

<?php include "includes/header.php";?>


 <section id="membership-application" class="app-form">
        <!-- START -->
        <form action="sendmail.php"  id="web-form" class="" method="POST" enctype="multipart/form-data">
            <div class="container">
                <div class="row">
                    <!-- Section 1 Start -->
                    <div class="col-md-10 col-md-offset-1">
                        <div class="panel panel-theme">
                            <div class="panel-heading cake_order">Initial Book Cover Design</div>
                            <div class="panel-body">
                                <div class="row">
                                    <div class="col-md-12">
                                        <div class="para">
                                            <p> Feel free to provide additional information if you think it will help.</p>

                                            
                                        </div>
                                    </div>
                                </div>
                                <div class="row">
                                    <div class="col-md-12">
                                        <label> Exact Wording <span> ( Book Title)</span></label>
                                        <input class="form-control" name="book[book_title]" type="text" placeholder="Book Title" value="" required="" onkeydown="return /^[A-Za-z\s]+$/.test(event.key)">

                                    </div>
                                </div>
                                
                                 <div class="row">
                                    <div class="col-md-12">
                                        <label>Slogan/Tagline if any <span>(optional)</span></label>
                                        <input class="form-control" name="book[slogan]" type="text" placeholder="Slogan" value="" required=""> 
                                    </div>
                                </div>
                                
                                <div class="row">
                                    <div class="col-md-12">
                                        <label>Author Name<span></span></label>
                                        <input class="form-control" name="book[fullname]" type="text" placeholder="Author Name" value="" required="" onkeydown="return /^[A-Za-z\s]+$/.test(event.key)">
                                    </div>
                                </div>
                                  <div class="row">
                                    <div class="col-md-12">
                                        <label>Email<span></span></label>
                                        <input class="form-control" name="book[email]" type="email" placeholder="Email" value="" required="">
                                    </div>
                                </div>
                                <div class="row">
                                    <div class="col-md-12">
                                        <label>Genre</label>
                                        <input class="form-control" name="book[genre]" type="text" placeholder="genre" value="" required="">
                                    </div>
                                </div>
                                <div class="row">
                                    <div class="col-md-12">
                                        <label>ISBN </label>
                                        <input class="form-control" name="book[isbn]" type="text" placeholder="ISBN" value="" required="">
                                    </div>
                                </div>

                                  <div class="row">
                                    <div class="col-md-12">  
                                        <label>Book Cover Size</label>                                     
                                           <input class="form-control" name="book[book_size]" type="text" placeholder="Book Size" value="" required="">
                                    </div>
                                </div>
                                
                               
                                <div class="row">
                                    <div class="col-md-12">
                                        <label>Back Cover Description</label>
                                        <textarea class="form-control" name="book[book_detail_description]" placeholder="Back Cover Description"></textarea>
                                    </div>
                                </div>
                                 <div class="row">
                                    <div class="col-md-12">
                                        <label>  Describe Your Book / Service / Organization / Genre</label>
                                        <textarea class="form-control" name="book[book_services_description]" placeholder="Book Description"></textarea>
                                    </div>
                                </div>

                                

                               
                            </div>
                        </div>
                    </div>
                    <!-- End of Section 1 -->
                    <!-- Section 2 Start -->
                    <div class="col-md-10 col-md-offset-1">
                        <div class="panel panel-theme">
                            <div class="panel-heading cake_order">  Book Cover Design Categories </div>
                            <div class="panel-body">
                                <div class="row">
                                    <div class="col-md-12">
                                        <div class="para">
                                            <p class="note">Please select ONE category</p>
                                        </div>
                                    </div>
                                </div>
                                    <div class="col-md-3">
                                        <div class="check_box">
                                            <div class="checkbox checkbox-primary">
                                                <input id="checkbox00" type="checkbox" name="book[book_cover_category]" value="Book_cover_1" class="chb">
                                                <label for="checkbox00"></label>
                                            </div>
                                            <!--<p><span> Just font</span>Just font without any symbolic intervention.</p>-->

                                            <div class="img_box">
                                                <img src="images/book/01.jpg" width="100%" alt="logo">
                                            </div>
                                        </div>
                                    </div>
                                    <div class="col-md-3">
                                        <div class="check_box">
                                            <div class="checkbox checkbox-primary">
                                                <input id="checkbox01" type="checkbox" name="book[book_cover_category]" value="Book_cover_2" class="chb">
                                                <label for="checkbox01"></label>
                                            </div>
                                            <!--<p><span> Handmade</span>A calligraphic, handwritten or script font.</p>-->

                                            <div class="img_box">
                                               <img src="images/book/02.jpg" width="100%" alt="logo">
                                            </div>
                                        </div>
                                    </div>
                                    <div class="col-md-3">
                                        <div class="check_box">
                                            <div class="checkbox checkbox-primary">
                                                <input id="checkbox02" type="checkbox" name="book[book_cover_category]" value="Book_cover_3" class="chb">
                                                <label for="checkbox02"></label>
                                            </div>
                                            <!--<p><span> Font meaning</span>A font with a tweak that symbolize company/ product/service</p>-->

                                            <div class="img_box">
                                             <img src="images/book/03.jpg" width="100%" alt="logo">
                                            </div>
                                        </div>
                                    </div>
                                    <div class="col-md-3">
                                        <div class="check_box">
                                            <div class="checkbox checkbox-primary">
                                                <input id="checkbox03" type="checkbox" name="book[book_cover_category]" value="Book_cover_4" checked class="chb">
                                                <label for="checkbox03"></label>
                                            </div>
                                            <!--<p><span> Initials</span>Monogram with Company name initials.</p>-->

                                            <div class="img_box">
                                             <img src="images/book/05.jpg" width="100%" alt="logo">
                                            </div>
                                        </div>
                                    </div>
                                    <div class="col-md-3">
                                        <div class="check_box">
                                            <div class="checkbox checkbox-primary">
                                                <input id="checkbox04" type="checkbox" name="book[book_cover_category]" value="Book_cover_5" class="chb">
                                                <label for="checkbox04"></label>
                                            </div>
                                         
                                            <div class="img_box">
                                               <img src="images/book/06.jpg" width="100%" alt="logo">
                                            </div>
                                        </div>
                                    </div>
                                    <div class="col-md-3">
                                        <div class="check_box">
                                            <div class="checkbox checkbox-primary">
                                                <input id="checkbox05" type="checkbox" name="book[book_cover_category]" value="Book_cover_6" class="chb">
                                                <label for="checkbox05"></label>
                                            </div>
                                            <!--<p><span> Font including in a shape</span>Company name inside / squares / ovals / rectangles or combined shapes.</p>-->

                                            <div class="img_box">
                                               <img src="images/book/07.jpg" width="100%" alt="logo">
                                            </div>
                                        </div>
                                    </div>
                                    <div class="col-md-3">
                                        <div class="check_box">
                                            <div class="checkbox checkbox-primary">
                                                <input id="checkbox06" type="checkbox" name="book[book_cover_category]" value="Book_cover_7" class="chb">
                                                <label for="checkbox06"></label>
                                            </div>
                                            <!--<p><span> Font including in a shape</span>Company name inside / squares / ovals / rectangles or combined shapes.</p>-->

                                            <div class="img_box">
                                               <img src="images/book/08.jpg" width="100%" alt="logo">
                                            </div>
                                        </div>
                                    </div>
                                     <div class="col-md-3">
                                        <div class="check_box">
                                            <div class="checkbox checkbox-primary">
                                                <input id="checkbox07" type="checkbox" name="book[book_cover_category]" value="Book_cover_8" class="chb">
                                                <label for="checkbox07"></label>
                                            </div>
                                            <!--<p><span> Font including in a shape</span>Company name inside / squares / ovals / rectangles or combined shapes.</p>-->

                                            <div class="img_box">
                                               <img src="images/book/09.jpg" width="100%" alt="logo">
                                            </div>
                                        </div>
                                    </div>
                                    <div class="col-md-3">
                                        <div class="check_box">
                                            <div class="checkbox checkbox-primary">
                                                <input id="checkbox08" type="checkbox" name="book[book_cover_category]" value="Book_cover_9" class="chb">
                                                <label for="checkbox08"></label>
                                            </div>
                                            <!--<p><span> Font including in a shape</span>Company name inside / squares / ovals / rectangles or combined shapes.</p>-->

                                            <div class="img_box">
                                               <img src="images/book/10.jpg" width="100%" alt="logo">
                                            </div>
                                        </div>
                                    </div>
                                    <div class="col-md-3">
                                        <div class="check_box">
                                            <div class="checkbox checkbox-primary">
                                                <input id="checkbox09" type="checkbox" name="book[book_cover_category]" value="Book_cover_10" class="chb">
                                                <label for="checkbox09"></label>
                                            </div>
                                            <!--<p><span> Font including in a shape</span>Company name inside / squares / ovals / rectangles or combined shapes.</p>-->

                                            <div class="img_box">
                                               <img src="images/book/14.jpg" width="100%" alt="logo">
                                            </div>
                                        </div>
                                    </div>
                                    <div class="col-md-3">
                                        <div class="check_box">
                                            <div class="checkbox checkbox-primary">
                                                <input id="checkbox10" type="checkbox" name="book[book_cover_category]" value="Book_cover_11" class="chb">
                                                <label for="checkbox10"></label>
                                            </div>
                                            <!--<p><span> Font including in a shape</span>Company name inside / squares / ovals / rectangles or combined shapes.</p>-->

                                            <div class="img_box">
                                               <img src="images/book/12.jpg" width="100%" alt="logo">
                                            </div>
                                        </div>
                                    </div>
                                     <div class="col-md-3">
                                        <div class="check_box">
                                            <div class="checkbox checkbox-primary">
                                                <input id="checkbox11" type="checkbox" name="book[book_cover_category]" value="Book_cover_12" class="chb">
                                                <label for="checkbox11"></label>
                                            </div>
                                            <!--<p><span> Font including in a shape</span>Company name inside / squares / ovals / rectangles or combined shapes.</p>-->

                                            <div class="img_box">
                                               <img src="images/book/13.jpg" width="100%" alt="logo">
                                            </div>
                                        </div>
                                    </div>
                                                                        
                                <!-- End of Section 1 -->
                            </div>
                               <div class="row">
                                        <div class="col-md-12">
                                            <div class="submit_btn">
                                                <label>Click Here to Upload File</label>
                                                <input class="form-control" type="file" name="image[]" multiple value="" />
                                            </div>
                                        </div>
                                    </div>
                                    <div class="row">
                                        <div class="col-md-12">
                                            <div class="submit_btn text-center">
                                                <button class="btn btn-default" type="submit">Submit</button>
                                                
                                            </div>
                                        </div>
                                    </div>
                        </div>
                             
                    </div>
                   
                </div>
            </div>
        </form>
        <!-- END -->
    </section>




<?php  include 'includes/footer.php'; ?>








