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


    <div class="container" style="border:0px solid #0F0;min-height:560px;">

      <div class="row">
        <div class="col-md-7 col-md-offset-2" style="padding-top:20px;">
        <p style="font-size:50px;" align="center">สมัครสมาชิกเว็บไซต์ </p><br>
        
        <span id="alert_regi_member"></span>
        
        <form class="form-horizontal" id="fm_reg_member" name="fm_reg_member"  method="post" enctype="multipart/form-data">
          <div class="form-group">
            <label for="inputEmail3" class="col-sm-3 control-label">ชื่อ  <span style="color:#F00">*</span></label>
            <div class="col-sm-9">
               <input type="text" class="form-control" id="name" name="name" placeholder="" onkeypress='validate_text(event)'>
            </div>
          </div>
          <div class="form-group">
            <label for="inputEmail3" class="col-sm-3 control-label">นามสกุล  <span style="color:#F00">*</span></label>
            <div class="col-sm-9">
               <input type="text" class="form-control" id="lastname" name="lastname" placeholder="" onkeypress='validate_text(event)'>
            </div>
          </div>
          <div class="form-group">
            <label for="inputEmail3" class="col-sm-3 control-label">รหัสผ่าน  <span style="color:#F00">*</span></label>
            <div class="col-sm-9">
               <input type="password" class="form-control" id="password" name="password" placeholder="">
            </div>
          </div>
          <div class="form-group">
            <label for="inputEmail3" class="col-sm-3 control-label">ยืนยันรหัสผ่าน  <span style="color:#F00">*</span></label>
            <div class="col-sm-9">
               <input type="password" class="form-control" id="password_con" name="password_con" placeholder="" value="">
            </div>
          </div>
          <div class="form-group">
            <label for="inputEmail3" class="col-sm-3 control-label">เบอร์โทรศัพท์  <span style="color:#F00">*</span></label>
            <div class="col-sm-9">
               <input type="text" class="form-control" id="phone" name="phone" placeholder="" onKeyPress="return validate_number(event)">
            </div>
          </div>
          <div class="form-group">
            <label for="inputEmail3" class="col-sm-3 control-label">อีเมล  <span style="color:#F00">*</span></label>
            <div class="col-sm-9">
               <input type="email" class="form-control" id="email" name="email" placeholder="">
            
            </div>
          </div>
          <div class="form-group">
            <label for="inputEmail3" class="col-sm-3 control-label">Line ID  </label>
            <div class="col-sm-9">
               <input type="text" class="form-control" id="" name="lineid" placeholder="">
            </div>
          </div>
          <div class="form-group">
            <div class="col-sm-12" align="center">
              <button type="submit" class="btn btn-success btn-save">สมัครสมาชิก</button>
            </div>
          </div>
        </form>
        </div>
        
       
      </div><!--/row-->
      
    </div><!--/.container-->
    
    
        
    <!--/.container-->
    
    
<?php 
include('../themes/footer.php');
include('../include/footer_js.php');
?>