File: /var/www/vhosts/creativefellows.nl/test.creativefellows.nl/ergatis/aanmelden-nascholing/index.php
<?php
/*
* Include config files
*/
$security_key = 'akz2TaXRfaZ4dAqEeugt';
require_once "../includes/main.inc.php";
//$cassette = new config();
?>
<!DOCTYPE HTML>
<head>
<?php
echo '<base href="'.$cassette->base.'aanmelden-nascholing/"/>';
echo '<title>Nascholing: Terug naar werk bij burn-out, verslaving en kanker</title>';
echo '<meta charset="utf-8"/>';
echo '<meta name="viewport" content="width=device-width, initial-scale=1"/>';
echo '<meta http-equiv="X-UA-Compatible" content="IE=edge,chrome=1"/>';
echo '<link rel="icon" type="image/png" sizes="16x16" href="images/favicon-16x16.png">';
?>
<link rel="stylesheet" href="css/base.css?v=0.1" type="text/css" />
<link rel="stylesheet" href="css/custom.css?v=0.1" type="text/css" />
<link rel="stylesheet" href="css/mobile.css?v=0.1" type="text/css" />
<script src="https://ajax.googleapis.com/ajax/libs/jquery/3.3.1/jquery.min.js"></script>
<script src="https://cdn.jsdelivr.net/npm/jquery-validation@1.17.0/dist/jquery.validate.min.js"></script>
<script src="js/script.js"></script>
</head>
<body>
<section class="container page-breadcrumbs">
<div class="hrzntl-spacer">
<div class="container-wrapper">
<div class="col16 offset4 align-right">
<img src="images/ergatis-logo.png" style="height:4em;margin:1.5em 0;float:left" />
<img src="images/sitagre-logo.png" style="height:4em;margin:1.5em 0;float:right" />
</div>
<?php
if( isset($_GET["s"]) && $_GET["s"] == 1 && $_REQUEST["hash"] == md5($security_key) ) {
echo '<div class="col16 offset4">';
echo '<hr />';
//echo '<h1 class="like-h2">Nascholing: Terug naar werk bij burn-out, verslaving en kanker</h1>';
echo '<h1><strong>Inschrijving verstuurd</strong>, u ontvangt een bevestiging per e-mail</h1>';
echo '</div>';
}
else{
?>
<div class="col16 offset4">
<hr />
<h1 class="like-h2" style="margin-bottom:0;">Nascholing: Terug naar werk bij burn-out, verslaving en kanker</h1>
<h3 style="color:#444;">Doelgroep: Casemanagers</h3>
<p>Voor eventuele vragen over deze nascholing kunt u een mail sturen naar <a href="mailto:nascholing@ergatis.nl" style="color:#009fdb;">nascholing@ergatis.nl</a>.</p>
<hr />
</div>
<div class="col16 offset4">
<form class="form" method="post" action="http://demo.creativefellows.nl/ergatis.nl/aanmelden-nascholing/nascholing-vj2018.php" id="nascholing-form">
<div>
<label>Aanhef</label>
<input type="radio" name="aanhef" value="dhr" class="input" checked> Dhr. <input type="radio" name="aanhef" value="mevr" class="input"> Mevr.
</div>
<div>
<label>Naam</label>
<input type="text" name="voornaam" value="" class="input voornaam" placeholder="Voornaam"><input type="text" name="tussenvoegsel" value="" class="input tussenvoegsel" placeholder="tussenvoegsel"><input type="text" name="achternaam" value="" class="input achternaam" placeholder="Achternaam">
</div>
<div>
<label>E-mailadres</label>
<input type="text" name="email" value="" class="input">
</div>
<div>
<label>Telefoon</label>
<input type="text" name="phone" value="" class="input">
</div>
<div>
<label>Datum/locatie</label>
<select name="date_location" class="required">
<option value="">-- Maak een keuze --</option>
<option value="31-05-2018,Eindhoven">Donderdag 31 mei Eindhoven</option>
<option value="06-06-2018,Zwolle">Woensdag 6 juni Zwolle</option>
<option value="12-06-2018,Arnhem">Dinsdag 12 juni Arnhem</option>
<option value="19-06-2018,Rotterdam">Dinsdag 19 juni Rotterdam</option>
<option value="28-06-2018,Amsterdam">Donderdag 28 juni Amsterdam</option>
</select>
</div>
<div>
<label>Opmerkingen</label>
<textarea name="opmerkingen" class="input"></textarea>
</div>
<br />
<input type="submit" value="Inschrijven" class="button primary">
<br /><br /><br />
</form>
</div>
<?php
}
?>
</div>
</div>
</section>
</body>
</html>