@extends('layouts.whitelabel.master') @section('title') {{ $marketplace->name }} @stop @section('header') @stop @section('content') Registration slug) }}'> Home Registration Register {!! Form::open(['action' => 'MemberController@storeUob', 'class' => 'form-horizontal register-form', 'id' => 'member-profile']) !!} Email Address * {!! Form::text('email', null, ['class' => 'form-control', 'data-required' => 1, ($errors->first('email') ? 'aria-required="true" aria-invalid="false" aria-describedby="email-error"' : '')]) !!} @if ($errors->first('email') ) {{ $errors->first('email') }} @endif First Name * {!! Form::text('first_name', null, ['class' => 'form-control', 'data-required' => 1, ($errors->first('first_name') ? 'aria-required="true" aria-invalid="false" aria-describedby="first_name-error"' : '')]) !!} @if ($errors->first('first_name') ) {{ $errors->first('first_name') }} @endif Last Name * {!! Form::text('last_name', null, ['class' => 'form-control', 'data-required' => 1, ($errors->first('lastname') ? 'aria-required="true" aria-invalid="false" aria-describedby="last_name-error"' : '')]) !!} @if ($errors->first('last_name') ) {{ $errors->first('last_name') }} @endif Prefer Name {!! Form::text('prefer_name', null, ['class' => 'form-control', 'data-required' => 1, ($errors->first('prefer_name') ? 'aria-required="true" aria-invalid="false" aria-describedby="prefer_name-error"' : '')]) !!} @if ($errors->first('prefer_name') ) {{ $errors->first('prefer_name') }} @endif Country Of Residence * {!! Form::select('country_residence', $countries, 193, ['class' => 'chosen-select selectcategory form-control', 'id' => 'countryOfResidence', 'data-placeholder' => 'Choose a Country...']) !!} @if ($errors->first('c_country_code') ) This field is mandatory @endif Gender * {!! Form::radio('gender', 'Male', true) !!} male {!! Form::radio('gender', 'Female') !!} female @if ($errors->first('lastname') ) {{ $errors->first('gender') }} @endif Birth Date * {!! Form::text('date_of_birth', null, ['class' => 'form-control date', 'id' => 'date-of-birth']) !!} @if ($errors->first('date_of_birth') ) This field is mandatory @endif NRIC/Passport No * {!! Form::text('nric_passport', null, ['class' => 'form-control', 'data-required' => 1, ($errors->first('nric_passport') ? 'aria-required="true" aria-invalid="false" aria-describedby="nric_passport-error"' : '')]) !!} @if ($errors->first('nric_passport') ) {{ $errors->first('nric_passport') }} @endif Nationality * {!! Form::select('nationality', $countries, 193, ['class' => 'chosen-select selectcategory form-control', 'id' => 'nationality', 'data-placeholder' => 'Choose a Country...']) !!} @if ($errors->first('c_country_code') ) This field is mandatory @endif Password * {!! Form::password('password', ['class' => 'form-control', 'data-required' => 1, 'id' => 'password' ]) !!} @if ($errors->first('password') ) {{ $errors->first('password') }} @endif Confirm Password * {!! Form::password('password_confirmation', ['class' => 'form-control', 'data-required' => 1 ]) !!} @if ($errors->first('password_confirmation') ) This field is mandatory @endif Mobile Number * {!! Form::select('c_country_code', $countries, 193, ['class' => 'chosen-select selectcategory form-control', 'id' => 'country', 'data-placeholder' => 'Choose a Country...']) !!} @if ($errors->first('c_country_code') ) This field is mandatory @endif +65 {!! Form::text('contact_no', null, ['class' => 'form-control', 'data-required' => 1]) !!} @if ($errors->first('contact_no') ) {{$errors->first('contact_no')}} @endif Receive exclusive {!! Form::checkbox('receive_exclusive', 1, true) !!} Receive exclusive, members-only offers and promotions from United Points. @if ($errors->first('receive_exclusive') ) This field is mandatory @endif Terms and Conditions* {!! Form::checkbox('terms_conditions', 1) !!} By registering as a Member, I have read, understood and agreed to UP Membership T & Cs and Privacy Policy. @if ($errors->first('terms_conditions') ) You Should have to agree Terms and Conditions to register the account. @endif {!! Form::checkbox('uob_signup', 1) !!} Sign up for UOB Travel Rewards Programs Register Cancel {!! Form::close() !!} @stop @section('footer') @stop