}
}
$DOB='';
- // old DOB form
- if (isset($_POST['DOB'])){
+ if (isset($_POST['DOB'])){
if ($_POST['DOB'] != ''){
$DOB = $_POST['DOB'];
setcookie("pDOB", $DOB);
}
}
- // new DOB form
- if (isset($_POST['web_dob_day'])){
- if ($_POST['web_dob_day'] != ''){
- $DOB = $_POST['web_dob_year'].'-'.$_POST['web_dob_month'].'-'.$_POST['web_dob_day'];
- setcookie("pDOB", $DOB);
- setcookie("web_dob_month", $_POST['web_dob_month']);
- setcookie("web_dob_year", $_POST['web_dob_year']);
- setcookie("web_dob_day", $_POST['web_dob_day']);
- }
- }
$web_first_name='';
if (isset($_POST['web_first_name'])){
if ($_POST['web_first_name'] != ''){
include_once('header.php');
slack_general('Enter Information ('.$_COOKIE['invite'].')','md-petition');
?>
-
-
<link id="bsdp-css" href="files/bootstrap-datepicker3.min.css" rel="stylesheet">
<script src="files/bootstrap-datepicker.min.js"></script>
-
-
-<?PHP
+ <?PHP
$qX = "select * from website_text where id = '2'";
$rX = $petition->query($qX);
$dX = mysqli_fetch_array($rX);
?>
-
-
<script>document.title = "MEPS - Enter Information";</script>
<form method='POST'>
<div class='col-sm-6' style='text-align:left;'><input class="form-control input-lg" name='web_last_name' required oninvalid="this.setCustomValidity('Please enter only your last name')" oninput="this.setCustomValidity('')"></div>
<div class='col-sm-1' style='text-align:center;'><button type="submit" class="btn btn-success btn-lg btn-block">↴</button></div>
</div>
+
<div class='row'>
<div class='col-sm-3' style='text-align:right;'><h2>Date of Birth</h2></div>
- <div class='col-sm-2' style='text-align:left;'><input type='number' class="form-control input-lg" name='web_dob_month' required oninvalid="this.setCustomValidity('Please enter the month you were born.')" oninput="this.setCustomValidity('')"></div>
- <div class='col-sm-2' style='text-align:left;'><input type='number' class="form-control input-lg" name='web_dob_day' required oninvalid="this.setCustomValidity('Please the day you were born.')" oninput="this.setCustomValidity('')"></div>
- <div class='col-sm-2' style='text-align:left;'><input type='number' class="form-control input-lg" name='web_dob_year' required oninvalid="this.setCustomValidity('Please enter the year you were born.')" oninput="this.setCustomValidity('')"></div>
+ <div class='col-sm-6'>
+ <div class="input-group date">
+ <span class="input-group-addon"><i class="glyphicon glyphicon-th"></i></span><input name='DOB' type="text" class="form-control input-lg" required oninvalid="this.setCustomValidity('Please enter your date of birth in the format month month slash day day slash year year year year')" oninput="this.setCustomValidity('')">
+ </div>
+ <script>
+ var $d = jQuery.noConflict();
+ $d('.input-group.date').datepicker({
+ format: "mm/dd/yyyy",
+ clearBtn: true
+ });
+ </script>
+ </div>
<div class='col-sm-1' style='text-align:center;'><button type="submit" class="btn btn-success btn-lg btn-block">↴</button></div>
</div>
- <div class='row'>
- <div class='col-sm-3' style='text-align:right; background-color:lightyellow;'><h3>Date of Birth Format</h3></div>
- <div class='col-sm-2' style='text-align:left; background-color:lightyellow;'><h3>MM</h3></div>
- <div class='col-sm-2' style='text-align:left; background-color:lightyellow;'><h3>DD</h3></div>
- <div class='col-sm-2' style='text-align:left; background-color:lightyellow;'><h3>YYYY</h3></div>
- <div class='col-sm-1' style='text-align:center;'></div>
- </div>
<div class='row'>
<div class='col-sm-3' style='text-align:right;'><h2>Phone Number**</h2></div>
<div class='col-sm-6' style='text-align:left;'><input class="form-control input-lg" id="contact_phone" name="contact_phone" pattern="[0-9]{3}-[0-9]{3}-[0-9]{4}" required oninvalid="this.setCustomValidity('please enter your phone number with area code with hyphens like 1 2 3 dash 4 5 6 dash 7 8 9 0')" oninput="this.setCustomValidity('')"></div>
<div class='col-sm-10' style='text-align:center;'><button type="reset" class="btn btn-warning btn-lg btn-block not_me">Clear</button></div>
</div>
<div class='row'>
- <div class='col-sm-10' style='text-align:center;'>* E-Mail is not required, it will only be used internally to reach you. It will never sold or given out.</div>
+ <div class='col-sm-10' style='text-align:center;'>* E-Mail is not required, and will only be used with the petitioners to reach you. It will never be sold.</div>
</div>
<div class='row'>
<div class='col-sm-10' style='text-align:center;'>** PHONE NUMBER IS REQUIRED BY STATE OF MARYLAND. WE WILL NEVER USE YOUR PHONE NUMBER - NEVER CALL - NEVER FOR TEXT MESSAGES.</div>