
<?php 
 
   $this->load->view('common_front/header');

?>
  

    <div class="page_banner">
        <div class="container">
            <div class="row">
                <div class="col-sm-12">
                    <h4>Fill your Detail</h4>
                    <p><a href="<?= base_url() ?>">Home</a> | Fill your Detail</p>
                </div>
            </div>
        </div>
    </div>
    
    <div class="section">
        <div class="container">
            <div class="row">
                <div class="col-sm-8">
                    <div class="fill_deatil_box">
                        <div class="fill_deatil_box_heading">
                            <span>Fill your detail</span>
                        </div>
                        <div class="fill_deatil_box_body">
                                <div class="query-form-box">
                                        <form action="<?= base_url('front/contact')?>" method="post">
                                            <input type="hidden" name="package" value="<?= $this->db->where('id',$id)->get('programe')->row_array()['title']?>">
                                        <div class="row">
                                        <div class="col-md-12"><input type="text" name="name" class="form-control" placeholder="Name" required=""></div>
                                        <div class="col-md-12"><input type="email" name="email" class="form-control" placeholder="Email ID" required=""></div>
                    
                                        <div class="col-md-6"><input type="text" name="phone" maxlength="10" class="form-control" placeholder="Mobile No." required=""></div>
                    
                        <div class="col-md-6"><input type="date" name="date" maxlength="10" value="<?= $date?>" class="form-control" placeholder="Mobile No." required=""></div>
                                        <div class="col-md-12"><input type="text" name="Address" class="form-control" placeholder="Address" required=""></div>
                                        <div class="col-md-6"><input type="text" name="City" class="form-control" placeholder="City" required=""></div>
                                        <div class="col-md-6"><input type="text" name="PinCode" class="form-control" placeholder="PinCode" required=""></div>


                    
                                        <div class="col-md-12">
                                        <a href="<?= base_url('front/check_out') ?>checkout.php" class="button_b" style="border: none;">Proceed</a>
                                        </div>
                    
                                        </div>
                                        </form>
                                        </div>
                        </div>
                    </div>
                </div>
            </div>
        </div>
    </div>

 





<?php 
 
   $this->load->view('common_front/footer');

?>