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<!DOCTYPE html>
<html>
<head>
<meta charset="utf-8">
<title>Khidmat Donation HTML-5 Template | Donation</title>

<link href="css/bootstrap.css" rel="stylesheet">
<link href="css/style.css" rel="stylesheet">
<link href="css/slick.css" rel="stylesheet">
<link href="css/responsive.css" rel="stylesheet">

<link href="css/color-switcher-design.css" rel="stylesheet">

<link id="theme-color-file" href="css/color-themes/default-theme.css" rel="stylesheet">

<meta http-equiv="X-UA-Compatible" content="IE=edge">
<meta name="viewport" content="width=device-width, initial-scale=1.0, maximum-scale=1.0, user-scalable=0">

</head>

<div class="page-wrapper">
 	
    
    <div class="preloader"></div>
 	
 	
<?php  require 'menu.php'; ?>
    
	
	
    <section class="page-title" style="background-image:url(images/background/12.jpg);">
    	<div class="auto-container">
        	<div class="row clearfix">
            	
            	<div class="title-column col-lg-6 col-md-12 col-sm-12">
                	<h1>Donation Form</h1>
                </div>
                
                <div class="breadcrumb-column col-lg-6 col-md-12 col-sm-12">
                    <ul class="bread-crumb clearfix">
                        <li><a href="index.html"><span class="icon fas fa-home"></span> Home</a></li>
                        <li class="active"><span class="icon fas fa-arrow-alt-circle-right"></span> Donation Form</li>
                    </ul>
                </div>
            </div>
        </div>
    </section>
    
	
	
    <div class="sidebar-page-container">
    	<div class="auto-container">
        	<div class="row clearfix">
            	
                
                <div class="content-side col-lg-8 col-md-12 col-sm-12">
					<div class="donation-section">
						
						<div class="sec-title">
							<?php 
									if($_GET['status'] == '1')
									{
										?>
											<p style="color:red;">Thank You For Registration. Please Click To Login Here <a href="login.php"> Login</a></p>
										<?php
									}
									?>
							<h2><span class="theme_color">Donner </span> Information</h2>
						</div>
						
						
						<div class="default-form style-two">
							<form method="post" action="save_donor.php">
							
								<div class="row clearfix">
									
									
									<div class="form-group col-lg-6 col-md-6 col-sm-12">
										<input type="text" name="fname" id="fname" value="" placeholder="First Name" required>
									</div>
									
									
									<div class="form-group col-lg-6 col-md-6 col-sm-12">
										<input type="text" name="lname" id="lname" value="" placeholder="Last Name" required>
									</div>
									
									
									<div class="form-group col-lg-12 col-md-12 col-sm-12">
										<input type="text" name="address" id="address" value="" placeholder="Address" required>
									</div>
									
									
									<div class="form-group col-lg-6 col-md-6 col-sm-12">
										<input type="text" name="country" id="country" value="" placeholder="Country" required>
									</div>
									
									
									<div class="form-group col-lg-6 col-md-6 col-sm-12">
										<input type="text" name="city" id="city" value="" placeholder="City" required>
									</div>
									
									
									<div class="form-group col-lg-6 col-md-6 col-sm-12">
										<input type="text" name="code" id="code" value="" placeholder="Postal Code" required>
									</div>
																		 
									
									
									<div class="form-group col-lg-6 col-md-6 col-sm-12">
										<input type="text" name="contact" id="contact" value="" placeholder="Contact No." required>
									</div>
									
									
									<div class="form-group col-lg-12 col-md-12 col-sm-12">
										<input type="email" name="email" value="" placeholder="Email Address" required>
									</div>

<div class="form-group col-lg-12 col-md-12 col-sm-12">
										<input type="password" name="password" value="" placeholder="Password" required>
									</div>
									
									
									<div class="form-group col-lg-12 col-md-12 col-sm-12">
										<div class=" ">
											<input type="checkbox" name="payment-group" id="privacy" onclick="status_privacy()" style="height:15px;">
											<label for="radio-one">
												 
												Please do not display my name publicly. I would like to remain anonymous
											</label>
										</div>
									</div>

<input type="hidden" name="hidden_privacy" id="hidden_privacy" value="public">
									
									
									
									
								</div>
								
								
								<div class="sec-title">
									<h2><span class="theme_color">Donation </span> Information</h2>
								</div>
								
								<div class="select-amount clearfix">
									 
									<div class="input-box">
										<input type="text" name="amount" id="amount" value="" placeholder="Enter Your Amount">
									</div>
								</div>
								
								<div class="row clearfix">
									
									
									<div class="form-group col-lg-6 col-md-12 col-sm-12">
										<div class=" ">
											<input type="checkbox" name="contribution[]" id="onetime" value="onetime" onclick="cont_onetime()" style="height:15px;">
											<label for="radio-seven">
												<span class="default-check"></span>
												<span class="check-icon "></span>
												I would like to make this Onetime contribution.
											</label>
										</div>
									</div>
									
									
									<div class="form-group col-lg-6 col-md-12 col-sm-12">
										<div class=" ">
											<input type="checkbox" name="contribution[]" id="daily" value="daily" onclick="cont_onetime()" style="height:15px;">
											<label for="radio-eight">
												<span class="default-check"></span>
												<span class="check-icon "></span>
												I would like to make this Daily contribution.
											</label>
										</div>
									</div>
									
									
									<div class="form-group col-lg-6 col-md-12 col-sm-12">
										<div class=" ">
											<input type="checkbox" name="contribution[]" id="weekly" value="weekly" onclick="cont_onetime()" style="height:15px;"> 
											<label for="radio-nine">
												<span class="default-check"></span>
												<span class="check-icon "></span>
												I would like to make this Weekly contribution.
											</label>
										</div>
									</div>
									
									
									<div class="form-group col-lg-6 col-md-12 col-sm-12">
										<div class=" ">
											<input type="checkbox" name="contribution[]" id="fortnightly" value="fortnightly" onclick="cont_onetime()" style="height:15px;">
											<label for="radio-ten">
												<span class="default-check"></span>
												<span class="check-icon "></span>
												I would like to make this Fortnightly contribution.
											</label>
										</div>
									</div>
									 
								</div>
								
								
								<div class="sec-title">
									<h2><span class="theme_color">Donate </span> For</h2>
								</div>
								
								<div class="row clearfix">
									
									
									<div class="form-group col-lg-4 col-md-12 col-sm-12">
										<div class=" ">
											<input type="checkbox" name="donate_for[]" id="education" value="education" style="height:15px;" >
											<label for="radio-eleven">
												<span class="default-check"></span>
												<span class="check-icon "></span>
												Children’s Eduction
											</label>
										</div>
									</div> 
									
									
									<div class="form-group col-lg-4 col-md-12 col-sm-12">
										<div class=" ">
											<input type="checkbox" name="donate_for[]" id="medical" value="medical" style="height:15px;" >
											<label for="radio-thirteen">
												<span class="default-check"></span>
												<span class="check-icon "></span>
												Medical Care
											</label>
										</div>
									</div>
									
									 
								</div>
																 
								<div class="form-group">
									<input type="submit" id="submit" name="submit" value="Submit" class="theme-btn btn-style-three"><span class="txt"> </span>	
								</div>  
								
							</form>
						</div>
						
						
					</div>
				</div>
				
				
                <div class="sidebar-side col-lg-4 col-md-12 col-sm-12">
                	<aside class="sidebar">
						
						
                       
						
						
                        
						
						
                        
						
						
                        <div class="sidebar-widget help-widget">
							<div class="sidebar-title">
                            	<h2>Need Help?</h2>
                            </div>
                            <div class="widget-content">
								<div class="text">if you have any question please don’t hesitate to contact us</div>
								<ul class="list">
									<li><span class="icon fas fa-phone-volume"></span>123 456 7890</li>
									<li><span class="icon fas fa-envelope"></span>info@khidmat.com use contact Form</li>
								</ul>
							</div>
						</div>
						
					</aside>
				</div>
			
			</div>
		</div>
	</div>
	
	
    <section class="newsletter-section margin-bottom">
    	<div class="auto-container">
        	<div class="inner-container" style="background-image:url(images/background/map-pattern-2.png)">
            	<div class="row clearfix">
                	
                    
                    <div class="title-column col-lg-6 col-md-12 col-sm-12">
                    	<div class="inner-column">
                        	<h4>Subscribe a Newsletter</h4>
                            <div class="title">Pleace enter your email and get news updete for donation company.</div>
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                    <div class="form-column col-lg-6 col-md-12 col-sm-12">
                    	<div class="inner-column">
                        	
                            
                            <div class="subscribe-form">
                                <form method="post" action="contact.html">
                                    <div class="form-group">
                                        <input type="email" name="email" value="" placeholder="Enter Your Email Address" required>
                                        <button type="submit" class="theme-btn submit-btn">Send Now</button>
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								<div class="footer-widget logo-widget">
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										<a href="index.html"><img src="images/footer-logo.png" alt="" /></a>
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									<div class="text">Core values are the fundamental beliefs of a person or organization. The core values are the guiding prin ples that dictate behavior and action suas labore saperet has there any quote for write lorem percit latineu.</div>
									
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										<figure class="post-thumb"><a href="blog-single.html"><img src="images/resource/news-thumb-1.jpg" alt=""></a></figure>
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										<div class="post-info">12 Dec, 2018</div>
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										<figure class="post-thumb"><a href="blog-single.html"><img src="images/resource/news-thumb-2.jpg" alt=""></a></figure>
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						<h2>About Us</h2>
						<p class="text">Core values are the fundamental beliefs of a person or organization. The core values are the guiding prin ples that dictate behavior and action suas labore saperet has there any quote for write lorem percit latineu.</p>
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							<li><span class="icon flaticon-map-1"></span>Chicago 12, Melborne City, USA</li>
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/*function cont_daily()
	{
		if(document.getElementById("daily").checked == true)
		{//alert("1");
			document.getElementById("hidden_contribution").value = "Daily,";
		}
		else
		{
			document.getElementById("hidden_contribution").value = "";
		}
	}