/* Decoded by unphp.net */


include("./includes/connection.php");
include("./includes/header.php");
if (!isset($_SESSION['userinfo'])) {
@session_destroy();
header("Location: ../index.php?InvalidPrivilege=yes");
}
if (isset($_SESSION['userinfo'])) {
if (isset($_SESSION['userinfo']['Setup_And_Configuration'])) {
if ($_SESSION['userinfo']['Setup_And_Configuration'] != 'yes') {
header("Location: ./index.php?InvalidPrivilege=yes");
}
}else {
header("Location: ./index.php?InvalidPrivilege=yes");
}
}else {
@session_destroy();
header("Location: ../index.php?InvalidPrivilege=yes");
}
;echo '
<script type="text/javascript" language="javascript">
    function getDistricts(Region_Name) {
        if (window.XMLHttpRequest) {
            mm = new XMLHttpRequest();
        } else if (window.ActiveXObject) {
            mm = new ActiveXObject(\'Micrsoft.XMLHTTP\');
            mm.overrideMimeType(\'text/xml\');
        }

        mm.onreadystatechange = AJAXP; //specify name of function that will handle server response....
        mm.open(\'GET\', \'GetDistricts.php?Region_Name=\' + Region_Name, true);
        mm.send();
    }
    function AJAXP() {
        var data = mm.responseText;
        document.getElementById(\'District\').innerHTML = data;
    }

//    function to verify NHIF STATUS
    function nhifVerify() {
        //code
    }
</script>
<a href=\'sponsorpage.php?SponsorConfiguration=SponsorConfigurationThisPage\' class=\'art-button\'>BACK</a>
<br/><br/>

';
if (isset($_POST['submittedAddNewSponsorForm'])) {
$Customer_Name = mysqli_real_escape_string($conn,$_POST['Customer_Name']);
$region = mysqli_real_escape_string($conn,$_POST['region']);
$District = mysqli_real_escape_string($conn,$_POST['District']);
$Phone_Number = mysqli_real_escape_string($conn,$_POST['Phone_Number']);
$Email_Address = mysqli_real_escape_string($conn,$_POST['Email_Address']);
$sql = mysqli_query($conn,"insert into tbl_patient_registration(
                            Patient_Name,phone_number,Country,region,district
                            ,Email_Address,registration_type)
                            values('$Customer_Name','$Phone_Number','Tanzania','$region',
                                '$District','$Email_Address','customer')") or die(mysqli_error($conn));
if ($sql) {
echo "
            <script type='text/javascript'>
                alert('CUSTOMER REGISTERED SUCCESSIFULLY');
            </script>";
}else{
echo "
            <script type='text/javascript'>
                alert('REGISTRATIION FAILS');
            </script>";
}
}
;echo '
<br/><br/><br/><br/><br/><br/>

<center>
    <table width=60%><tr><td>
        <center>
            <fieldset>
                <legend align="center" ><b>ADD NEW CUSTOMER</b></legend>
                <table>
                    <form action=\'#\' method=\'post\' name=\'myForm\' id=\'myForm\' onsubmit="return validateForm();" enctype="multipart/form-data">

                        <tr>
                            <td width=40% style=\'text-align: right;\'><b>Customer Name</b></td>
                            <td width=60%><input type=\'text\' name=\'Customer_Name\' required=\'required\' size=70 id=\'Customer_Name\' placeholder=\'Enter Customer Name\' autocomplete=\'off\' required></td>
                        </tr>
                        <tr>
                            <td style=\'text-align: right;\'><b>Phone Number</b></td>
                            <td>
                                <input type=\'text\' name=\'Phone_Number\' id=\'Phone_Number\' autocomplete=\'off\' placeholder=\'Enter Phone Number\' required>
                            </td>
                        </tr>
                        <tr>
                            <td style=\'text-align: right;\'><b>Email Address</b></td>
                            <td>
                                <input type=\'email\' name=\'Email_Address\' id=\'Email_Address\' autocomplete=\'off\' placeholder=\'Enter Email Address\'>
                            </td>
                        </tr>
                        <!--tr>
                            <td width=40% style=\'text-align: right;\'><b>Postal Address</b></td>
                            <td width=60%><textarea name=\'Postal_Address\' id=\'Postal_Address\' cols=20 rows=1 placeholder=\'Enter Postal Address\' autocomplete=\'off\'></textarea></td>
                        </tr-->
                        <tr>
                            <td style=\'text-align: right;\'><b>Region</b></td>
                            <td>
                                <select name=\'region\' id=\'region\' onchange=\'getDistricts(this.value)\'>
                                    <option selected=\'selected\' value=\'Dar es salaam\'>Dar es salaam</option>
                                    ';
$data = mysqli_query($conn,"select * from tbl_regions");
while ($row = mysqli_fetch_array($data)) {
;echo '                                        <option value=\'';echo $row['Region_Name'];;echo '\'>
                                            ';echo $row['Region_Name'];;echo '                                        </option>
                                        ';
}
;echo '                                </select>
                            </td>
                        </tr>
                        <tr>
                            <td style=\'text-align: right;\'>
                                <b>District</b>
                            </td>
                            <td>
                                <select name=\'District\' id=\'District\'>
                                    <option selected=\'selected\'>Kinondoni</option>
                                    <option>Ilala</option>
                                    <option>Temeke</option>  
                                </select>
                            </td>
                        </tr>
                        <tr>
                            <td colspan=2 style=\'text-align: right;\'>
                                <input type=\'submit\' name=\'submit\' id=\'submit\' value=\'   SAVE   \' class=\'art-button\'>
                                <input type=\'reset\' name=\'clear\' id=\'clear\' value=\' CLEAR \' class=\'art-button\'>
                                <input type=\'hidden\' name=\'submittedAddNewSponsorForm\' value=\'true\'/> 
                            </td>
                        </tr>
                    </form></table>
            </fieldset>
        </center></td></tr></table>
</center>
<br/><br/><br/><br/><br/><br/>
';
include("./includes/footer.php");