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applyPage.php
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applyPage.php
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<!DOCTYPE html>
<html lang="en" dir="ltr">
<head>
<meta charset="utf-8">
<title>TELEARC | Apply</title>
<link rel="stylesheet" href="css/applyPageOption2.css">
<!-- <link rel="stylesheet" href="css/applyPage.css"> -->
</head>
<body style="background-image:url('pics/mainBackground.png')">
<!-- Page heading -->
<h1 id="Page-heading">TELEARC</h1>
<!-- The Form -->
<form class="Apply-form">
<div class="form-element">
<p class="Form-Divition">Personal Information</p>
<br>
<!-- Application Name -->
<div class="NameInput TextInput">
<label for="Name">Full Name</label>
<input type="text" id="Name" class="InputData" name="fullname" placeholder="Your name.." required>
</div>
<!-- Application Email -->
<div class="EmailInput TextInput">
<label for="Email">Email</label>
<input type="email" id="Email" class="InputData" name="Email" placeholder="Your email.." required>
</div>
<!-- Application Number -->
<div class="NumberInput TextInput">
<label for="Number">Number</label>
<input type="text" class="InputData" id="Number" name="Number" placeholder="Your number.." required>
</div>
<!-- Application State -->
<div class="StateInput TextInput">
<label for="State">State</label>
<select id="State" class="InputData" name="State" required>
<option value="" disabled selected hidden>Select One...</option>
<option value="Andhra Pradesh">Andhra Pradesh</option>
<option value="Arunachal Pradesh">Arunachal Pradesh</option>
<option value="Assam">Assam</option>
<option value="Bihar">Bihar</option>
<option value="Chhattisgarh">Chhattisgarh</option>
<option value="Goa">Goa</option>
<option value="Gujarat">Gujarat</option>
<option value="Haryana">Haryana</option>
<option value="Karnataka">Karnataka</option>
<option value="Kerala">Kerala</option>
<option value="Madhya Pradesh">Madhya Pradesh</option>
<option value="Maharashtra">Maharashtra</option>
<option value="Manipur">Manipur</option>
<option value="Meghalaya">Meghalaya</option>
<option value="Mizoram">Mizoram</option>
<option value="Nagaland">Nagaland</option>
<option value="National Capital (Delhi)">National Capital (Delhi)</option>
<option value="Odisa">Odisa</option>
<option value="Punjab">Punjab</option>
<option value="Rajasthan">Rajasthan</option>
<option value="Sikkim">Sikkim</option>
<option value="Tamil Nadu">Tamil Nadu</option>
<option value="Telangana">Telangana</option>
<option value="Tripura">Tripura</option>
<option value="Uttar Pradesh">Uttar Pradesh</option>
<option value="Uttarakhand">Uttarakhand</option>
<option value="West Bengal">West Bengal</option>
</select>
</div>
<!-- Application Signature -->
<br>
<fieldset class="SignatureInput TextInput FileInput">
<legend>Your Signature</legend>
<label for="Signature"></label>
<input type="file" class="InputData InputFile" id="Signature" name="Signature" required>
</fieldset>
</div>
<div class="form-element">
<p class="Form-Divition">Official Information</p>
<br>
<!-- Application MBBS Degree -->
<fieldset class="MBBSInput TextInput FileInput">
<legend>MBBS or Equivalent Degree</legend>
<label for="MBBS"></label>
<input type="file" class="InputData InputFile" id="MBBS" name="MBBS" required>
</fieldset>
<br><br>
<!-- Application MD Degree -->
<fieldset class="MDInput TextInput FileInput">
<legend>MD in Radiology or Equivalent Degree</legend>
<label for="MD"></label>
<input type="file" class="InputData InputFile" id="MD" name="MD" required>
</fieldset>
<br><br>
<!-- Application License -->
<fieldset class="LicenseInput TextInput FileInput">
<legend>License to Practice</legend>
<label for="License"></label>
<input type="file" class="InputData InputFile" id="License" name="License" required>
</fieldset>
<br><br>
<!-- Application Diplomas -->
<fieldset class="DiplomasInput TextInput FileInput">
<legend>Additional Diplomas</legend>
<label for="Diplomas"></label>
<input type="file" class="InputData InputFile" id="Diplomas" name="Diplomas" multiple>
</fieldset>
<br><br>
<!-- Application Specialisation -->
<fieldset class="SpecialisationInput TextInput FileInput">
<legend>Sub Specialisation Degree</legend>
<label for="Specialisation"></label>
<input type="file" class="InputData InputFile" id="Specialisation" name="Specialisation" multiple>
</fieldset>
<br><br>
<!-- Application Fellowship -->
<fieldset class="FellowshipInput TextInput FileInput">
<legend>Fellowship Degree</legend>
<label for="Fellowship"></label>
<input type="file" class="InputData InputFile" id="Fellowship" name="Fellowship" multiple>
</fieldset>
<br><br>
<!-- Application Fellowship -->
<fieldset class="LORInput TextInput FileInput">
<legend>Letters of Recomendation</legend>
<label for="LOR"></label>
<input type="file" class="InputData InputFile" id="LOR" name="LOR" multiple>
</fieldset>
<br>
</div>
<div class="form-element">
<!-- Buttons to transfer you to other pages -->
<div class="Transfer-Buttons">
<a href="#"><button type="button" name="button" id="Submit-button">Submit</button></a>
</div>
</div>
</form>
<br><br><br><br>
</body>
</html>