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  1. <!-- modal register club start -->
  2. <div class="modal fade" id="tambahData" tabindex="-1" role="dialog" aria-labelledby="registerModalLabel" aria-hidden="true">
  3. <div class="modal-dialog" role="document">
  4. <div class="modal-content">
  5. <div class="modal-header modal-danger">
  6. <h5 class="modal-title" id="FormulirTambahLabel">Register Club</h5>
  7. <button type="button" class="close" data-dismiss="modal" aria-label="Close">
  8. <span aria-hidden="true">&times;</span>
  9. </button>
  10. </div>
  11. <div class="modal-body">
  12. <?php echo form_open('#','id="FormulirTambah" enctype="multipart/form-data"');?>
  13. <div class="form-group tanggal_daftar">
  14. <label class="control-label">Tanggal Daftar<span class="required">*</span></label>
  15. <div class="">
  16. <input type="text" name="tanggal_daftar" id="tanggal_daftar_edit" class="form-control datepicker"/>
  17. </div>
  18. </div>
  19. <div class="form-group propinsi">
  20. <label class="control-label">Propinsi<span class="required">*</span></label>
  21. <div class="">
  22. <select class="form-control select2-input" name="propinsi" style="width:100%;" id="propinsi_edit" >
  23. <?php foreach ($propinsi as $kat): ?>
  24. <option value="<?php echo $kat->id;?>"><?php echo $kat->name;?></option>
  25. <?php endforeach; ?>
  26. </select>
  27. </div>
  28. </div>
  29. <div class="form-group kota_kab">
  30. <label class="control-label">Kota / Kab <span class="required">*</span></label>
  31. <div class="">
  32. <select class="form-control select2-input" name="kota_kab" style="width:100%;" id="kota_kab_edit">
  33. </select>
  34. </div>
  35. </div>
  36. <div class="form-group nama_ketua_club">
  37. <label class="control-label">Nama Ketua Club<span class="required">*</span></label>
  38. <div class="">
  39. <input type="text" name="nama_ketua_club" id="nama_ketua_club_edit" class="form-control"/>
  40. </div>
  41. </div>
  42. <div class="form-group nik">
  43. <label class="control-label">NIK Ketua Club<span class="required">*</span></label>
  44. <div class="">
  45. <input type="text" name="nik" id="nik_edit" class="form-control"/>
  46. </div>
  47. </div>
  48. <div class="form-group no_hp">
  49. <label class="control-label">No HP<span class="required">*</span></label>
  50. <div class="">
  51. <input type="text" name="no_hp" id="no_hp_edit" class="form-control"/>
  52. </div>
  53. </div>
  54. <div class="form-group foto">
  55. <label class="control-label">Foto Ketua Club </label>
  56. <div class="">
  57. <input type="file" name="foto" class="form-control"/>
  58. <br/>
  59. <span id="foto_edit"></span>
  60. </div>
  61. </div>
  62. <div class="form-group nama_club">
  63. <label class="control-label">Nama Club<span class="required">*</span></label>
  64. <div class="">
  65. <input type="text" name="nama_club" id="nama_club_edit" class="form-control"/>
  66. </div>
  67. </div>
  68. <div class="form-group gambar">
  69. <label class="control-label">Logo Club </label>
  70. <div class="">
  71. <input type="file" name="gambar" class="form-control"/>
  72. <br/>
  73. <span id="logo_club_edit"></span>
  74. </div>
  75. </div>
  76. <div class="form-group alamat">
  77. <label class="control-label">Alamat Club<span class="required">*</span></label>
  78. <div class="">
  79. <input type="text" name="alamat" id="alamat_edit" class="form-control"/>
  80. </div>
  81. </div>
  82. <div class="form-group no_telp">
  83. <label class="control-label">No. Telp<span class="required">*</span></label>
  84. <div class="">
  85. <input type="text" name="no_telp" id="no_telp_edit" class="form-control"/>
  86. </div>
  87. </div>
  88. <div class="form-group email">
  89. <label class="control-label">Email<span class="required">*</span></label>
  90. <div class="">
  91. <input type="text" name="email" id="email_edit" class="form-control"/>
  92. </div>
  93. </div>
  94. <div class="form-group password">
  95. <label class="control-label">Password<span class="required">*</span></label>
  96. <div class="">
  97. <input type="password" name="password" class="form-control"/>
  98. </div>
  99. </div>
  100. <div class="form-group password2">
  101. <label class="control-label">Konfirmasi Password<span class="required">*</span></label>
  102. <div class="">
  103. <input type="password" name="password2" class="form-control"/>
  104. </div>
  105. </div>
  106. <div class="form-group status">
  107. <label class="control-label">Status <span class="required">*</span></label>
  108. <div class="">
  109. <select class="form-control select2-input" style="width:100%" name="status" id="status_edit">
  110. <option value="baru">baru</option>
  111. <option value="aktif">aktif</option>
  112. <option value="tidak aktif">tidak aktif</option>
  113. </select>
  114. </div>
  115. </div>
  116. </div>
  117. <div class="modal-footer">
  118. <button class="btn btn-primary modal-confirm" type="submit" id="submitform">Submit</button>
  119. <button class="btn btn-default" data-dismiss="modal">Tutup</button>
  120. </div>
  121. </div>
  122. </div>
  123. </div>
  124. <!-- end modal register club -->
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