<style>
input{
	background-color:#fff !important;
}

</style>
<br>
<section>
        <div class="container-fluid">
            <!-- main-heading -->
 <div class="head-title"><h1 >Registrer</h1></div>            <!--// main-heading -->
            <div class="login-main" style="background-image:url(images/bg2.jpg); background-size:cover;">
              <div class="row">
             <div class="col-md-3">
             </div>
            <div class="col-md-6">
            <div class="login">
                <form id="frmRegistration" name="frmRegistration" method="GET" action="#" onsubmit="return false">
                    <div class="form-group">
                            <label>Name</label>
                            <input type="text" id="name" name="name" class="form-control" placeholder="Enter Name" required>
                        </div>
                    <div class="form-group">
                      <label for="" class="control-label">Gender:</label>
                      <label class="radio-inline">
                        <input name="gender" id="gender1" value="M" required type="radio">
                        Male</label>
                      <label class="radio-inline">
                        <input name="gender" id="gender2" value="F" required type="radio">
                        Female</label>
                    </div>
                    <!-----<div class="form-group">
                        <label>Email</label>
                        <input type="text" id="email" name="email" class="form-control" placeholder="Enter Mobile No">
                    </div>---->
                    <div class="form-group">
                        <label>Mobile No:</label>
                        <input type="text" id="mobile" name="mobile" class="form-control" placeholder="Enter Mobile No" required>
                    </div>
                    <!------<div class="form-group">
                        <label>PAN</label>
                        <input type="text" id="pan" name="pan" class="form-control" placeholder="PAN no." >
                    </div>
                    <div class="form-group">
                        <label>Adhar No</label>
                        <input type="text" id="adhar" name="adhar" class="form-control" placeholder="Enter Adhar">
                    </div>
                    <div class="form-group">
                        <label>State</label>
                        <select id="state" name="state" class="form-control">
                        	<option>-- Select State --</option>
                        	<?php echo getTableDD($DB->pre."state","stateID","state",$D["state"]," status='1'");?>
                        </select>
                    </div>
                    <div class="form-group">
                        <label>District</label>
                        <select id="district" name="district" class="form-control">
                        	<option value="">-Select District-</option>
              				<?php echo getTableDD($DB->pre."district","districtID","district",$D["district"]," status='1'")?>
                        </select>
                    </div>----->
                    <div class="form-group">
                        <label>Address</label>
                         <textarea id="address" name="address" class="form-control" rows="3" required="required"></textarea>               
                     </div>
                     <div class="form-group">
                        <label>Reference No</label>
                        <input type="text" id="referenceNo" name="referenceNo" class="form-control" placeholder="Enter Reference No"required>
                        <div class="alert alert-danger cls-ref-msg" role="alert" style="display:none;">Invalid Reference Number</div>
	    				<div class="alert alert-success cls-ref-name" role="alert" style="display:none;"></div>	
                    </div>
                     
                     <div class="form-group">
                        <label>Tree Side</label>
                   		<select id="side" name="side" class="form-control" required>
              				<option value="">-Select Side-</option>
                          	<option value="R">Right</option>
                          	<option value="L">Left</option>
                        </select>
                   </div>
                   	
          			<div class="alert alert-danger cls-err-msg" role="alert" style="display:none;">Some thing is wrong</div>
                   <div class="form-group">
          				<input type="checkbox" /><a href="<?php echo SITEURL?>/terms"> I Accept All Tems And Conditions</a>
          			</div>
                    <div class="form-check text-center">
                     <button type="submit" class="btn btn-primary error-w3l-btn mt-sm-5 mt-3 px-4" id="btnSubmit">Submit</button>

                    </div>
                </form>
                 <center><p class="paragraph-agileits-w3layouts mt-4">Already have account?
                    <a href="<?php echo SITEURL?>/binary-admin">Login</a>
                </p></center>
                <div class="alert alert-success cls-reg-msg" role="alert" style="display:none;">Regitration completed</div>
                 </div>
            </div>
            <div class="col-md-3">
             </div>
               </div>
            </div>
    </div>
    </section>