@extends('layouts.app')

@section('content')

<!-- *****************************************************************************************************************
	 BLUE WRAP
	 ***************************************************************************************************************** -->
	<div id="blue">
	    <div class="container">
			<div class="row">
				<h3>Registration</h3>
			</div><!-- /row -->
	    </div> <!-- /container -->
	</div><!-- /blue -->
	
	
<!-- *****************************************************************************************************************
	 CONTACT FORMS
	 ***************************************************************************************************************** -->

	 <div class="container mtb">
	 	<div class="row">
	 		<div class="col-lg-8">
	 			<h4>Register Form</h4>
	 			<div class="hline"></div>
		 			<p>Fill the form for registration.</p>
		 			<form role="form" method="POST" action="{{ route('register') }}">
						{{ csrf_field() }}
						<div class="form-group{{ $errors->has('fname') ? ' has-error' : '' }}">
							<label for="fname">Name</label>
							<input id="fname" type="text" class="form-control" name="name" value="{{ old('name') }}" required autofocus>
								@if ($errors->has('name'))
									<span class="help-block">
										<strong>{{ $errors->first('name') }}</strong>
									</span>
								@endif
						</div>
						<!-- <div class="form-group{{ $errors->has('lname') ? ' has-error' : '' }}">
                            <label for="lname">Last Name</label>
							<input id="lname" type="text" class="form-control" name="lname" value="{{ old('lname') }}" required>
				                @if ($errors->has('lname'))
                                    <span class="help-block">
                                        <strong>{{ $errors->first('lname') }}</strong>
                                    </span>
                                @endif
                        </div> -->

                        <div class="form-group{{ $errors->has('email') ? ' has-error' : '' }}">
                            <label for="email">E-Mail Address</label>
							<input id="email" type="email" class="form-control" name="email" value="{{ old('email') }}" required>
							@if ($errors->has('email'))
								<span class="help-block">
									<strong>{{ $errors->first('email') }}</strong>
								</span>
							@endif
                        </div>

						<div class="form-group{{ $errors->has('phone_number') ? ' has-error' : '' }}">
                            <label for="phone_number">Phone Number</label>
							<input id="phone_number" type="text" class="form-control" name="phone_number" value="{{ old('phone_number') }}" required>
							@if ($errors->has('phone_number'))
								<span class="help-block">
									<strong>{{ $errors->first('phone_number') }}</strong>
								</span>
							@endif
                        </div>
						
                        <div class="form-group{{ $errors->has('password') ? ' has-error' : '' }}">
                            <label for="password">Password</label>
							<input id="password" type="password" class="form-control" name="password" required>
							@if ($errors->has('password'))
								<span class="help-block">
									<strong>{{ $errors->first('password') }}</strong>
								</span>
							@endif
                        </div>
                        <div class="form-group">
                            <label for="password-confirm">Confirm Password</label>
							<input id="password_confirmation" type="password" class="form-control" name="password_confirmation" required>
                        </div>

						
						<div class="form-group{{ $errors->has('useridentification') ? ' has-error' : '' }}">
                            <label for="useridentification">User Identification</label>
							<input id="useridentification" type="text" class="form-control" name="useridentification" value="{{ old('useridentification') }}" required>
							@if ($errors->has('useridentification'))
								<span class="help-block">
									<strong>{{ $errors->first('useridentification') }}</strong>
								</span>
							@endif
                        </div>
						<div class="form-group">
							<button type="submit" class="btn btn-theme">Register</button>
						</div>
					</form>
			</div><! --/col-lg-8 -->
	 		
	 	</div><! --/row -->
	 </div><! --/container -->


@endsection