<?php
use yii\helpers\Html;
use yii\bootstrap\ActiveForm;

/* @var $this yii\web\View */
/* @var $form yii\bootstrap\ActiveForm */
/* @var $model common\models\SignupForm */

$this->title = 'Sign up';
// $this->params ['breadcrumbs'] [] = $this->title;
?>
<div class="site-signup">


  <div class="jumbotron"><h2>Sign up</h2></div>
<!--   <p>Please fill out the following fields to signup:</p> -->
<div class="browser">
  <div class="row">
    <div class="col-lg-5">
            <?php $form = ActiveForm::begin(['id' => 'form-signup']); ?>
            	<p style="font-size:large" ><b>Select a username and password</b> </p>
                <?= $form->field($model, 'username')?>
                <?= $form->field($model, 'password')->passwordInput()?>
                <?= $form->field($model, 'passwordSecond')->passwordInput()?>
                
                <p style="font-size:large" ><b>Contact information</b> </p>
                <?= $form->field($model, 'form_of_address')->dropDownList( ['Mr'=>'Mr', 'Mrs'=>'Mrs'], ['prompt'=>'-----'])?>
                <?= $form->field($model, 'title')?>
                <?= $form->field($model, 'name')?>
                <?= $form->field($model, 'firstName')?>
                <?= $form->field($model, 'email')?>
                <?= $form->field($model, 'emailSecond')?>
                
                <p style="font-size:large" ><b>Billing address</b> </p>
                <?= $form->field($model, 'institution')?>
                <?= $form->field($model, 'division')?>
                <?= $form->field($model, 'streetPOBox')?>
                <?= $form->field($model, 'postalCode')?>
                <?= $form->field($model, 'locationCity')?>
                <?= $form->field($model, 'stateProvince')?>
                <?= $form->field($model, 'country')->dropDownList($countryList, ['prompt'=>'-----'])?>
                <p style="font-size:large" ><b>Delivery address</b> </p>
                <?= $form->field($model, 'deliveryInstitution')?>
                <?= $form->field($model, 'deliveryDivision')?>
                <?= $form->field($model, 'deliveryStreet')?>
                <?= $form->field($model, 'deliveryPostalCode')?>
                <?= $form->field($model, 'deliveryLocation')?>
                 <?= $form->field($model, 'deliveryState')?>
                <?= $form->field($model, 'deliveryCountry')->dropDownList($countryList, ['prompt'=>'-----'])?>
                <p style="font-size:large" ><b>CITES code of your institution</b> </p>
                <?= $form->field($model, 'citesCode')?>
                
   				<?= $form->field($model, 'verifyCode')->widget(common\models\CaptchaRefreshable::className()) ?>
				<p>* mandatory field</p>

                <div class="form-group">
                    <?= Html::submitButton('Signup', ['class' => 'btn btn-primary', 'name' => 'signup-button'])?>
                </div>
            <?php ActiveForm::end(); ?>
        </div>
  </div>
</div>
 </div>