@extends('layouts.app')

@section('content')
<div class="container">
    <div class="row justify-content-center">
        <div class="col-md-8">
            <div class="card">
                <div class="card-header">{{ __('Register') }}</div>
                @include('layouts.flash-messages')
                <div class="card-body">
                    <form class="register-form" method="POST" action="{{ route('register.non-student') }}">
                        @csrf
 
 
                            <div class="form-group row">
                                <label for="name" class="col-md-4 col-form-label text-md-right">{{ __('Full Name (as per passport)') }}</label>

                                <div class="col-md-6">
                                    <input id="name" type="text" class="form-control @error('name') is-invalid @enderror" name="name" value="{{ old('name') }}" autocomplete="name" autofocus >

                                    @error('name')
                                        <span class="invalid-feedback" role="alert">
                                            <strong>{{ $message }}</strong>
                                        </span>
                                    @enderror
                                </div>
                            </div>

                            <div class="form-group row">
                                <label for="email" class="col-md-4 col-form-label text-md-right">{{ __('E-Mail Address') }}</label>

                                <div class="col-md-6">
                                    <input id="email" type="email" class="form-control @error('email') is-invalid @enderror" name="email" value="{{ old('email') }}" autocomplete="email" >

                                    @error('email')
                                        <span class="invalid-feedback" role="alert">
                                            <strong>{{ $message }}</strong>
                                        </span>
                                    @enderror
                                </div>
                            </div>



                            <div class="form-group row">
                                <label for="phone_number" class="col-md-4 col-form-label text-md-right">{{ __('Phone Number') }}</label>

                                <div class="col-md-6">
                                    <input id="phone_number" type="text" class="form-control @error('phone_number') is-invalid @enderror" name="phone_number" value="{{ old('phone_number') }}"  autocomplete="phone_number">

                                    @error('phone_number')
                                        <span class="invalid-feedback" role="alert">
                                            <strong>{{ $message }}</strong>
                                        </span>
                                    @enderror
                                </div>
                            </div>

                            <div class="form-group row">
                                <label for="name" class="col-md-4 col-form-label text-md-right">{{ __('Nationality') }}</label>

                                <div class="col-md-6">
                                    <input id="nationality" type="text" class="form-control @error('nationality') is-invalid @enderror" name="nationality" value="{{ old('nationality') }}"  autocomplete="nationality" autofocus>

                                    @error('nationality')
                                        <span class="invalid-feedback" role="alert">
                                            <strong>{{ $message }}</strong>
                                        </span>
                                    @enderror
                                </div>
                            </div>

                            <div class="form-group row">
                                <label for="age" class="col-md-4 col-form-label text-md-right">{{ __('Age') }}</label>

                                <div class="col-md-6">
                                    <input id="age" type="text" class="form-control @error('age') is-invalid @enderror" name="age" value="{{ old('age') }}" autocomplete="age" autofocus>

                                    @error('age')
                                        <span class="invalid-feedback" role="alert">
                                            <strong>{{ $message }}</strong>
                                        </span>
                                    @enderror
                                </div>
                            </div>

                            <div class="form-group row">
                                <label for="gender" class="col-md-4 col-form-label text-md-right">{{ __('Gender') }}</label>

                                <div class="col-md-6">
                                    <input id="gender" type="text" class="form-control @error('gender') is-invalid @enderror" name="gender" value="{{ old('gender') }}" autocomplete="gender" autofocus>

                                    @error('gender')
                                        <span class="invalid-feedback" role="alert">
                                            <strong>{{ $message }}</strong>
                                        </span>
                                    @enderror
                                </div>
                            </div>

                            <div class="form-group row">
                                <label for="categories" class="col-md-4 col-form-label text-md-right">{{ __('eVAL Issue Date') }}</label>

                                <div class="col-md-6">
                                    <input id="categories" type="text" class="form-control @error('categories') is-invalid @enderror" name="categories" value="{{ old('categories') }}" autocomplete="categories" autofocus>

                                    @error('categories')
                                        <span class="invalid-feedback" role="alert">
                                            <strong>{{ $message }}</strong>
                                        </span>
                                    @enderror
                                </div>
                            </div>

                            <div class="form-group row">
                                <label for="interest" class="col-md-4 col-form-label text-md-right">{{ __('Arrival Date') }}</label>

                                <div class="col-md-6">
                                    <input id="interest" type="text" class="form-control @error('interest') is-invalid @enderror" name="interest" value="{{ old('interest') }}" autocomplete="interest" autofocus>

                                    @error('interest')
                                        <span class="invalid-feedback" role="alert">
                                            <strong>{{ $message }}</strong>
                                        </span>
                                    @enderror
                                </div>
                            </div>

                        
                            <div class="form-group row">
                                <label for="password" class="col-md-4 col-form-label text-md-right">{{ __('Password') }}</label>

                                <div class="col-md-6">
                                    <input id="password" type="password" class="form-control @error('password') is-invalid @enderror" name="password"  autocomplete="new-password">

                                    @error('password')
                                        <span class="invalid-feedback" role="alert">
                                            <strong>{{ $message }}</strong>
                                        </span>
                                    @enderror
                                </div>
                            </div>

                        
                            <div class="form-group row">
                                <label for="password-confirm" class="col-md-4 col-form-label text-md-right">{{ __('Confirm Password') }}</label>

                                <div class="col-md-6">
                                    <input id="password-confirm" type="password" class="form-control" name="password_confirmation" autocomplete="new-password">
                                </div>
                            </div>

                        

                        <div class="form-group row mb-0">
                            <div class="col-md-6 offset-md-4">
                                <button type="submit" class="btn btn-primary">
                                    {{ __('Register') }}
                                </button>
                            </div>
                        </div>
                    </form>
                </div>
            </div>
        </div>
    </div>
</div>




@endsection