Utkarsha Bangla Registration

* Marked fields are mandatory

{!! Form::open(['url' => '', 'method' => 'post' ,'name' => 'application_registration', 'id'=>'application_registration']) !!}

{!! Form::label('organization_name', 'Organization Name:', ['class' =>'required']) !!}

{!! Form::text('organization_name', null, ['id'=>'organization_name','class'=>'form-control','placeholder'=>'Enter Name','autocomplete'=>'off']) !!}

{!! Form::label('organization_contact_pr_name', 'Organization Name (Officer`s Contact Person):', ['class' =>'required']) !!}

{!! Form::text('organization_contact_pr_name', null, ['id'=>'organization_contact_pr_name','class'=>'form-control','placeholder'=>'Enter Organization Name','autocomplete'=>'off']) !!}

{!! Form::label('district', 'District:', ['class'=>'required']) !!}

{!! Form::text('district', null, ['id'=>'district','class'=>'form-control','placeholder'=>'Enter District','autocomplete'=>'off']) !!}

{!! Form::label('subdivision', 'Subdivision:', ['class'=>'required']) !!}

{!! Form::text('subdivision', null, ['id'=>'subdivision','class'=>'form-control','placeholder'=>'Enter Subdivision','autocomplete'=>'off']) !!}

{!! Form::label('block', 'Block:', ['class'=>'required']) !!}

{!! Form::text('block', null, ['id'=>'block','class'=>'form-control','placeholder'=>'Enter Block','autocomplete'=>'off']) !!}

{!! Form::label('ps', 'PS:', ['class'=>'required']) !!}

{!! Form::text('ps', null, ['id'=>'ps','class'=>'form-control','placeholder'=>'Enter Police Station','autocomplete'=>'off']) !!}

{!! Form::label('mobile_no','Mobile No:',['class'=>'required']) !!}

{!! Form::text('mobile_no',null,['class'=>'form-control','id'=>'mobile_no','placeholder'=>'Enter Mobile No','maxlength'=>'10','pattern'=>'[0-9]']) !!}

{!! Form::label('email_address','Email Address:',['class'=>'']) !!}

{!! Form::email('email_address',null,['class'=>'form-control','id'=>'email_address','placeholder'=>'Enter Email Address', 'autocomplete'=>'off']) !!}

{!! Form::label('password','Password:',['class'=>'required']) !!}

{!! Form::password('password',['class'=>'form-control','id'=>'password','placeholder'=>'Enter Password','maxlength'=>'10']) !!}

{!! Form::label('confirm_password','Confirm Password:',['class'=>'required']) !!}

{!! Form::password('confirm_password',['class'=>'form-control','id'=>'confirm_password','placeholder'=>'Enter Confirm Password','maxlength'=>'10']) !!}

{!! Form::submit('Save',['class' => 'btn btn-primary','id' => 'save_update']) !!}

{!! Form::close() !!}