<?php include('include/server.php');?>
<?php include('header.php');?>

<title><?php echo $site_name; ?> - Register</title>

<div class="inner-banner">
</div>
<section class="w3l-breadcrumb">
    <div class="container">
        <ul class="breadcrumbs-custom-path">
            <li><a href="index.php">Home</a></li>
            <li class="active"><span class="fa fa-arrow-right mx-2" aria-hidden="true"></span>Register</li>
        </ul>
    </div>
</section>
<br>

<div class="w3l-contact-info py-5" id="contact">
    <div class="container py-lg-5 py-md-4">
        <div class="title text-center">
            <h3 class="title-big">Register</h3>
            <p class="mt-2 mx-lg-5">Please fill the below form correctly!
            <b>Your Personal Account Number will be auto generated after a successful registration.</b></p>
        </div>
        
        
        <br><br>
        <div class="container">
            <div class="col-lg-6 form-inner-cont mt-lg-0 mt-sm-5 mt-4">
                <form action="" method="post" class="signin-form">
                    <?php include('include/errors.php'); ?>
                    <div class="form-input">
                        <input type="text" name="firstname" id="w3lName" placeholder="Your First Name">
                    </div>
                    <div class="form-input">
                        <input type="text" name="lastname" id="w3lName" placeholder="Your Last Name">
                    </div>
                    <div class="form-input">
                        <input type="email" name="email" id="w3lSender" placeholder="Your Email Address"
                            required="">
                    </div>
                    <div class="form-input">
                        <input type="number" name="phone" id="w3lSender" placeholder="Your Phone Number"
                            required="">
                    </div>
                    <div class="form-input">
                        <input type="text" name="city" id="w3lSender" placeholder="Your City"
                            required="">
                    </div>
                    <div class="form-input">
                        <input type="text" name="country" id="w3lName" placeholder="Country">
                    </div>
                    <div class="form-input">
                        <input type="password" name="password_1" id="w3lSender" placeholder="Password"
                            required="">
                    </div>
                    
                    <div class="form-input">
                        <input type="password" name="password_2" id="w3lSender" placeholder="Confirm Password"
                            required="">
                    </div>
                    
                    <div class="text-right">
                        
                        <button type="submit" name="reg_user" class="btn btn-style btn-primary">Submit</button>
                    </div>
                    
                </form>
            </div>
        </div>
    </div>
</div>



<?php include('footer.php');?>