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<script src="//netdna.bootstrapcdn.com/bootstrap/3.0.0/js/bootstrap.min.js"></script>
<script src="//code.jquery.com/jquery-1.11.1.min.js"></script>
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<div class="container" id="wrap">
<div class="row">
<div class="col-md-6 col-md-offset-3">
<form action="" method="post" accept-charset="utf-8" class="form" role="form"> <legend>ODTÜ Derneği Üye Kayıt Formu</legend>
<h4>ODTÜ Gönüllüleri ve Emeklileri Sosyal Yardımlaşma ve Dayanışma Derneği</h4>
<div class="account-wall">
<img class="profile-img" src="static/images/add_user.png"
<label>Cinsiyet : </label> <label class="radio-inline">
<input type="radio" name="gender" value="M" id=male required> Erkek
</label>
<label class="radio-inline">
<input type="radio" name="gender" value="F" id=female required> Bayan
</label>
<div class="row">
<div class="col-xs-12 col-md-12">
<input type="text" name="TCNo" value="" class="form-control input-lg" placeholder="Tc Kimlik Numarası" required > </div>
<div class="col-xs-6 col-md-6">
<input type="text" name="adı" value="" class="form-control input-lg" placeholder="Adı" required> </div>
<div class="col-xs-6 col-md-6">
<input type="text" name="soyadı" value="" class="form-control input-lg" placeholder="Soyadı" required> </div>
<div class="col-xs-6 col-md-6">
<input type="text" name="anadaı" value="" class="form-control input-lg" placeholder="Ana Adı" required> </div>
<div class="col-xs-6 col-md-6">
<input type="text" name="babaadı" value="" class="form-control input-lg" placeholder="Baba Adı" required> </div>
<div class="col-xs-6 col-md-6">
<input type="text" name="dogumyeri" value="" class="form-control input-lg" placeholder="Doğum Yeri" required> </div>
</div>
<div class="row">
<div class="col-xs-4 col-md-4">
<select name="day" class = "form-control input-lg">
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
<option value="7">7</option>
<option value="8">8</option>
<option value="9">9</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
<option value="13">13</option>
<option value="14">14</option>
<option value="15">15</option>
<option value="16">16</option>
<option value="17">17</option>
<option value="18">18</option>
<option value="19">19</option>
<option value="20">20</option>
<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
<option value="24">24</option>
<option value="25">25</option>
<option value="26">26</option>
<option value="27">27</option>
<option value="28">28</option>
<option value="29">29</option>
<option value="30">30</option>
<option value="31">31</option>
</select> </div>
<div class="col-xs-4 col-md-4">
<select name="month" class = "form-control input-lg">
<option value="01">Ocak</option>
<option value="02">Şubat</option>
<option value="03">Mart</option>
<option value="04">Nisan</option>
<option value="05">Mayıs</option>
<option value="06">Haziran</option>
<option value="07">Temmuz</option>
<option value="08">Ağustos</option>
<option value="09">Eylül</option>
<option value="10">Ekim</option>
<option value="11">Kasım</option>
<option value="12">Aralık</option>
</select> </div>
<div class="col-xs-4 col-md-4">
<select name="year" class = "form-control input-lg">
<option value="1935">1935</option>
<option value="1936">1936</option>
<option value="1937">1937</option>
<option value="1938">1938</option>
<option value="1939">1939</option>
<option value="1940">1940</option>
<option value="1941">1941</option>
<option value="1942">1942</option>
<option value="1943">1943</option>
<option value="1944">1944</option>
<option value="1945">1945</option>
<option value="1946">1946</option>
<option value="1947">1947</option>
<option value="1948">1948</option>
<option value="1949">1949</option>
<option value="1950">1950</option>
<option value="1951">1951</option>
<option value="1952">1952</option>
<option value="1953">1953</option>
<option value="1954">1954</option>
<option value="1955">1955</option>
<option value="1956">1956</option>
<option value="1957">1957</option>
<option value="1958">1958</option>
<option value="1959">1959</option>
<option value="1960">1960</option>
<option value="1961">1961</option>
<option value="1962">1962</option>
<option value="1963">1963</option>
<option value="1964">1964</option>
<option value="1965">1965</option>
<option value="1966">1966</option>
<option value="1967">1967</option>
<option value="1968">1968</option>
<option value="1969">1969</option>
<option value="1970">1970</option>
<option value="1971">1971</option>
<option value="1972">1972</option>
<option value="1973">1973</option>
<option value="1974">1974</option>
<option value="1975">1975</option>
<option value="1976">1976</option>
<option value="1977">1977</option>
<option value="1978">1978</option>
<option value="1979">1979</option>
<option value="1980">1980</option>
<option value="1981">1981</option>
<option value="1982">1982</option>
<option value="1983">1983</option>
<option value="1984">1984</option>
<option value="1985">1985</option>
<option value="1986">1986</option>
<option value="1987">1987</option>
<option value="1988">1988</option>
<option value="1989">1989</option>
<option value="1990">1990</option>
<option value="1991">1991</option>
<option value="1992">1992</option>
<option value="1993">1993</option>
<option value="1994">1994</option>
<option value="1995">1995</option>
<option value="1996">1996</option>
<option value="1997">1997</option>
<option value="1998">1998</option>
<option value="1999">1999</option>
<option value="2000">2000</option>
<option value="2001">2001</option>
<option value="2002">2002</option>
<option value="2003">2003</option>
<option value="2004">2004</option>
<option value="2005">2005</option>
<option value="2006">2006</option>
<option value="2007">2007</option>
<option value="2008">2008</option>
<option value="2009">2009</option>
<option value="2010">2010</option>
<option value="2011">2011</option>
<option value="2012">2012</option>
<option value="2013">2013</option>
</select> </div>
<div class="col-xs-4 col-md-4">
<input type="text" name="lastname" value="" class="form-control input-lg" placeholder="Kayıtlı il" required> </div>
<div class="col-xs-4 col-md-4">
<input type="text" name="lastname" value="" class="form-control input-lg" placeholder="Kayıtlı ilçe" required> </div>
<div class="col-xs-4 col-md-4">
<input type="text" name="lastname" value="" class="form-control input-lg" placeholder="Mahalle/Köy" required> </div>
<div class="col-xs-4 col-md-4">
<input type="text" name="lastname" value="" class="form-control input-lg" placeholder="Cilt No" required> </div>
<div class="col-xs-4 col-md-4">
<input type="text" name="lastname" value="" class="form-control input-lg" placeholder="Aile Sıra No" required> </div>
<div class="col-xs-4 col-md-4">
<input type="text" name="lastname" value="" class="form-control input-lg" placeholder="Sıra No" required> </div>
<div class="col-xs-4 col-md-4">
<input type="text" name="lastname" value="" class="form-control input-lg" placeholder="Kan Grubu" required> </div>
</div>
<div class="row">
<div class="col-xs-6 col-md-6">
<input type="text" name="lastname" value="" class="form-control input-lg" placeholder="Yabancı Dil" required> </div>
<div class="col-xs-6 col-md-6">
<select name="egitimdurumu" class = "form-control input-lg" >
<option selected>Eğitim Durumu</option>
<option value="ilkokul">İlkokul</option>
<option value="ortaokul">Ortaokul</option>
<option value="lise">Lise</option>
<option value="universite">Üniversite</option>
<option value="yukseklisans">Yüksek Lisans</option>
</select> </div>
<div class="col-xs-6 col-md-6">
<input type="text" name="lastname" value="" class="form-control input-lg" placeholder="Üniversite'deki Göreviniz " required> </div>
<div class="col-xs-6 col-md-6">
<input type="text" name="lastname" value="" class="form-control input-lg" placeholder="Görev Yeri " required> </div>
<div class="col-xs-12 col-md-12">
<input type="text" name="lastname" value="" class="form-control input-lg" placeholder="Neden Ayrıldınız " required> </div>
<div class="col-xs-6 col-md-6">
<input type="text" name="lastname" value="" class="form-control input-lg" placeholder="Emekli Tarihi " required> </div>
<div class="col-xs-6 col-md-6">
<select name="egitimdurumu" class = "form-control input-lg" >
<option selected>Emekli Sandığı</option>
<option value="ilkokul">SSK</option>
<option value="ortaokul">BAĞKUR</option>
<option value="lise">Emekli Sandığı</option>
</select> </div>
<div class="col-xs-12 col-md-12">
<input type="text" name="lastname" value="" class="form-control input-lg" placeholder="Ev Adresi" required> </div>
<div class="col-xs-12 col-md-12">
<input type="text" name="lastname" value="" class="form-control input-lg" placeholder="İş Adresi" required> </div>
<div class="col-xs-12 col-md-12">
<input type="text" name="lastname" value="" class="form-control input-lg" placeholder="Ev Telefonu" required> </div>
<div class="col-xs-12 col-md-12">
<input type="text" name="lastname" value="" class="form-control input-lg" placeholder="İş Telefonu" required> </div>
</div>
<h4>Portal Kullanıcı Bilgileri</h4>
<input class="form-control" id="emailInput" required="" onchange="try{setCustomValidity('')}catch(e){}" oninvalid="setCustomValidity('Lütfen E-posta adresinizi Giriniz !')" type="email" placeholder="E-posta adresi">
<input class="form-control" id="posswordInput" required="" onchange="try{setCustomValidity('')}catch(e){}" oninvalid="setCustomValidity('Lütfen Şifrenizi Giriniz !')" type="password" placeholder="Şifre">
<input class="form-control" id="posswordInput" required="" onchange="try{setCustomValidity('')}catch(e){}" oninvalid="setCustomValidity('Lütfen Şifrenizi Giriniz !')" type="password" placeholder="Tekrar Şifre ">
<br />
<label>Üye Türü: </label> <label class="radio-inline">
<input type="radio" name="gender" value="M" id=male required> Sandık Üyesi
</label>
<label class="radio-inline">
<input type="radio" name="gender" value="F" id=female required> Dernek Üyesi
</label>
<span class="help-block">Kullanıcı Adı ve Şifrenizi yabancı insanlar ile paylaşmayınız.</span>
<button class="btn btn-lg btn-primary btn-block signup-btn" type="submit">
Üyeliği Tamamla</button>
</form>
</div>
</div>
</div>
</div>
#wrap{
background-image: -ms-linear-gradient(top, #FFFFFF 0%, #D3D8E8 100%);
/* Mozilla Firefox */
background-image: -moz-linear-gradient(top, #FFFFFF 0%, #D3D8E8 100%);
/* Opera */
background-image: -o-linear-gradient(top, #FFFFFF 0%, #D3D8E8 100%);
/* Webkit (Safari/Chrome 10) */
background-image: -webkit-gradient(linear, left top, left bottom, color-stop(0, #FFFFFF), color-stop(1, #D3D8E8));
/* Webkit (Chrome 11+) */
background-image: -webkit-linear-gradient(top, #FFFFFF 0%, #D3D8E8 100%);
/* W3C Markup, IE10 Release Preview */
background-image: linear-gradient(to bottom, #FFFFFF 0%, #D3D8E8 100%);
background-repeat: no-repeat;
background-attachment: fixed;
}
legend{
color:#141823;
font-size:25px;
font-weight:bold;
}
.signup-btn {
background: #79bc64;
background-image: -webkit-linear-gradient(top, #79bc64, #578843);
background-image: -moz-linear-gradient(top, #79bc64, #578843);
background-image: -ms-linear-gradient(top, #79bc64, #578843);
background-image: -o-linear-gradient(top, #79bc64, #578843);
background-image: linear-gradient(to bottom, #79bc64, #578843);
-webkit-border-radius: 4;
-moz-border-radius: 4;
border-radius: 4px;
text-shadow: 0px 1px 0px #898a88;
-webkit-box-shadow: 0px 0px 0px #a4e388;
-moz-box-shadow: 0px 0px 0px #a4e388;
box-shadow: 0px 0px 0px #a4e388;
font-family: Arial;
color: #ffffff;
font-size: 20px;
padding: 10px 20px 10px 20px;
border: solid #3b6e22 1px;
text-decoration: none;
}
.signup-btn:hover {
background: #79bc64;
background-image: -webkit-linear-gradient(top, #79bc64, #5e7056);
background-image: -moz-linear-gradient(top, #79bc64, #5e7056);
background-image: -ms-linear-gradient(top, #79bc64, #5e7056);
background-image: -o-linear-gradient(top, #79bc64, #5e7056);
background-image: linear-gradient(to bottom, #79bc64, #5e7056);
text-decoration: none;
}
.navbar-default .navbar-brand{
color:#fff;
font-size:30px;
font-weight:bold;
}
.form .form-control { margin-bottom: 10px; }
@media (min-width:768px) {
#home{
margin-top:50px;
}
#home .slogan{
color: #0e385f;
line-height: 29px;
font-weight:bold;
}
}
.profile-img
{
width: 126px;
height: 126px;
margin: 0 auto 10px;
display: block;
-moz-border-radius: 50%;
-webkit-border-radius: 50%;
border-radius: 50%;
}
/* Credit to bootsnipp.com for the css for the color graph */
.colorgraph {
height: 5px;
border-top: 0;
background: #c4e17f;
border-radius: 5px;
background-image: -webkit-linear-gradient(left, #c4e17f, #c4e17f 12.5%, #f7fdca 12.5%, #f7fdca 25%, #fecf71 25%, #fecf71 37.5%, #f0776c 37.5%, #f0776c 50%, #db9dbe 50%, #db9dbe 62.5%, #c49cde 62.5%, #c49cde 75%, #669ae1 75%, #669ae1 87.5%, #62c2e4 87.5%, #62c2e4);
background-image: -moz-linear-gradient(left, #c4e17f, #c4e17f 12.5%, #f7fdca 12.5%, #f7fdca 25%, #fecf71 25%, #fecf71 37.5%, #f0776c 37.5%, #f0776c 50%, #db9dbe 50%, #db9dbe 62.5%, #c49cde 62.5%, #c49cde 75%, #669ae1 75%, #669ae1 87.5%, #62c2e4 87.5%, #62c2e4);
background-image: -o-linear-gradient(left, #c4e17f, #c4e17f 12.5%, #f7fdca 12.5%, #f7fdca 25%, #fecf71 25%, #fecf71 37.5%, #f0776c 37.5%, #f0776c 50%, #db9dbe 50%, #db9dbe 62.5%, #c49cde 62.5%, #c49cde 75%, #669ae1 75%, #669ae1 87.5%, #62c2e4 87.5%, #62c2e4);
background-image: linear-gradient(to right, #c4e17f, #c4e17f 12.5%, #f7fdca 12.5%, #f7fdca 25%, #fecf71 25%, #fecf71 37.5%, #f0776c 37.5%, #f0776c 50%, #db9dbe 50%, #db9dbe 62.5%, #c49cde 62.5%, #c49cde 75%, #669ae1 75%, #669ae1 87.5%, #62c2e4 87.5%, #62c2e4);
}
