}})
@if($message = Session::get('success'))
{{ $message }}
@elseif($message = Session::get('error'))
{{ $message }}
@endif
{{ Form::open(array('url'=>'pooled-campus-registration-post','method'=>'POST','id'=>'pooled-register')) }}
{{ $title }}
*
{{ Form::select('exam_center',$center,'',array('class'=>'form-control select8 common','required','id'=>'select1','placeholder'=>'Exam center*')) }}
*
{{ Form::text('first_name','',array('class'=>'form-control','required','placeholder'=>'Name*')) }}
*
{{ Form::text('mobile_number','',array('id'=>'mobile_number', 'class'=>'form-control','required','placeholder'=>'Mobile Number*','maxlength'=>'10')) }}
*
{{ Form::text('email_address','',array('id'=>'email_address','class'=>'form-control','required','placeholder'=>'Email Address*')) }}
*
{{ Form::password('password',array('id'=>'password','class'=>'form-control','required','placeholder'=>'Password*')) }}
*
{{ Form::select('course_type',array(''=>\Lang::get('validation.pooled_campus_choose_course_type'))+$course_type,'',array('class'=>'form-control select8 course_type depend common','required','id'=>'select2','data-type'=>'course')) }}
*
{{ Form::select('course_name',array(''=>\Lang::get('validation.pooled_campus_choose_course_name')),'',array('id'=>'select3' ,'class'=>'form-control select8 course_name depend common','required','disabled','data-type'=>'specialization','placeholder'=>'Select Course Name*' )) }}
*
{{ Form::select('specialization',array(''=>\Lang::get('validation.pooled_campus_choose_specialization')),'',array('id'=>'select4' ,'class'=>'form-control select8 specialization common','required','disabled','data-type'=>'specializationId')) }}
*
{{ Form::select('university',array(''=>\Lang::get('validation.pooled_campus_choose_university'))+$university,'',array('id'=>'select5' ,'class'=>'form-control select8 depend university common','required','data-type'=>'universityid')) }}
*
{{ Form::text('others_university_name','',['class'=>'form-control','id'=>'others_university_name','Placeholder'=>'Other University']) }}
*
{{ Form::select('college',array(''=>\Lang::get('validation.pooled_campus_choose_college')),'',array('id'=>'select6' ,'class'=>'form-control select8 college common','required','disabled','data-type'=>'collegeId')) }}
*
{{ Form::text('others_college_name','',['class'=>'form-control','id'=>'others_college_name','Placeholder'=>'Other College']) }}
*
{{ Form::select('year',array(''=>\Lang::get('validation.pooled_campus_choose_year'))+$year,'',array('id'=>'select7' ,'class'=>'form-control select8 year common','required')) }}
{{-- Terms & conditions --}}
{{-- Terms & conditions --}}
{{ Form::submit(\Lang::get('validation.pooled_campus_submit'),array('class'=>'btn btn-primary f-16 btn-block submit','id'=>'pooled_register')) }}
Copyright © {{date('Y')}}. All Rights Reserved