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signup.php
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<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="utf-8">
<meta name="viewport" content="width=device-width, initial-scale=1">
<title>Medilab Free Bootstrap HTML5 Template</title>
<meta name="description" content="Free Bootstrap Theme by BootstrapMade.com">
<meta name="keywords" content="free website templates, free bootstrap themes, free template, free bootstrap, free website template">
<link rel="stylesheet" type="text/css" href="https://fonts.googleapis.com/css?family=Open+Sans|Raleway|Candal">
<link rel="stylesheet" type="text/css" href="css/font-awesome.min.css">
<link rel="stylesheet" type="text/css" href="css/bootstrap.min.css">
<link rel="stylesheet" type="text/css" href="css/style.css">
<link rel="stylesheet" type="text/css" href="css/login.css">
<!-- =======================================================
Theme Name: Medilab
Theme URL: https://bootstrapmade.com/medilab-free-medical-bootstrap-theme/
Author: BootstrapMade.com
Author URL: https://bootstrapmade.com
======================================================= -->
</head>
<body id="myPage" data-spy="scroll" data-target=".navbar" data-offset="60">
<!--banner-->
<div class="bg-color">
<nav class="navbar navbar-default navbar-fixed-top" class="bg-color">
<div class="container">
<div class="col-md-12">
<div class="navbar-header">
<button type="button" class="navbar-toggle" data-toggle="collapse" data-target="#myNavbar">
<span class="icon-bar"></span>
<span class="icon-bar"></span>
<span class="icon-bar"></span>
</button>
<a class="navbar-brand" href="#"><img src="img/logo.png" class="img-responsive" style="width: 140px; margin-top: -16px;"></a>
</div>
<div class="collapse navbar-collapse navbar-right" id="myNavbar">
<ul class="nav navbar-nav">
<li class=""><a href="#banner">Home</a></li>
<li class=""><a href="#service">Services</a></li>
<li class=""><a href="#about">About</a></li>
<li class=""><a href="#testimonial">Testimonial</a></li>
<li class=""><a href="#contact">Contact</a></li>
<li class="active"><a href="login.php">Log in</a></li>
<li class=""><a href="logout.php">Log Out</a></li>
</ul>
</div>
</div>
</div>
</nav>
<div class="container-fluid" >
<div class="row main-content bg-success text-center" style="margin-top:15%">
<div class="col-md-4 text-center company__info">
<span class="company__logo"><h2><img src="img/logo.png" class="img-responsive" style="width: 140px; margin-top: -16px;margin-left:20%"></h2></span>
</div>
<div class="col-md-8 col-xs-12 col-sm-12 login_form ">
<div class="container-fluid" style="padding:60px;">
<div class="row">
<h2>Register Here!!</h2>
</div>
<div class="row">
<form control="" class="form-group" name="signup" action="register.php" method="POST" onclick="signup()">
<div class="row">
<input type="text" name="name" id="name" class="form__input" placeholder="Name">
</div>
<div class="row">
<input type="text" name="email" id="email" class="form__input" placeholder="Email">
</div>
<div class="row">
<input type="number" name="mobile" id="mobile" class="form__input" placeholder="Mobile No.">
</div>
<div class="row">
<!-- <span class="fa fa-lock"></span> -->
<input type="password" name="password" id="password" class="form__input" placeholder="Password">
</div>
<div class="row">
<label for="remember_me">Upload Your Image</label>
<input type="file" name="image" id="image" class="form__input" placeholder="Upload Your Image">
</div>
<div class="row">
<label for="remember_me">security Purpose</label>
<input type="text" name="security" id="security" class="form__input" placeholder="What is your Birth Palce ?">
</div>
<div class="row">
<input type="submit" value="Submit" class="btn">
</div>
</form>
</div>
</div>
</div>
</div>
<br>
<br>
<br>
<br>
</div>
</div>
<!--/ banner-->
<!--/ contact-->
<!--footer-->
<footer id="footer">
<div class="top-footer">
<div class="container">
<div class="row">
<div class="col-md-4 col-sm-4 marb20">
<div class="ftr-tle">
<h4 class="white no-padding">About Us</h4>
</div>
<div class="info-sec">
<p>Our success is measured by our patients’ satisfaction with our services and the care they receive while visiting us for treatments. Read below to know what our patients say about us and how coming to Medilab Hospitals changed their lives.</p>
</div>
</div>
<div class="col-md-4 col-sm-4 marb20">
<div class="ftr-tle">
<h4 class="white no-padding">Quick Links</h4>
</div>
<div class="info-sec">
<ul class="quick-info">
<li><a href="index.php"><i class="fa fa-circle"></i>Home</a></li>
<li><a href="#service"><i class="fa fa-circle"></i>Service</a></li>
<li><a href="#contact"><i class="fa fa-circle"></i>Appointment</a></li>
</ul>
</div>
</div>
<div class="col-md-4 col-sm-4 marb20">
<div class="ftr-tle">
<h4 class="white no-padding">Follow us</h4>
</div>
<div class="info-sec">
<ul class="social-icon">
<li class="bglight-blue"><i class="fa fa-facebook"></i></li>
<li class="bgred"><i class="fa fa-google-plus"></i></li>
<li class="bgdark-blue"><i class="fa fa-linkedin"></i></li>
<li class="bglight-blue"><i class="fa fa-twitter"></i></li>
</ul>
</div>
</div>
</div>
</div>
</div>
<div class="footer-line">
<div class="container">
<div class="row">
<div class="col-md-12 text-center">
© Copyright Medilab Theme. All Rights Reserved
<div class="credits">
<!--
All the links in the footer should remain intact.
You can delete the links only if you purchased the pro version.
Licensing information: https://bootstrapmade.com/license/
Purchase the pro version with working PHP/AJAX contact form: https://bootstrapmade.com/buy/?theme=Medilab
-->
Designed by <a href="https://github.com/arth912">MegaSoftware.com</a>
</div>
</div>
</div>
</div>
</div>
</footer>
<!--/ footer-->
<script src="js/jquery.min.js"></script>
<script src="js/jquery.easing.min.js"></script>
<script src="js/bootstrap.min.js"></script>
<script src="js/custom.js"></script>
<script src="js/signup.js"></script>
<script src="contactform/contactform.js"></script>
</body>
</html>