| <!DOCTYPE html> |
| <html lang="en"> |
| <head> |
| <meta charset="UTF-8" /> |
| <meta name="viewport" content="width=device-width, initial-scale=1" /> |
| <title>Register - Shelleng Team for Change (STC)</title> |
| <link rel="stylesheet" href="style.css" /> |
| <script src="script.js" defer></script> |
| </head> |
| <body> |
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| |
| <nav class="navbar"> |
| <div class="nav-left"> |
| <div class="nav-logo">STC</div> |
| <div class="nav-toggle" onclick="toggleMenu()">☰</div> |
| </div> |
| <ul class="nav-links" id="navLinks"> |
| <li><a href="index.html">Home</a></li> |
| <li><a href="about.html">About</a></li> |
| <li><a href="register.html">Register</a></li> |
| <li><a href="contact.html">Contact</a></li> |
| </ul> |
| </nav> |
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| |
| <header class="hero"> |
| <div class="hero-overlay"> |
| <h1>Register with Shelleng Team for Change (STC)</h1> |
| <p>Empowering Youth Through Innovation and Unity</p> |
| </div> |
| </header> |
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| |
| <section class="form-section" style="padding: 40px 20px; max-width: 600px; margin: auto;"> |
| <h2 style="text-align: center; color: #004e56;">Application Form</h2> |
| <form id="registrationForm" action="process.php" method="POST" enctype="multipart/form-data" style="display: flex; flex-direction: column; gap: 15px;"> |
| <input type="text" name="fullname" placeholder="Full Name" required /> |
| <input type="email" name="email" placeholder="Email Address" required /> |
| <input type="tel" name="phone" placeholder="Phone Number" required /> |
| <input type="date" name="dob" placeholder="Date of Birth" required /> |
| |
| <select name="gender" required> |
| <option value="">Select Gender</option> |
| <option value="Male">Male</option> |
| <option value="Female">Female</option> |
| </select> |
|
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| <select name="religion" required> |
| <option value="">Select Religion</option> |
| <option value="Islam">Islam</option> |
| <option value="Christianity">Christianity</option> |
| <option value="Other">Other</option> |
| </select> |
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| <select name="academic" required> |
| <option value="">Select Academic Level</option> |
| <option value="SSCE">SSCE</option> |
| <option value="ND/NCE">ND/NCE</option> |
| <option value="HND/BSc">HND/BSc</option> |
| <option value="Others">Others</option> |
| </select> |
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| |
| <select id="state" name="state" required onchange="populateLGAs()"> |
| <option value="">Select State</option> |
| |
| </select> |
|
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| <select id="lga" name="lga" required> |
| <option value="">Select LGA</option> |
| </select> |
|
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| <input type="text" name="address" placeholder="Full Address" required /> |
| <select name="membership_type" required> |
| <option value="">Select Membership Type</option> |
| <option value="Member">Member</option> |
| <option value="EXCO">EXCO</option> |
| </select> |
| |
| <textarea name="note" placeholder="Why do you want to join STC?" rows="4" required></textarea> |
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| <label style="text-align: center;">Upload Passport Photo</label> |
| <input type="file" accept="image/*" id="passport" name="passport" required /> |
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| <button type="submit" class="btn" style="margin-top: 10px;">Submit Application</button> |
| </form> |
| </section> |
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| |
| <footer> |
| <p>Email: <a href="mailto:maaidasong@gmail.com">maaidasong@gmail.com</a> | Phone: 09077426767</p> |
| <p>© 2025 Shelleng Team for Change. All Rights Reserved.</p> |
| </footer> |
|
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| </body> |
| </html> |
