Client Registration Form

0)
{

$errorMMM=”Username Already Exist! Please Try Another Username.”;
}

$selectAll = “SELECT * FROM tbl_client WHERE email='”.$email.”‘”;
$mysqlQAll = mysql_query($selectAll);
$mysqlRAll = mysql_num_rows($mysqlQAll);
if($mysqlRAll > 0)
{

$errorMMM=”Email Already Exist! Please Try Another Email Adddress.”;

}

if(trim($error) == “” && $errorMMM==””)
{
$Insert_Pages = “INSERT INTO tbl_client SET
username = ‘”.$username.”‘,
password = ‘”.$userpass.”‘,
affiliate_id = ‘”.$affiliate_name.”‘,
first_name = ‘”.$first_name.”‘,
last_name = ‘”.$last_name.”‘,
gender = ‘”.$gender.”‘,
mobile = ‘”.$mobile.”‘,
email = ‘”.$email.”‘,
address = ‘”.$address.”‘,
country = ‘”.$country.”‘,
state = ‘”.$state.”‘,
city = ‘”.$city.”‘,
zip = ‘”.$zip.”‘,
desc1 = ‘”.$desc1.”‘,
terms = ‘”.$terms.”‘,
user_image = ‘”.$user_image.”‘,
reg_date = NOW(),
employer_type = ‘gen’,
status = ‘”.$status.”‘,
conditions = ‘”.$psy.”‘,
medication = ‘”.$med.”‘,
danger = ‘”.$threathening.”‘”;

if($_FILES[“user_image”][“name”] != “”)
{
move_uploaded_file($tmp_name, “$uploads_dir/$user_image”);
}

$result_insert = mysql_query($Insert_Pages) or die(mysql_error());
include(“mail.php”);
Mail::sendMail($email,$username,$userpass,$first_name,’gen’);
//header(“location:thanks.php”);
header(“location:page.php?name=registration-auto-response”);
exit;
}
}

include(“includes/header_cms.php”);
include(“includes/js.php”);
?>

Client Registration Form

* Fields are mandatory

* Affiliate Name -->



* Username
* Password
* Confirm Password
* First Name
* Last Name
* Gender Male Female
* Mobile
* Email

* Street Address
  State
* City
* Postcode
  Sort Description
  Have you been diagnosed with any severe mental health conditions or personality disorders?&nbsp:
  Are you currently taking prescribed medication?&nbsp:
  You currently in extreme life-threathening danger?&nbsp:
* Terms I agree to all the
Validation code:


Can’t read the image? click here to refresh