$agreement', '$archived', '$date_registered')"; $run = mysqli_query($con, $insert); if ($run) { echo "<div class='alert alert-success'> Thank you $surname $first_name $middle_name! for registering as Dominican Institute Alumnus. Its pleasure having you back. Please dont register again. Our team will get in touch with you. Thank you. </div>"; ?> <?php } else { echo "<div class='alert alert-danger'> An error occured, please try again! </div>"; } } } } ?> <div class="comment-form"> <div class="login-form bg-white p-5"> <div class="panel panel-default"> <div class="panel-heading"> <h3 class="panel-title">Alumni Registration</h3> <p>Complete and submit the form below to Register as Dominican Institute alumnus.</p> </div> <div class="panel-body"> <div class="col-lg-10"> <script src="https://www.google.com/recaptcha/api.js" async defer></script> <script src="https://www.google.com/recaptcha/api.js?render=6LfTgrYgAAAAAO-xgeLKm8L6A2xdiYQ1yUyMyqW1"></script> <form action="<?php echo htmlspecialchars($_SERVER["PHP_SELF"]); ?>" method="POST"> <fieldset> <div class="row"> <div class="col-lg-6"> <div class="form-group"> <label for="exampleInputEmail1">Title</label> <input class="form-control" placeholder="Title e.g Prof., Dr., Fr., Rev., Chief, Mr., Mrs., Miss " name="title" type="text" style="padding: 20px;" required> </div> </div> <div class="col-lg-6"> <div class="form-group"> <label for="exampleInputEmail1">Surname</label> <input class="form-control" placeholder="Surname" name="surname" type="text" style="padding: 20px;" required> </div> </div> </div> <div class="row"> <div class="col-lg-6"> <div class="form-group"> <label for="exampleInputEmail1">Middle Name</label> <input class="form-control" placeholder="Middle Name" name="middle_name" type="text" style="padding: 20px;" required> </div> </div> <div class="col-lg-6"> <div class="form-group"> <label for="exampleInputEmail1">First Name</label> <input class="form-control" placeholder="First Name" name="first_name" type="text" style="padding: 20px;" required> </div> </div> </div> <div class="row"> <div class="col-lg-12"> <div class="form-group"> <label for="exampleInputEmail1">email address</label> <input class="form-control" placeholder="Email Address" name="email" type="text" style="padding: 20px;" required> </div> </div> </div> <div class="row"> <div class="col-lg-6"> <div class="form-group"> <label for="exampleInputEmail1">Nationality</label> <input class="form-control" placeholder="Nationality" name="nationality" type="text" style="padding: 20px;" required> </div> </div> <div class="col-lg-6"> <div class="form-group"> <label for="exampleInputEmail1">Country of Residence</label> <input class="form-control" placeholder="Country of Residence" name="country_of_residence" type="text" style="padding: 20px;" required> </div> </div> </div> <div class="row"> <div class="col-lg-6"> <div class="form-group"> <label for="exampleInputEmail1">Date of Birth</label> <input class="form-control" name="date_of_birth" type="date" style="padding: 20px;" required> </div> </div> <div class="col-lg-6"> <div class="form-group"> <label for="affliation">Institutional/Congregational/Diocesan Affiliation</label> <select class="form-control" name="affiliation" style="color:black;" required> <option value="" selected>Select Institutional/Congregational/Diocesan Affiliation</option> <option value="Order of Preachers">Order of Preachers</option> <option value="Order of Discalced Carmelites">Order of Discalced Carmelites</option> <option value="Order of Friars Minor (Capuchin)">Order of Friars Minor (Capuchin)</option> <option value="Schoenstate Fathers">Schoenstatt Fathers</option> <option value="Society of the two Hearts of Love of Jesus and Mary">Society of the two Hearts of Love of Jesus and Mary</option> <option value="Consolers of Christ">Consolers of Christ</option> <option value="Josephites of Murialdo">Josephites of Murialdo</option> <option value="Society of Divine Vocations (vocationists)">Society of Divine Vocations (vocationists)</option> <option value="Claretsan Missionaries">Claretsan Missionaries</option> <option value="Little sons of the Eucharist">Little sons of the Eucharist</option> <option value="Missionary Sons of Blessed Tansi (Tansians)">Missionary Sons of Blessed Tansi (Tansians)</option> <option value="SMA formation Houses">SMA formation Houses</option> <option value="Society of St. Joseph or the sacred Heart">Society of St. Joseph or the sacred Heart</option> <option value="Friend of Jesus Missionary Society">Friend of Jesus Missionary Society</option> <option value="Congregation of the Most Holy Redeemer">Congregation of the Most Holy Redeemer</option> <option value="Oblates of Saint Joseph">Oblates of Saint Joseph</option> <option value="Diocesan">Diocesan</option> <option value="Lay Faithful">Lay Faithful </option> </select> </div> </div> </div> <div class="row"> <div class="col-lg-6"> <div class="form-group"> <label for="exampleInputEmail1">Current Address</label> <textarea class="form-control" cols="30" rows="20" placeholder="Current Address" name="current_address" required></textarea> </div> </div> <div class="col-lg-6"> <div class="form-group"> <label for="exampleInputEmail1">Functional Phone number</label> <input class="form-control" placeholder="Functional Phone number" name="phone_number" type="text" style="padding: 20px;" required> </div> </div> </div> <div class="row"> <div class="col-lg-6"> <div class="form-group"> <label for="exampleInputEmail1">Alternate Phone Number</label> <input class="form-control" placeholder="Alternate Phone Number" name="alternate_phone_number" type="text" style="padding: 20px;" required> </div> </div> <div class="col-lg-6"> <div class="form-group"> <label for="exampleInputEmail1">Current Profession/Occupation/Position</label> <input class="form-control" placeholder="Current Profession" name="current_profession" type="text" style="padding: 20px;" required> </div> </div> </div> <div class="row"> <div class="col-lg-12"> <div class="form-group"> <label for="exampleInputEmail1">Programme of Study</label> <br> <div class="form-check form-check-block"> <input class="form-check-input" type="checkbox" name="program_of_study" id="inlineRadio1" value="Bachelor of Arts in Philosophy"> <label class="form-check-label" for="inlineRadio1">Bachelor of Arts in Philosophy </label> <br> <input class="form-check-input" type="checkbox" name="program_of_study" id="inlineRadio2" value="Bachelor of Sacred Theology"> <label class="form-check-label" for="inlineRadio2">Bachelor of Sacred Theology</label> <br> <input class="form-check-input" type="checkbox" name="program_of_study" id="inlineRadio2" value="Master of Arts in Theology"> <label class="form-check-label" for="inlineRadio2">Master of Arts in Theology</label> <br> <input class="form-check-input" type="checkbox" name="program_of_study" id="inlineRadio2" value="Diploma in Catholic Theology"> <label class="form-check-label" for="inlineRadio2">Diploma in Catholic Theology</label> <br> <input class="form-check-input" type="checkbox" name="program_of_study" id="inlineRadio2" value="Diploma in Religious Formation and Spirituality"> <label class="form-check-label" for="inlineRadio2">Diploma in Religious Formation and Spirituality</label> <br> <input class="form-check-input" type="checkbox" name="program_of_study" id="inlineRadio2" value="Diploma in Religious Formation and Spirituality"> <label class="form-check-label" for="inlineRadio2">Diploma in Religious Formation and Spirituality</label> <br> <input class="form-check-input" type="checkbox" name="program_of_study" id="inlineRadio2" value="Certificate in Theology"> <label class="form-check-label" for="inlineRadio2">Certificate in Theology</label> <br> </div> </div> </div> </div> <div class="row"> <div class="col-lg-6"> <div class="form-group"> <label for="exampleInputEmail1">Year of Entry</label> <input class="form-control" name="year_of_entry" type="text" placeholder="Year of Entry" style="padding: 20px;" required> </div> </div> <div class="col-lg-6"> <div class="form-group"> <label for="exampleInputEmail1">Year of Graduation/Exit</label> <input class="form-control" name="year_of_graduation" type="text" placeholder="Year of Graduation/Exit" style="padding: 20px;" required> </div> </div> </div> <div class="row"> <div class="col-lg-12"> <div class="form-group"> <label for="affliation">I would like to:</label> <select class="form-control col-lg-12 text-red" name="email_assignment" style="color:black;" required> <option value="" selected>Select what you would like to do</option> <option value="be assigned a personal institutional e-mail address (xx000@dominicaninstitute.edu.ng)">be assigned a personal institutional e-mail address (xx000@dominicaninstitute.edu.ng)</option> <option value="retain already assigned personal institutional e-mail address (xx000@dominicaninstitute.edu.ng)">retain already assigned personal institutional e-mail address (xx000@dominicaninstitute.edu.ng)</option> <option value="have my already assigned personal institutional e-mail address deleted completely">have my already assigned personal institutional e-mail address deleted completely</option> <option value="decline assignation of any personal institutional e-mail address.">decline assignation of any personal institutional e-mail address.</option> </select> </div> </div> </div> <div class="row"> <div class="col-lg-12"> <div class="form-group"> <label for="exampleInputEmail1">Would you like to receive e-mail updates about intellectual and social activities of students and staff of the Institute?</label> <br> <div class="form-check form-check-block"> <input class="form-check-input" type="radio" name="email_update" id="inlineRadio1" value="Yes"> <label class="form-check-label" for="inlineRadio1">Yes </label> <br> <input class="form-check-input" type="radio" name="email_update" id="inlineRadio1" value="No"> <label class="form-check-label" for="inlineRadio1">No </label> <br> <input class="form-check-input" type="radio" name="email_update" id="inlineRadio1" value="Maybe"> <label class="form-check-label" for="inlineRadio1">Maybe </label> <br> </div> </div> </div> </div> <div> <input type="hidden" name="token_generate" id="token_generate"> </div> <div class="row"> <div class="col-lg-12"> <div class="form-group"> <label for="affliation">I agree to the terms and conditions of the Dominican Institute Electronic Mail Account Service</label> <select class="form-control col-lg-12 text-red" name="agreement" style="color:black;" required> <option value="" selected>Select terms and conditions</option> <option value="Yes">Yes</option> <option value="No">No</option> </select> </div> </div> </div> <div class="row"> <div class="col-lg-6"> <div class="g-recaptcha" data-sitekey="6Le-OLcgAAAAAPcQrF03N76juLKGVAkT6x71Z1fQ"></div> </div> </div> <div class="row"> <div class="col-lg-6"> <input class="btn btn-lg btn-block default-btn" name="submit" type="submit" value="Register as Alumni"> </div> </div> <script> grecaptcha.ready(function() { grecaptcha.execute('6LfTgrYgAAAAAO-xgeLKm8L6A2xdiYQ1yUyMyqW1', {action: 'submit'}).then(function(token) { var response = document.getElementById("token_generate") response.value = token // Add your logic to submit to your backend server here. }); }); </script> </div> </fieldset> </form> </div> </div> </div> </div> </div> </div> </div> <?php include("section/footer.php"); ?> <a data-scroll href="#header" id="scroll-to-top"><i class="arrow_up"></i></a> <!-- jQuery Lib --> <script src="js/vendor/jquery-1.12.4.min.js"></script> <!-- Bootstrap JS --> <script src="js/vendor/bootstrap.min.js"></script> <!-- Tether JS --> <script src="js/vendor/tether.min.js"></script> <!-- Imagesloaded JS --> <script src="js/vendor/imagesloaded.pkgd.min.js"></script> <!-- OWL-Carousel JS --> <script src="js/vendor/owl.carousel.min.js"></script> <!-- isotope JS --> <script src="js/vendor/jquery.isotope.v3.0.2.js"></script> <!-- Smooth Scroll JS --> <script src="js/vendor/smooth-scroll.min.js"></script> <!-- venobox JS --> <script src="js/vendor/venobox.min.js"></script> <!-- ajaxchimp JS --> <script src="js/vendor/jquery.ajaxchimp.min.js"></script> <!-- Counterup JS --> <script src="js/vendor/jquery.counterup.min.js"></script> <!-- waypoints js --> <script src="js/vendor/jquery.waypoints.v2.0.3.min.js"></script> <!-- Slick Nav JS --> <script src="js/vendor/jquery.slicknav.min.js"></script> <!-- Nivo Slider JS --> <script src="js/vendor/jquery.nivo.slider.pack.js"></script> <!-- Letter Animation JS --> <script src="js/vendor/letteranimation.min.js"></script> <!-- Wow JS --> <script src="js/vendor/wow.min.js"></script> <!-- Contact JS --> <script src="js/contact.js"></script> <!-- Main JS --> <script src="js/main.js"></script> </body> </html>