@extends('front/layout')
@section('page_title','Video Description')
@section('container')

<div class="homeHeader innerpage">

<div class="header_top">

	<div class="hdlogo"><img src="images/logo.jpg" alt="AdiClasses"></div>

	<div class="hdnav"></div>

</div><!-- header_top ends here -->

<div class="reg_form">

<div class="form_wrap">
	<form action="{{route('registration_process')}}" method="post" enctype="multipart/form-data">
        @csrf
		<div class="form-group halfw">
			<label for="first_name" class="label-title">Name *</label>
			<input type="text" class="form-control" id="first_name" name="first_name">
		</div>
		<div class="form-group halfw">
			<label>Phone</label>
			<input type="text" class="form-control" id="phone" name="phone">
		</div>
		<div class="form-group halfw">
			<label>Email</label>
			<input type="text" class="form-control" id="email" name="email">
		</div>
		<div class="form-group halfw">
			<label>Institute Name</label>
			<input type="text" class="form-control" id="institute_name" name="institute_name">
		</div>
		<div class="form-group halfw">
			<label>City</label>
			<input type="text" class="form-control" id="city" name="city">
		</div>
		<div class="form-group halfw">
			<label>State</label>
			<input type="text" class="form-control" id="state" name="state">
		</div>
		<div class="form-group halfw">
			<label>Country</label>
			<input type="text" class="form-control" id="country" name="country">
		</div>
		<div class="form-group halfw radiobtn">
			<input type="radio" id="student" name="student" value="Student">
			<label>Student</label>
			<input type="radio" id="teacher" name="teacher" value="Teacher">
			<label>Teacher</label>
		</div>
		<div class="form-group halfw formgrade">
			<label>Grade</label>
			<input type="text" class="form-control" id="grade" name="grade">
		</div>
		<div class="form-group halfw formsub">
			<label>Subject</label>
			<input type="text" class="form-control" id="subject" name="subject">
		</div>
		<input type="submit" name="submit" class="btn btn-primary btn-send" value="Send Message">
	</form>
</div>



</div>



</div><!-- homeHeader ends here -->

@endsection