@extends('index')
@section('web')

<main>

    <!-- sign up area start -->
    <section class="signup__area po-rel-z1 pt-100 pb-145">
        <div class="sign__shape">
            <img class="circle" src="{{url('web/')}}/img/icon/sign/circle.png" alt="">
            <img class="dot" src="{{url('web/')}}/img/icon/sign/dot.png" alt="">
            <img class="bg" src="{{url('web/')}}/img/icon/sign/sign-up.png" alt="">
        </div>
        <div class="container">
            <div class="row">
                <div class="col-xxl-8 offset-xxl-2 col-xl-8 offset-xl-2">
                    <div class="section__title-wrapper text-center mb-55">
                        <h2 class="section__title">{{trans('web.year')}} {{$config->year}}</h2>
                    </div>
                </div>
            </div>
            <form action="{{url('subscription/register')}}" method="POST">
                {{csrf_field()}}
                <div class="row justify-content-center">
                    <div class="col-md-6">
                        @if (session('success'))
                        <div class="alert alert-success">
                            {{ session('success') }}
                        </div>
                        @endif
                        @if (session('error'))
                        <div class="alert alert-danger">
                            {{ session('error') }}
                        </div>
                        @endif
                        @if ($errors->any())
                        <div class="alert alert-danger">
                            <ul>
                                @foreach ($errors->all() as $error)
                                <li>{{ $error }}</li>
                                @endforeach
                            </ul>
                        </div>
                        @endif
                    </div>
                    <div class="col-md-8">
                        <div class="row justify-content-center">
                            <div class="col-md-6">
                                <div class="sign__input-wrapper mb-25">
                                    <h5>{{trans('web.identify')}}</h5>
                                    <div class="">
                                        <input class="form-control" type="number" name="identify" placeholder="{{trans('web.identify')}}" value="{{old('identify') ? old('identify') : request('identify')}}">
                                    </div>
                                </div>
                            </div>
                            <div class="col-md-12"></div>
                            <div class="col-md-3">
                                <div class="sign__input-wrapper mb-25">
                                    <h5>{{trans('web.first_name')}}</h5>
                                    <div class="">
                                        <input class="form-control" type="text" name="first_name" placeholder="{{trans('web.first_name')}}" value="{{old('first_name')}}">
                                    </div>
                                </div>
                            </div>
                            <div class="col-md-3">
                                <div class="sign__input-wrapper mb-25">
                                    <h5>{{trans('web.second_name')}}</h5>
                                    <div class="">
                                        <input class="form-control" type="text" name="second_name" placeholder="{{trans('web.second_name')}}" value="{{old('second_name')}}">
                                    </div>
                                </div>
                            </div>
                            <div class="col-md-3">
                                <div class="sign__input-wrapper mb-25">
                                    <h5>{{trans('web.third_name')}}</h5>
                                    <div class="">
                                        <input class="form-control" type="text" name="third_name" placeholder="{{trans('web.third_name')}}" value="{{old('third_name')}}">
                                    </div>
                                </div>
                            </div>
                            <div class="col-md-3">
                                <div class="sign__input-wrapper mb-25">
                                    <h5>{{trans('web.last_name')}}</h5>
                                    <div class="">
                                        <input class="form-control" type="text" name="last_name" placeholder="{{trans('web.last_name')}}" value="{{old('last_name')}}">
                                    </div>
                                </div>
                            </div>
                            <div class="col-md-6">
                                <div class="sign__input-wrapper mb-25">
                                    <h5>{{trans('web.gender')}}</h5>
                                    <div class="">
                                        <select class="form-control" name="gender">
                                            <option value="male" {{old('gender') == 'male' ? 'selected' : ''}}>{{trans('web.male')}}</option>
                                            <option value="female" {{old('gender') == 'female' ? 'selected' : ''}}>{{trans('web.female')}}</option>
                                        </select>
                                    </div>
                                </div>
                            </div>
                            <div class="col-md-6">
                                <div class="sign__input-wrapper mb-25">
                                    <h5>{{trans('web.nationality')}}</h5>
                                    <div class="">
                                        <select class="form-control" name="nationality">
                                            <option value="">...</option>
                                            @foreach(\App\Nationality::where('active', 'active')->get() as $val)
                                            <option value="{{$val->id}}" {{old('nationality') == $val->id ? 'selected' : ''}}>{{$val->$name}}</option>
                                            @endforeach
                                        </select>
                                                                            </div>
                                </div>
                            </div>
                            <div class="col-md-6">
                                <div class="sign__input-wrapper mb-25">
                                    <h5>{{trans('web.birthday')}}</h5>
                                    <div class="">
                                        <input class="form-control" type="date" name="birthday" placeholder="{{trans('web.birthday')}}" value="{{old('birthday')}}">
                                    </div>
                                </div>
                            </div>
                            <div class="col-md-6">
                                <div class="sign__input-wrapper mb-25">
                                    <h5>{{trans('web.email')}}</h5>
                                    <div class="">
                                        <input class="form-control" type="email" name="email" placeholder="{{trans('web.email')}}" value="{{old('email')}}">
                                    </div>
                                </div>
                            </div>
                            <div class="col-md-6">
                                <div class="sign__input-wrapper mb-25">
                                    <h5>{{trans('web.city')}}</h5>
                                    <div class="">
                                        <select class="form-control" name="city" id="change-city-register-page">
                                            <option value="0">...</option>
                                            @foreach(\App\City::where('active', 'active')->get() as $val)
                                            <option value="{{$val->id}}" {{old('city') == $val->id ? 'selected' : ''}}>{{$val->$name}}</option>
                                            @endforeach
                                        </select>
                                                                            </div>
                                </div>
                            </div>
                            <div class="col-md-6">
                                <div class="sign__input-wrapper mb-25">
                                    <h5>{{trans('web.state')}}</h5>
                                    <div class="" id="result-change-city-register-page">
                                        <select class="form-control" name="region">
                                            <option value="">...</option>
                                        </select>
                                                                            </div>
                                </div>
                            </div>
                            <div class="col-md-6">
                                <div class="sign__input-wrapper mb-25">
                                    <h5>{{trans('web.mobile')}}</h5>
                                    <div class="">
                                        <input class="form-control" type="number" name="mobile" placeholder="{{trans('web.mobile')}}" value="{{old('mobile')}}">
                                    </div>
                                </div>
                            </div>
                            <div class="col-md-6">
                                <div class="sign__input-wrapper mb-25">
                                    <h5>{{trans('web.mobile2')}}</h5>
                                    <div class="">
                                        <input class="form-control" type="number" name="mobile2" placeholder="{{trans('web.mobile2')}}" value="{{old('mobile2')}}">
                                    </div>
                                </div>
                            </div>
                        </div>
                    </div>
                    <div class="col-md-6">

                        <div class="sign__input-wrapper mb-10">
                            <h5>{{trans('web.subscription_type')}}</h5>
                            <div class="sign__input">
                                <select name="subscription_type" class="form-select change-select-subscription-type">
                                    <option value="0">{{trans('web.select_subscription_type')}}</option>
                                    @foreach(\App\SubscriptionsName::get() as $val)
                                    <option value="{{$val->id}}">{{$val->$name}}</option>
                                    @endforeach
                                </select>
                            </div>
                        </div>
                        <div class="result-select-subscription-type"></div>
                        <div class="sign__input-wrapper mb-10">
                            <h5>{{trans('web.subscription_notes')}}</h5>
                            <div class="sign__input">
                                <textarea class="form-control" name="subscription_notes" cols="30" rows="7"></textarea>
                            </div>
                        </div>
                    </div>
                    <div class="col-md-12"></div>
                    <div class="col-md-2">
                        <button class="e-btn  w-100"> <span></span> {{trans('web.subscription')}}</button>
                    </div>
                </div>

            </form>
        </div>
    </section>
    <!-- sign up area end -->

</main>

@endsection