OwlCyberSecurity - MANAGER

Edit File: online.php

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 <title>Downloads</title>
 <?php 
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    <div class="hero-area">
    	<div class="page-banner parallax" style="background-image:url(images/banner/about.jpg);">
        	<div class="container">
            	<div class="page-banner-text">
        			<h1 class="block-title">Online Registration</h1>
                </div>
            </div>
        </div>
    </div>
    
	<br>	<br>
    <div id="main-container">
    	<div class="content">
        	<div class="container">
        		<div class="row">
                	<div class="col-md-4 col-sm-4">
                       <div class="row">
                <div class="col-md-12" data-appear-animation="bounceInRight">
                   
                    <h3>Online Registration</h3>
                  <hr class="sm">
                    
                    <div class="alert alert-info fade in"> <div class="close"> <p style="padding-top:10px; line-height:30px;"><strong>U.S. Ostwal Group of Colleges</strong><br>
<font color="#ef4328">(A unit of U.S. Ostwal Education Society)</font><br>
<strong style="color:#000000;">Address :- </strong><br>
Toll Plaza, Udaipur Road, Mangalwad, <br>
Distt. - Chittorgarh (Rajasthan)<br><br>
Contact No. : 9799479999, 9116618991<br>
E-Mail : info@usostwaledu.com<br>
Web : www.usostwaledu.com  </p></div></div>
                    
                </div>
            </div>
                   	</div>
                    <div class="col-md-8 col-sm-8">
                    	 
						
<table border="0" cellpadding="0" cellspacing="0" width="100%">
											<tr>
												<td valign="top">
													<div style="background-color:#FFFFFF;padding:0px 15px;text-align:justify;">
													<div style="padding:15px 0px 15px 0px;">
														<h1>Registration Form</h1>

<table border="0" cellpadding=0 cellspacing=0 width="730px" style="background-color:#FFFFFF;">
	<tr>
		<td colspan=1 style="">
		<table border="0" cellpadding=0 cellspacing=0 width="100%">
			<tr>
				
				<td valign=top>
					<div class="td">
						<fieldset style="padding: 10px; border: 1px solid;">
							<legend style="padding-left:5px; color:#0775ad; font-size:18px; ">Personal Details</legend><br/>
							<table border="0" cellpadding="0" cellspacing="0" width="100%">
								<tr>
									<td>
										<label for="NAME"><span class="required">Name of the Candidate</span></label>
										<input type="text" name="NAME"  class="text required" required>
									</td>
								</tr>
								<tr>
									<td>
										<label for="FNAME"><span class="norequired">Father's / Guardian's name</span></label>
										<input  name="FNAME" class="text norequired" type="text" required />
										
									</td>
								</tr>
                                <tr>
									<td>
										<label for="MNAME"><span class="norequired">Mother's Name</span></label>
										<input  name="MNAME" class="text norequired" type="text" required />
									</td>
								</tr>
								<tr>
									<td>
										<label for="DOB"><span class="required">Date of Birth
                                        <span style="font-size: 7pt">(DD.MM.YYYY)</span></span></label>
										<input type="text" name="DOB" class="text required" required>
									</td>
								</tr>
								<tr>
									<td>
										<label for="GENDER"><span class="required">Gender</span></label>
										
<select name="GENDER"  class="text required">
<option value="">Select Gender</option>  
<option value="Male">Male</option> 
<option value="Female">Female</option> 
</select>
									</td>
								</tr>
								
								<tr>
									<td>
										<label for="NATIONALITY"><span class="norequired">Nationality</span></label>
										<input type="text" name="NATIONALITY"  class="text norequired" required>
									</td>
								</tr>
								<tr>
									<td>
						<label for="CADDRESS"><span class="required">Correspondence Address</span></label>
                        <textarea  name="CADDRESS" class="text required" cols="35" rows="4" required></textarea>
									</td>
								</tr>
								<tr>
									<td>
										<label for="CCONTACT"><span class="required">Contact Nos.</span></label>
										<input type="text" name="CCONTACT" required>
									</td>
								</tr>
								<tr>
									<td>
										<label for="PADDRESS"><span class="required">Permanent Address</span></label>
                <textarea  name="PADDRESS" class="text required" cols="35" rows="4" required></textarea>
									</td>
								</tr>
								<tr>
									<td>
										<label for="PINCODE"><span class="required">Pin Code</span></label>
										<input type="text" name="PINCODE"  class="text required" required>
									</td>
								</tr>
								<tr>
									<td>
	    <label for="MOBILE"><span class="required">Mobile</span></label>
		<input type="text" name="MOBILE" class="text required" required>
									</td>
								</tr>

<span class="required">&nbsp;  Examination Passed</span>

<span class="required">&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; School/ Institute Name</span> 
										
<span class="required">Board/University</span>
										
<span class="required">Passing Year</span>
										
<span class="required">&nbsp; &nbsp; %Agg.</span> 
										
<span class="required">&nbsp; &nbsp; &nbsp; Subjects</span>
									
</td>
								
</tr>
								
<tr>
									
<td>
										<label for="X"><span class="required"><b>X</b></span></label>
										<input type="text" name="XINST"  class="text required" size="13"> &nbsp; 
									<input type="text" name="XBU" id="XBU" class="text required" size="10">&nbsp;&nbsp; 
						<input type="text" name="XYOP" id="XYOP" class="text required" size="9">&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
										<input type="text" name="XPER" id="XPER" class="text required" size="3">  
										 
	                                </td>
								</tr>
								<tr>
									<td>
										<label for="X"><span class="required"><b>XII</b></span></label>
										<input type="text" name="XIIINST" id="XIIINST" class="text norequired" size="13">&nbsp;&nbsp;
										<input type="text" name="XIIBU" id="XIIBU" class="text required" size="10">&nbsp;&nbsp;
										<input type="text" name="XIIYOP" id="XIIYOP" class="text required" size="9"> &nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
										<input type="text" name="XIIPER" id="XIIPER" class="text required" size="3"> &nbsp;
										 
	                                </td>
								</tr>
								<tr>
									<td>
										<p align="left">
										<label for="HOWKITESOM"><span class="required">How did you come to know &nbsp;&nbsp;&nbsp;about 
                                        US Ostwal Group?</span></label>
										<input type="text" name="HOWKITESOM" id="HOWKITESOM" class="text required" size="40">
									</td>
								</tr>
								
								<tr>
									<td>
										<label for="B.Pharm"><span class="norequired">
										<strong style="font-weight: 400">
                                        B.Pharm</strong></span></label>
										<input id="BRANCH" name="BRANCH" value="B.pharm" class="text norequired" type="radio" /> 
                                        B.Pharm
									</td>
								</tr>
								
								<tr>
									<td>
										<label for="D.Pharm"><span class="norequired">
										<strong style="font-weight: 400">
                                        D.Pharm</strong></span></label>
										<input id="BRANCH" name="BRANCH" value="D.pharm" class="text norequired" type="radio" /> 
                                        D.Pharm
									</td>
								</tr>
								
                                <tr>
									<td>
										<label for="BCA"><span class="norequired">
										<strong style="font-weight: 400">
                                        Computer</strong></span></label>
										<input id="BRANCH" name="BRANCH" value="BCA" class="text norequired" type="radio" /> 
                                        BCA 
									</td>
								</tr>
                                
								<tr>
									<td>
										<label for="MANAGEMENT"><span class="norequired">
                                        <strong style="font-weight: 400">
                                        Management</strong></span></label>
										<input id="BRANCH" name="BRANCH" value="BBA" class="text norequired" type="radio" /> 
                                        BBA 
									</td>
								</tr>
                                
                                <tr>
									<td>
										<label for="BA"><span class="norequired">
										<strong style="font-weight: 400">
                                        Bachelor of Arts</strong></span></label>
										<input id="BRANCH" name="BRANCH" value="B.A." class="text norequired" type="radio" /> 
                                        B.A. 
									</td>
								</tr>
                                
                                <tr>
									<td>
										<label for="Integrated"><span class="norequired">
                                        <strong style="font-weight: 400">
                                        Bachelor of Commerce</strong></span></label>
										<input id="BRANCH" name="BRANCH" value="B.Com" class="text norequired" type="radio" /> 
                                        B.Com. 
									</td>
								</tr>
                                
                                <tr>
									<td>
										<label for="Integrated"><span class="norequired">
                                        <strong style="font-weight: 400">
                                        Bachelor of Science</strong></span></label>
										<input id="BRANCH" name="BRANCH" value="B.Sc." class="text norequired" type="radio" /> 
                                        B.Sc. 
									</td>
								</tr>
                                
                                
								<tr>
									<td>
										<label for="BTECH"><span class="norequired">
                                        Polytechnic Diploma</span></label>
										<input id="BRANCH" name="BRANCH" value="B.Tech-CIVIL" class="text norequired" type="radio" /> CIVIL &nbsp; &nbsp; &nbsp;
										<input id="BRANCH" name="BRANCH" value="B.Tech-CSE" class="text norequired" type="radio" /> CSE &nbsp; &nbsp; &nbsp; &nbsp;
										<input id="BRANCH" name="BRANCH" value="B.Tech-EE" class="text norequired" type="radio" /> EE &nbsp; &nbsp; &nbsp;
										<input id="BRANCH" name="BRANCH" value="B.Tech-ME" class="text norequired" type="radio" /> ME &nbsp; &nbsp; &nbsp;
									</td>
								</tr>
                                
                                
								<tr>
									<td>
										<label for="SCATEGORY"><span class="required">Category of Student</span></label>
										<input id="SCATEGORY" name="SCATEGORY" value="Genral" class="text required" type="radio" /> General &nbsp; &nbsp; &nbsp; &nbsp;&nbsp;
										<input id="SCATEGORY" name="SCATEGORY" value="OBC" class="text required" type="radio" /> OBC &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;
                                        <input id="SCATEGORY" name="SCATEGORY" value="SBC" class="text required" type="radio" /> SBC &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;
										<input id="SCATEGORY" name="SCATEGORY" value="SC" class="text required" type="radio" /> SC &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;
										<input id="SCATEGORY" name="SCATEGORY" value="ST" class="text required" type="radio" /> ST
									</td>
								</tr>
							</table>
						</fieldset><br/>
							<div align="center">
							    
							    
							        <div class="g-recaptcha" data-sitekey="6LfDM4gUAAAAAO_NM_6ZDxXnlJPzunWbw54mMrdb" data-callback="enableBtn1"></div>
							    
							    
								<input name="Submit" disabled value="Submit" type="submit" id="button2"/>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
								<input name="reset" value="Reset" type="reset" />
							</div>
							<div align="center">
								&nbsp;</div>
					
					</div>
				</td>
			</tr>
		</table>
		</td>
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</table>
</form>
</tr>
</table>
 
 
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