<?

$market= $_POST['market'];
$ip= $_POST['ip'];
//**************************************************************************************************
//*   Program Name   : form-account-hbm.php
//*   Purpose        : Register new provider for hbm system
//*   Author         : Robert B. Hyte
//*   Date           : August 15, 2013
//*   Revised        : Sept 12, 2013
//**************************************************************************************************
//**************************************************************************************************
//* All functions -- strip credit card numbers for safety
//**************************************************************************************************
//************************************************
//*  Clean input
//************************************************
function test_input($data) {
  $data = trim($data);
  $data = stripslashes($data);
  $data = htmlspecialchars($data);
  return $data;
}
//************************************************
//*  Smart Clean
//*  Quote variable to make safe
//************************************************
    function quote_smart($value)
    {
        // Stripslashes
        if ( get_magic_quotes_gpc() )
        {
            $value = stripslashes( $value );
        }
        // Quote if not a number or a numeric string
        if ( !is_numeric( $value ) )
        {
             $value = mysqli_real_escape_string($con,$value) ;
        }
        return $value;
    }
    function get_ip() {
		//Just get the headers if we can or else use the SERVER global
		if ( function_exists( 'apache_request_headers' ) ) {
			$headers = apache_request_headers();
		} else {
			$headers = $_SERVER;
		}
		//Get the forwarded IP if it exists
		if ( array_key_exists( 'X-Forwarded-For', $headers ) && filter_var( $headers['X-Forwarded-For'], FILTER_VALIDATE_IP, FILTER_FLAG_IPV4 ) ) {
			$the_ip = $headers['X-Forwarded-For'];
		} elseif ( array_key_exists( 'HTTP_X_FORWARDED_FOR', $headers ) && filter_var( $headers['HTTP_X_FORWARDED_FOR'], FILTER_VALIDATE_IP, FILTER_FLAG_IPV4 )
		) {
			$the_ip = $headers['HTTP_X_FORWARDED_FOR'];
		} else {
			
			$the_ip = filter_var( $_SERVER['REMOTE_ADDR'], FILTER_VALIDATE_IP, FILTER_FLAG_IPV4 );
		}
		return $the_ip;
	}
function randomstring($length) {
    $keys = array_merge(range(0,9), range('a', 'z'));

    for($i=0; $i < $length; $i++) {
        $key .= $keys[mt_rand(0, count($keys) - 1)];
    }
    return $key;
}


//**************************************************************************************************
//*  Set up database
//**************************************************************************************************
$con = mysqli_connect("careconsulcom.ipowermysql.com","consul","Hijt:4983","consul");
if (!$con){
die("Can not connect: " . mysql_error());
}

 
//**************************************************************************************************
//* Harvest posted data from user input
//**************************************************************************************************
if($_POST['form_mode'] =='add') {
$firstname= quote_smart($_POST['firstname']);
$lastname= quote_smart($_POST['lastname']);
$address1= quote_smart($_POST['address1']);
$address2= quote_smart($_POST['address2']);
$city= quote_smart($_POST['city']);
$state= quote_smart($_POST['state']);
$zip= quote_smart($_POST['zip']);
$phone_number= quote_smart($_POST['phone_number']);
$email= quote_smart($_POST['email']);
$username= quote_smart($_POST['username']);
$password= quote_smart($_POST['password']);
$market_form= quote_smart($_POST['market_form']);
$screen_name= quote_smart($_POST['screen_name']);
$gender= quote_smart($_POST['gender']);
$reg_date=date('Y-m-d H:i:s');
$type='2';
$screen_name=strtolower($screen_name);
$confirmcode='y';
$active='y';
$username = strtolower($username);
//**************************************************************************************************
//**************************************************************************************************
//* write data base
//**************************************************************************************************
$timer=time();
$pwdmd5 = md5($password);
  $iquery = "INSERT INTO fgusers3 (
  firstname,
  lastname,
  address1,
  address2,
  city,
  state,
  zip,
  email,
  phone_number,
  username,
  password,
  type,
  level,
screen_name,
gender,
  reg_date,

  active)
  VALUES (
  '$firstname',
  '$lastname',
  '$address1',
  '$address2',
  '$city',
  '$state',
  '$zip',
  '$email',
  '$phone_number',
  '$username',
  '$pwdmd5',
  '$type',
  '$level',
   '$screen_name',
'$gender',
   '$reg_date',
   
  '$active')"; 

		$retval = MYSQLi_QUERY($con,$iquery);
		if(! $retval )
        {
         die('Could not enter data: ' . mysql_error());
        } 
        $real_name=$firstname.' '.$lastname;
    $_SESSION['real_name']=$real_name;
    $_SESSION['reg_uname']=$username; 
  
        // echo "Entered data successfully\n";
         mysql_close($connection);

      
  echo "<META http-equiv='refresh' content='0;URL=/form-thanks.php'>"; 
 
exit;   

}
//**************************************************************************************************
//* End of PHP process of data - Start of HTML
//**************************************************************************************************    
?>
<!DOCTYPE html>
<html>
	<head>
<!-- Basic -->
		<meta charset="utf-8"> <meta http-equiv="X-UA-Compatible" content="IE=edge"> 
		<title>
			Member Registration
		</title>
		<meta name="keywords" content="HTML5 Template" /> <meta name="description" content="Bob Hyte"> <meta name="author" content="Bob Hytet"> 
<!-- Favicon -->
		<link rel="shortcut icon" href="img/favicon.ico" type="image/x-icon" /> <link rel="apple-touch-icon" href="img/apple-touch-icon.png"> 
<!-- Mobile Metas -->
		<meta name="viewport" content="width=device-width, minimum-scale=1.0, maximum-scale=1.0, user-scalable=no"> 
<!-- Web Fonts  -->
		<link href="https://fonts.googleapis.com/css?family=Open+Sans:300,400,600,700,800%7CShadows+Into+Light" rel="stylesheet" type="text/css"> 
<!-- Vendor CSS -->
		<link rel="stylesheet" href="vendor/bootstrap/css/bootstrap.min.css"> <link rel="stylesheet" href="vendor/font-awesome/css/font-awesome.min.css"> <link rel="stylesheet" href="vendor/simple-line-icons/css/simple-line-icons.min.css"> <link rel="stylesheet" href="vendor/owl.carousel/assets/owl.carousel.min.css"> <link rel="stylesheet" href="vendor/owl.carousel/assets/owl.theme.default.min.css"> <link rel="stylesheet" href="vendor/magnific-popup/magnific-popup.min.css"> 
<!-- Theme CSS -->
		<link rel="stylesheet" href="css/theme.css"> <link rel="stylesheet" href="css/theme-elements.css"> <link rel="stylesheet" href="css/theme-blog.css"> <link rel="stylesheet" href="css/theme-shop.css"> <link rel="stylesheet" href="css/theme-animate.css"> 
<!-- Skin CSS -->
		<link rel="stylesheet" href="css/skins/default.css"> 
<!-- Theme Custom CSS -->
		<link rel="stylesheet" href="css/custom.css"> 
<!-- Head Libs -->
		<script src="vendor/modernizr/modernizr.min.js">
		</script>
		<link href='css/rotating-card.css' rel='stylesheet' /> 
		<style>
		fieldset.scheduler-border {
    border: 1px groove #1069b3 !important;
    padding: 0 2.5em 1.4em 2.5em !important;
    margin: 0 0 1.5em 0 !important;
    -webkit-box-shadow:  0px 0px 0px 0px #000;
            box-shadow:  0px 0px 0px 0px #000;
            -webkit-border-radius: 8px;
-moz-border-radius: 8px;
border-radius: 8px;
 margin: 30px;

}

    legend.scheduler-border {
        font-size: 1.2em !important;
        font-weight: bold !important;
        text-align: left !important;
        width:auto;
        padding:0 10px;
        border-bottom:none;
        color: #1069b3;
    }
    .fs-color {
     background-color: #eee;
    
    }
    .invisable {
    display:none;
    
    }
</style>
<script src="vendor/jquery-validation/lib/jquery.js"></script>
	

		<script src="vendor/jquery-validation/dist/jquery.validate.min.js"></script>
		<script src="vendor/jquery-validation/dist/additional-methods.min.js"></script>
	<script>


	$().ready(function() {
		// validate the comment form when it is submitted
		

		// validate signup form on keyup and submit
		$("#signupForm").validate({
			rules: {
				firstname: "required",
				lastname: "required",
				city: "required",
				zip: "required",
				state: "required",
				lastname: "required",
				gender: "required",
				username: {
					required: true,
					minlength: 5
				},
				password: {
					required: true,
					minlength: 5
				},
				password2: {
					required: true,
					minlength: 5,
					equalTo: "#password"
				},
				screen_name: {
					required: true,
					minlength: 5
				},
		
				email: {
					required: true,
					email: true
				}
			
				
			},
			messages: {
				firstname: "Please enter your firstname",
				lastname: "Please enter your lastname",
				city: "Please enter your City Name",				
								zip: "Please enter your Zip Code Dude",
				
				username: {
					required: "Please enter a username",
					minlength: "Your username must consist of at least 5 characters"
				},
				screen_name: {
					required: "Please enter a screen name",
					minlength: "Your screen name must consist of at least 5 characters"
				},				
				password: {
					required: "Please provide a password",
					minlength: "Your password must be at least 5 characters long"
				},
				password2: {
					required: "Please provide a password",
					minlength: "Your password must be at least 5 characters long",
					equalTo:"Please enter the same password as above"
				},
								token: {
					required: "Please provide an invite code",
				
					equalTo:"Please enter a valid invite code"
				},
				
				
				email: "Please enter a valid email address"
				
			}
		});

		// propose username by combining first- and lastname
	

	});
	</script>
	<script type="text/javascript">
function check_username() {

  uname=document.getElementById("uname").value;
  var params = "user_id="+uname;
  var url = "chk_username.php";
  $.ajax({
    type: 'POST',
    url: url,
    dataType: 'html',
    data: params,
    beforeSend:
      function() {
      document.getElementById("usernamechk").innerHTML= 'checking'  ;
     
                 },
    complete: function() {},
    success:
     
      function(html) {
                  if (html == "success"){
              
                document.getElementById("usernamechk").innerHTML= "<label style='margin:10px;color: #018500;font-size:11pt;'>Username Is Available</label>" ;
           $('#usname').removeClass('has-error');
           $('#showme').removeClass('invisable');
            }
            if (html == "error"){
          
                document.getElementById("usernamechk").innerHTML= "<label style='margin:10px;color: #B70404;font-size:11pt;'>Username Is Not Available</label>" ;
            $('#usname').addClass('has-error');
          $('#showme').addClass('invisable');
            }
            if (html == "invalid"){
          
               document.getElementById("usernamechk").innerHTML= "<label style='margin:10px;color: #B70404;font-size:11pt;'>Username Is Invalid Format: 0-9 or a-z characters only</label>" ;
            $('#usname').addClass('has-error');
         $('#showme').addClass('invisable');
            }
     
      } 
                   
  });                     
}
 
</script>

	</head>
	<body>
		<div class="body">
			<header id="header" data-plugin-options='{"stickyEnabled": false, "stickyEnableOnBoxed": true, "stickyEnableOnMobile": true, "stickyStartAt": 87, "stickySetTop": "-87px", "stickyChangeLogo": true}'>
				<div class="header-body">
					<div class="header-container container">
						<div class="header-row">
							<div class="header-column">
								<div class="header-logo">
									<a href="index.html">
										<img class="img-responsive" alt="familyrecordsvault" width="30%"  src="img/mycaremate-red.jpg">
									</a>
								</div>
							</div>
						</div>
					</div>
				</div>
			</header>
			<div role="main" class="main">
				<section class="page-header">
					<div class="container">
						<div class="row">
							<div class="col-md-12">
								<ul class="breadcrumb">
								
									<li>
										<a href="index.php">
											Home
										</a>
									</li>
								
									<li class="active">
										<a href="#">
											Registration
										</a>
									</li>
								</ul>
							</div>
						</div>
						<div class="row">
							<div class="col-md-12">
								<h1>
									Member Registration
								</h1>
							</div>
						</div>
					</div>
				</section>
				<br> 
				<div class="container">
					<div class="row">
						<div class="border-last col-xs-12 col-sm-12 col-md-12 pull-right">
							<p>
								Enter the appropriate account profile information. This information is needed to customize specific needs.
							</p>
						</div>
					</div>
				</div>
				<br><br> 
				<div class="container">
					<h2>
						<strong>
							Member
						</strong>
						Registration
					</h2>
					<div class="row">
						<div class="col-md-12">


            <!-- form: -->
                      <section>
                <div class="col-lg-8 col-lg-offset-2">
                    <!-- <div class="page-header">
                    <h2>Account Registration</h2> 
                    </div> -->

                    <form id="signupForm" method="post" class="form-horizontal" action="form-register-frv.php"
                     data-fv-addons="requiredIcon"
                        data-fv-addons-requiredicon-icon="glyphicon glyphicon-asterisk">
                    <input id="id_user" name="id_user" type="hidden" value="<? echo $id_user; ?>" />
                      <input id="form_mode" name="form_mode" type="hidden" value="add" /> 
                      <input id="market_form" name="market_form" type="hidden" value="<? echo $market; ?>" />
                                            <input id="invite" name="invite" type="hidden" value="53737" /> 
                      <fieldset class="scheduler-border">
                      <legend class="scheduler-border">Account Information</legend>
                        <div class="form-group">
                            <label class="col-lg-3 control-label">First Name</label>
                            <div class="col-lg-5">
                                <input type="text" class="form-control" name="firstname" placeholder="First Name"  />
                            </div>
                        </div>
                         <div class="form-group">
                            <label class="col-lg-3 control-label">Last Name</label>
                            <div class="col-lg-5">
                                <input type="text" class="form-control" name="lastname" placeholder="Last Name" />
                            </div>
                        </div>                           

                        <div class="form-group">
                            <label class="col-lg-3 control-label">Address</label>
                            <div class="col-lg-5">
                                <input type="text" class="form-control" name="address1"  />
                            </div>
                        </div>

                        <div class="form-group">
                            <label class="col-lg-3 control-label">Suite</label>
                            <div class="col-lg-5">
                                <input type="text" class="form-control" name="address2"  />
                            </div>
                        </div>

                        <div class="form-group">
                            <label class="col-lg-3 control-label">City</label>
                            <div class="col-lg-5">
                                <input type="text" class="form-control" name="city"  />
                            </div>
                        </div>

                        <div class="form-group">
                            <label class="col-lg-3 control-label">State</label>
                          <div class="col-sm-5">
                               <select id="state" name='state' class="form-control"  >
            <option value=''>State</option>
            <option value='AK'  >Alaska</option>
            <option value='AL'  >Alabama</option>
   <option value='AR'  >Arkansas</option>
   <option value='AZ'  >Arizona</option>
   <option value='CA'  >California</option>
   <option value='CO'  >Colorado</option>
   <option value='CT'  >Connecticut</option>
   <option value='DC'  >District of Columbia</option>
   <option value='DE'  >Delaware</option>
   <option value='FL'  >Florida</option>
   <option value='GA'  >Georgia</option>
   <option value='HI'  >Hawaii</option>
   <option value='IA'  >Iowa</option>
   <option value='ID'  >Idaho</option>
   <option value='IL'  >Illinois</option>
   <option value='IN'  >Indiana</option>
   <option value='KS'  >Kansas</option>
   <option value='KY'  >Kentucky</option>
   <option value='LA'  >Louisiana</option>
   <option value='MA'  >Massachusetts</option>
   <option value='MD'  >Maryland</option>
   <option value='ME'  >Maine</option>
   <option value='MI'  >Michigan</option>
   <option value='MN'  >Minnesota</option>
   <option value='MO'  >Missouri</option>
   <option value='MS'  >Mississippi</option>
   <option value='MT'  >Montana</option>
   <option value='NC'  >North Carolina</option>
   <option value='ND'  >North Dakota</option>
   <option value='NE'  >Nebraska</option>
   <option value='NH'  >New Hampshire</option>
   <option value='NJ'  >New Jersey</option>
   <option value='NM'  >New Mexico</option>
   <option value='NV'  >Nevada</option>
   <option value='NY'  >New York</option>
   <option value='OH'  >Ohio</option>
   <option value='OK'  >Oklahoma</option>
   <option value='OR'  >Oregon</option>
   <option value='PA'  >Pennsylvania</option>
   <option value='PR'  >Puerto Rico</option>
   <option value='RI'  >Rhode Island</option>
   <option value='SC'  >South Carolina</option>
   <option value='SD'  >South Dakota</option>
   <option value='TN'  >Tennessee</option>
   <option value='TX'  >Texas</option>
   <option value='UT'  >Utah</option>
   <option value='VA'  >Virginia</option>
   <option value='VT'  >Vermont</option>
   <option value='WA'  >Washington</option>
   <option value='WI'  >Wisconsin</option>
   <option value='WV'  >West Virginia</option>
   <option value='WY'  >Wyoming</option>
            </select>
                            </div>
                        </div>
     
     
                           <div class="form-group">
                            <label class="col-lg-3 control-label">Gender</label>
                          <div class="col-sm-5">
                               <select id="gender" name='gender' class="form-control"  >
          <option value=''  ></option>
            <option value='Female'  >Female</option>
             <option value='Male'  >Male</option>
     
     </select>
     </div>
                        </div>
     
                        
                        <div class="form-group">
                            <label class="col-lg-3 control-label">Zip</label>
                            <div class="col-lg-5">
                                <input type="text" class="form-control" name="zip"  />
                            </div>
                        </div>
                        
                        <div class="form-group">
                            <label class="col-lg-3 control-label">Phone</label>
                            <div class="col-lg-5">
                                <input type="text" class="form-control" name="phone_number"  />
                            </div>
                        </div>
                               <div class="form-group">
                            <label class="col-lg-3 control-label">Mobile Carrier</label>
                          <div class="col-sm-5">
                               <select id="gender" name='carrier' class="form-control"  >
          <option value=''  ></option>
            <option value='att'  >AT&T</option>
             <option value='verizon'  >Verizon</option>
     
     </select>
     </div></div>                    
                         <div class="form-group">
                            <label class="col-lg-3 control-label">Email</label>
                            <div class="col-lg-5">
                                <input type="email" class="form-control" name="email"  />
                            </div>
                        </div> 

                                                                  
   </fieldset>                                           
                          <fieldset class="scheduler-border">
                      <legend class="scheduler-border">Login Information</legend>                  
            
                           <div class="form-group" id="usname">
                            <label class="col-lg-3 control-label">User Name</label>
                            <div class="col-lg-5">
                                <input type="text" class="form-control" id="uname" name="username" placeholder="User Name" onkeyup='check_username()' />
                        
                            </div>
                            </div>
                   
                          <div class="form-group">   
                            <label class="col-lg-3 control-label">New Password</label>
                            <div class="col-lg-5">
                                <input type="password" class="form-control" id="password" name="password" placeholder="New Password"  />
                            </div>
                       
                        </div>

                        <div class="form-group">
                            <label class="col-lg-3 control-label">Confirm New Password</label>
                            <div class="col-lg-5">
                                <input type="password" class="form-control" id="password2" name="password2" placeholder="Confirm Password" />
                            </div>
                        </div>
                        
               
  <div class="form-group">
                            <label class="col-lg-3 control-label"></label>
                            <div class="col-lg-5" id='usernamechk'>

                            </div>
                        </div>
                   
            
</fieldset>

                        <div class="form-group">
                            <div class="col-lg-9 col-lg-offset-3" id="showme">
                                <button type="submit" class="btn btn-primary" name="signup" id="submitbtn" value="Sign up">Submit</button>
                                <button type="button" onclick="goBack()" class="btn btn-primary" >Cancel</button>
                            </div>
                        </div>

                    </form>
                </div>
            </section>
            <!-- :form --> 
            

<!-- end col-sm-3 -->
						</div>
					</div>
				</div>
			</div>
<? include 'frv-footer.php'; ?>
		</div>
<!-- Vendor -->

		<script src="vendor/jquery.appear/jquery.appear.min.js">
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		<script src="vendor/jquery.easing/jquery.easing.min.js">
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		<script src="vendor/bootstrap/js/bootstrap.min.js">
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		<script src="vendor/jquery.stellar/jquery.stellar.min.js">
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		</script>
		<script src="vendor/vide/vide.min.js">
		</script>
<!-- Theme Base, Components and Settings -->
		<script src="js/theme.js">
		</script>
<!-- Theme Custom -->
		<script src="js/custom.js">
		</script>
<!-- Theme Initialization Files -->
		<script src="js/theme.init.js">
		</script>
		<script src="vendor/bootstrap/js/bootstrap.min.js" type="text/javascript">
		</script>
<!-- Google Analytics: Change UA-XXXXX-X to be your site's ID. Go to http://www.google.com/analytics/ for more information.
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		<script type="text/javascript">
			$().ready(function(){
			    $('[rel="tooltip"]').tooltip();
			
			});
			
			function rotateCard(btn){
			    var $card = $(btn).closest('.card-container');
			    console.log($card);
			    if($card.hasClass('hover')){
			        $card.removeClass('hover');
			    } else {
			        $card.addClass('hover');
			    }
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		</script>

	</body>
</html>