@extends('frontend.layouts.landing')

@section('title', 'Enter to Win - ' . app_name())

@push('head-area')
    <meta property="og:title" content="Grand Giveaway - Veterinary Deciduous Canine Extraction Set">
    <meta property="og:image" content="https://www.gervetusa.com/up_data/editor/monthly-deciduous.jpg">
@endpush

@section('content')

    <div class="enter-to-win-bg">
        {{--<div class="text-center pl-3">
            <a href="/pages/equine-special-products?utm=ESP" target="_blank"><img src="vsi/image/aaep_show_special_enter_to_win.jpg" alt="AAEP Show Special"></a>
        </div>--}}
        <div class="enter-to-win-container">
            <div class="row">
                <div class="col-md-7 p-4">
                    <div class="text-center"><a href="https://www.gervetusa.com"><img src="vsi/image/gvu_logo.png" alt="{{ app_name() }}" width="300"></a></div>
                    <div class="enter-to-win-text-bg p-3 mt--10">
                        <div style="color:#367BBF; font-size: 18px; padding-bottom: 10px;" class="text-center">Sign up! To get free access to webinars hosted by Dr.Jan Bellows DAVDC, DABVP</div>
                        <div style="font-size: 18px; padding-bottom: 10px;">Doctor Bellows has earned various distinctions throughout his career, including the Gold Star Award from the Florida Veterinary Medical Association and the Peter Emily Service Award. He has also authored five veterinary dentistry textbooks and facilitated the creation of all three versions of the American Animal Hospital Dental Guidelines.</div>
                        
                        <div style="padding:56.25% 0 0 0;position:relative;"><iframe src="https://player.vimeo.com/video/712883292?h=8766d8215f&amp;badge=0&amp;autopause=0&amp;player_id=0&amp;app_id=58479" frameborder="0" allow="autoplay; fullscreen; picture-in-picture" allowfullscreen style="position:absolute;top:0;left:0;width:100%;height:100%;" title="Welcome Dr. Jan Bellows to GerVetUSA"></iframe></div><script src="https://player.vimeo.com/api/player.js"></script>

                        <div style="font-size: 18px; padding-top: 10px;">He brings a wealth of knowledge and experience that will benefit veterinarians and their patients. He practiced for over twenty years in Pembroke Pines before establishing Hometown Animal Hospital and Dental Clinic in February 2000 in Weston, Florida. </div>

                    </div>
                </div>
                <div class="col-md-5" style="background-color: #cccccc;">
                    <div style="padding: 5px; background-color: #0c7abf; color: #FFFFFF; margin: 0px -15px; font-weight: 500; font-size: 20px;" class="text-center mb--10">REGISTER FOR WEBINARS</div>
                    @include('includes.partials.messages')
                    {!! Form::open(array('method' => 'POST', 'id' => 'frm_enter_to_win')) !!}

                    <div class="row pl--5 pr--5">

                        <div class="col-md-12 col-12 mb--10">
                            {!! Form::label('email', 'Email Address:') !!}  <span class="text-red">*</span>
                            {!! Form::text('email', null, ['type' => 'email', 'required' => 'required', 'class' => 'form-control', 'placeholder' => 'Enter email address ...', 'id' => 'sp_email']) !!}
                        </div>

                        <div class="col-md-12 col-12 mb--10">
                            {!! Form::label('first_name', 'First Name:') !!}  <span class="text-red">*</span>
                            {!! Form::text('first_name', null,['class'=>'form-control', 'required' => 'required', 'placeholder'=>'Enter first name ...']) !!}
                        </div>

                        <div class="col-md-12 col-12 mb--10">
                            {!! Form::label('last_name', 'Last Name:') !!} <span class="text-red">*</span>
                            {!! Form::text('last_name', null,['class'=>'form-control', 'required' => 'required', 'placeholder'=>'Enter last name ...']) !!}
                        </div>

                        <div class="col-md-12 col-12 mb--10">
                            {!! Form::label('company', 'Company/Institute:') !!} <span class="text-red">*</span>
                            {!! Form::text('company', null,['class'=>'form-control', 'required' => 'required', 'placeholder'=>'Enter company/institute name ...']) !!}
                        </div>

                        <div class="col-md-12 col-12 mb--10">
                            {!! Form::label('phone', 'Phone:') !!} <span class="text-red">*</span>
                            {!! Form::text('phone', null,['class'=>'form-control', 'required' => 'required', 'placeholder'=>'Enter phone ...']) !!}
                        </div>

                        <div class="col-md-12 col-12 mb--10">
                            {!! Form::label('address', 'Address:') !!} <span class="text-red">*</span>
                            {!! Form::text('address', null,['class'=>'form-control', 'required' => 'required', 'placeholder'=>'Enter address ...']) !!}
                        </div>

                        <div class="col-md-12 col-12 mb--10">
                            {!! Form::label('city', 'City:') !!} <span class="text-red">*</span>
                            {!! Form::text('city', null,['class'=>'form-control', 'required' => 'required', 'placeholder'=>'Enter city ...']) !!}
                        </div>

                        <div class="col-md-12 col-12 mb--10">
                            {!! Form::label('state', 'State:') !!} <span class="text-red">*</span>
                            {!! Form::select('state',
                            $data['states']
                            ,null
                            ,['class'=>'form-control', 'required' => 'required', 'placeholder'=>'Please Select ...']) !!}
                        </div>

                        <div class="col-md-12 col-12 mb--10">
                            {!! Form::label('zip', 'Zip / Post Code:') !!} <span class="text-red">*</span>
                            {!! Form::text('zip', null,['class'=>'form-control',  'required' => 'required', 'placeholder'=>'Enter zip / post code ...']) !!}
                        </div>

                        <div class="col-md-12 col-12 mb--10">
                            {!! Form::label('role', 'Your Role:') !!} <span class="text-red">*</span>
                            {!! Form::select('role',
                            ['Veterinarian' => 'Veterinarian', 'Dentist' => 'Dentist', 'Technician' => 'Technician', 'Office Manager' => 'Office Manager', 'Clinic Owner' => 'Clinic Owner', 'Associated with Hospital' => 'Associated with Hospital', 'Other' => 'Other']
                            ,null
                            ,['class'=>'form-control', 'required' => 'required', 'placeholder'=>'Please Select ...']) !!}
                        </div>

                        <div class="col-md-12 col-12 mb--10">
                            {!! Form::label('role', 'Your Speciality:') !!} <span class="text-red">*</span>
                            {!! Form::select('speciality',
                            ['Dental' => 'Dental', 'Orthopedic' => 'Orthopedic', 'Soft Tissue' => 'Soft Tissue', 'Spay Neuter' => 'Spay Neuter']
                            ,null
                            ,['id' => 'newsletter-speciality', 'class'=>'form-control', 'required' => 'required', 'placeholder' => 'Your speciality ...']) !!}
                        </div>

                        <div class="col-md-12 col-12 mb--10">
                            {!! Form::label('comments', 'Additional Comments:') !!}
                            {!! Form::textarea('comments', null,['class'=>'form-control', 'placeholder'=>'Additional Comments ...', 'rows' => '3']) !!}
                        </div>

                        <div class="col-md-12 col-12 mb--10">
                            <div class="recaptcha">
                                <div class="g-recaptcha" data-sitekey="6LfcLOIUAAAAALCab8T2PSUyLVSqwa0sPfpSqLHM"></div>
                            </div>
                        </div>

                        <div class="col-md-12 col-12 mb--10">
                            <button type="submit" class="btn-blue">Submit</button>
                        </div>

                        <div style="color:#b40000; padding: 0px 15px 0px 15px;">
                            Please fill complete details in order to make yourself eligible for free webinars.
                        </div>

                    </div>

                    {!! Form::close() !!}
                </div>
            </div>
        </div>
    </div>

    @push('after-scripts')
        <script src="https://www.google.com/recaptcha/api.js" async defer></script>
        <script>
            document.getElementById("frm_landing").addEventListener("submit",function(evt)
            {

                var response = grecaptcha.getResponse();
                if(response.length == 0)
                {
                    //reCaptcha not verified
                    alert("Please verify you are human!");
                    evt.preventDefault();
                    return false;
                }
            });
        </script>
    @endpush
@endsection