Untitled

<!DOCTYPE html>
<html lang="en">
  <head>
    <meta charset="utf-8">
    <meta name="viewport" content="width=device-width, initial-scale=1.0">
    <title>Registration</title>

	<link rel="stylesheet" href="http://maxcdn.bootstrapcdn.com/bootstrap/3.3.5/css/bootstrap.min.css">
	<script src="https://ajax.googleapis.com/ajax/libs/jquery/1.11.3/jquery.min.js"></script>
	<script src="http://maxcdn.bootstrapcdn.com/bootstrap/3.3.5/js/bootstrap.min.js"></script>
	<link href="style.css" rel="stylesheet">

	</head>
	<body>
	<div class="container-fluid">

<nav class="navbar navbar-inverse">
  <div class="container">
    <div class="navbar-header">
      <a class="navbar-brand" >MedTech</a>
    </div>
    <ul class="nav navbar-nav">
      <li class="active"><a href="index.html">Home</a></li>
      <li><a href="register.html">Register</a></li>
      <li><a href="about.html">About</a></li>
      <li><a href="contact.html">Contact Us</a></li>
    </ul>
  </div>
</nav>
	<div class="container">
	<form class="form-horizontal" action='register.php' method="POST">
  <fieldset>
    <div id="legend">
      <legend class=""><font color="white">Register</font></legend>
    </div>

<?php
if(isset($_POST['first_name'])) {
	$servername = "localhost";
	$dbusername = "root";
	$dbpassword = "";
	$dbname = "danie129_project";

	$first_name = $_POST ['first_name'];
	$last_name = $_POST ['last_name'];
	$email = $_POST ['email'];
	$optin = $_POST ['optin'];
	$captcha = $_POST['captcha'];

	$conn = new mysqli($servername, $dbusername, $dbpassword, $dbname);

	if ($conn->connect_error){
	    die("Connection Error: " . $conn->connect_error);
	}

	if($captcha != 5) {
		echo "Captcha is incorrect.  Please try again";
		die();
	}
	if (empty($first_name)) {
    		echo "First name cannot be left blank";
    		die();
	}

	if (empty($last_name)) {
    		echo "Last name cannot be left blank";
    		die();
	}

	if (empty($email)) {
    		echo "Email cannot be left blank";
    		die();
	}


	$data = "INSERT INTO registration (first_name, last_name, email, optin) VALUES ('$first_name', '$last_name', '$email', '$optin')";

	if ($conn->query($data) === TRUE) {
    		echo header("thanks.html");
	} else {
    		echo "Connection Error: " . $data . "<br>" . $conn->error;
	}

	$conn->close();

?>


    <div class="control-group">

      <label class="control-label"  for="first_name"><font color="white">First Name</font></label>
      <div class="controls">
        <input type="text" id="first_name" name="first_name" placeholder="" class="input-xlarge">
        <p class="help-block">Username can contain any letters or numbers, without spaces</p>
      </div>
    </div>

    <div class="control-group">

      <label class="control-label" for="last_name"><font color="white">Last Name</font></label>
      <div class="controls">
        <input type="text" id="last_name" name="last_name" placeholder="" class="input-xlarge">
        <p class="help-block">Please provide your E-mail</p>
      </div>
    </div>

    <div class="control-group">

      <label class="control-label" for="email"><font color="white">E-mail</font></label>
      <div class="controls">
        <input type="text" id="email" name="email" placeholder="" class="input-xlarge">
        <p class="help-block">Password should be at least 4 characters</p>
      </div>
    </div>

    <div class="checkbox">
	<form action="connect.php" method="post">
	<label><input type="checkbox" name='optin' value="1" id='optin'><font color="white">Click here to recieve information regarding other MedTech products.</font></label>
</div>

<p><font color = "white">2 + 3 =</font></p>
<input type="text" name="captcha" />

</form>


    <div class="control-group">

      <div class="controls">
        <button class="btn btn-info">Register</button>
      </div>
    </div>
  </fieldset>
</form>
	</body>
</html>