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     <h1></h1><div class="container mx-auto mt-8 -mb-6 flex flex-col flex-wrap md:flex-row" style="font-size: 40px;">
	Completeaza datele din formularul de mai jos pentru a participa gratuit.
    
</div>
<br />
<form class="b-form w-full form-block" method="post"  id="form_contact" name="form_contact" action="">
     <!-- rand 1 -->
     <div class="container mx-auto mt-8 -mb-6 flex flex-col flex-wrap md:flex-row">
          <div class="w-full md:max-w-auto md:w-1/2 lg:w-1/2 px-2 mx-auto mb-6 md:mx-0 border-box">
               <label class="mb-2 text-sm text-gray-600 flex">Nume</label>
               <input class="b-input form-input focus:border-primary rounded dark:bg-gray-800 dark:border-gray-700 dark:text-white bg-white w-full" name="nume" id="nume" placeholder="" type="text" value="" onblur="validareForm()"/>
               <div id="prenumeErr" style="color: #cc0000; display:none; font-size: 10px;">
                    Introdu nume.
               </div>
            </div>
            <div class="w-full md:max-w-auto md:w-1/2 lg:w-1/2 px-2 mx-auto mb-6 md:mx-0 border-box">
                 <label class="mb-2 text-sm text-gray-600 flex">Prenume</label>
                 <input class="b-input form-input focus:border-primary rounded dark:bg-gray-800 dark:border-gray-700 dark:text-white bg-white w-full" name="prenume" id="prenume" placeholder="" type="text" value="" onblur="validareForm()"/>
                 <div id="numeErr" style="color: #cc0000; display:none; font-size: 10px;">
                     Introdu prenume.
                </div>
            </div>
     </div>
     <!-- rand 2 -->
     <div class="container mx-auto mt-8 -mb-6 flex flex-col flex-wrap md:flex-row">
          <div class="w-full md:max-w-auto md:w-1/3 lg:w-1/3 px-2 mx-auto mb-6 md:mx-0 border-box">
               <label class="mb-2 text-sm text-gray-600 flex">Telefon</label>
               <input class="b-input form-input focus:border-primary rounded dark:bg-gray-800 dark:border-gray-700 dark:text-white bg-white w-full" name="telefon" id="telefon" placeholder="" type="text" value="" onblur="validareForm()"/>
               <div id="telefonErr" style="color: #cc0000; display:none; font-size: 10px;">
                   Introdu numar de telefon.
              </div>
            </div>
            <div class="w-full md:max-w-auto md:w-1/3 lg:w-1/3 px-2 mx-auto mb-6 md:mx-0 border-box">
                 <label class="mb-2 text-sm text-gray-600 flex">Email</label>
                 <input class="b-input form-input focus:border-primary rounded dark:bg-gray-800 dark:border-gray-700 dark:text-white bg-white w-full" name="email" id="email" placeholder="" type="text" value="" onblur="validareForm()"/>
                <div id="emailErr" style="color: #cc0000; display:none; font-size: 10px;">
                     Email invalid.
                </div>
            </div>
            <div class="w-full md:max-w-auto md:w-1/3 lg:w-1/3 px-2 mx-auto mb-6 md:mx-0 border-box">
               <label class="mb-2 text-sm text-gray-600 flex">CUIM/NRU </label>
               <input class="b-input form-input focus:border-primary rounded dark:bg-gray-800 dark:border-gray-700 dark:text-white bg-white w-full" name="cuim" id="cuim" placeholder="" type="text" value="" onblur="validareForm()"/>
               <div id="cuimErr" style="color: #cc0000; display:none; font-size: 10px;">
                   Introdu CUIM.
              </div>
            </div>
     </div>
     <!-- rand 3 -->

     <!-- rand 5 -->
     <div class="container mx-auto mt-8 -mb-6 flex flex-col flex-wrap md:flex-row">
            <div class="w-full md:max-w-auto md:w-1/2 lg:w-1/2 px-2 mx-auto mb-6 md:mx-0 border-box">
                 <label class="mb-2 text-sm text-gray-600 flex">Specialitate medicala</label>
                 <!-- <input class="b-input form-input focus:border-primary rounded dark:bg-gray-800 dark:border-gray-700 dark:text-white bg-white w-full" name="spec_med" id="spec_med" placeholder="" type="text" value="" onblur="validareForm()"/> -->
                
                 <select class="b-select form-select focus:border-primary rounded dark:bg-gray-800 dark:border-gray-700 dark:text-white bg-white w-full" id="spec_med" name="spec_med">
                                            <option value="administrativ">administrativ</option>
                                            <option value="alergologie si imunologie clinica">alergologie si imunologie clinica</option>
                                            <option value="anatomie patologica">anatomie patologica</option>
                                            <option value="anestezie si terapie intensiva">anestezie si terapie intensiva</option>
                                            <option value="balneologie">balneologie</option>
                                            <option value="boli infectioase">boli infectioase</option>
                                            <option value="cardiologie">cardiologie</option>
                                            <option value="chirurgie cardiovasculara">chirurgie cardiovasculara</option>
                                            <option value="chirurgie generala">chirurgie generala</option>
                                            <option value="chirurgie oro-maxilo-faciala">chirurgie oro-maxilo-faciala</option>
                                            <option value="chirurgie pediatrica">chirurgie pediatrica</option>
                                            <option value="chirurgie plastica si reparatorie">chirurgie plastica si reparatorie</option>
                                            <option value="chirurgie toracica">chirurgie toracica</option>
                                            <option value="chirurgie vasculara">chirurgie vasculara</option>
                                            <option value="dermatovenerologie">dermatovenerologie</option>
                                            <option value="diabet zaharat nutritie si boli metabolice">diabet zaharat nutritie si boli metabolice</option>
                                            <option value="endocrinologie">endocrinologie</option>
                                            <option value="epidemiologie">epidemiologie</option>
                                            <option value="fiziokinetoterapie">fiziokinetoterapie</option>
                                            <option value="fizioterapie">fizioterapie</option>
                                            <option value="gastroenterologie">gastroenterologie</option>
                                            <option value="genetica medicala">genetica medicala</option>
                                            <option value="geriatrie si gerontologie">geriatrie si gerontologie</option>
                                            <option value="hematologie">hematologie</option>
                                            <option value="igiena">igiena</option>
                                            <option value="interne">interne</option>
                                            <option value="kinetoterapie">kinetoterapie</option>
                                            <option value="medicina de familie">medicina de familie</option>
                                            <option value="medicina de laborator">medicina de laborator</option>
                                            <option value="medicina de urgenta">medicina de urgenta</option>
                                            <option value="medicina generala">medicina generala</option>
                                            <option value="medicina legala">medicina legala</option>
                                            <option value="medicina muncii">medicina muncii</option>
                                            <option value="medicina nucleara">medicina nucleara</option>
                                            <option value="medicina sportiva">medicina sportiva</option>
                                            <option value="microbiologie">microbiologie</option>
                                            <option value="nefrologie">nefrologie</option>
                                            <option value="neonatologie">neonatologie</option>
                                            <option value="neurochirurgie">neurochirurgie</option>
                                            <option value="neurologie">neurologie</option>
                                            <option value="obstetrica-ginecologie">obstetrica-ginecologie</option>
                                            <option value="oftalmologie">oftalmologie</option>
                                            <option value="oncologie medicala">oncologie medicala</option>
                                            <option value="ORL">ORL</option>
                                            <option value="ortopedie pediatrica">ortopedie pediatrica</option>
                                            <option value="ortopedie si traumatologie">ortopedie si traumatologie</option>
                                            <option value="otorinolaringologie">otorinolaringologie</option>
                                            <option value="pediatrie">pediatrie</option>
                                            <option value="pneumoftiziologie">pneumoftiziologie</option>
                                            <option value="pneumologie">pneumologie</option>
                                            <option value="psihiatrie">psihiatrie</option>
                                            <option value="radiologie si imagistica medicala">radiologie si imagistica medicala</option>
                                            <option value="radioterapie">radioterapie</option>
                                            <option value="recuperare, medicina fizica si balneologie">recuperare, medicina fizica si balneologie</option>
                                            <option value="reseller">reseller</option>
                                            <option value="reumatologie">reumatologie</option>
                                            <option value="senologie">senologie</option>
                                            <option value="urologie">urologie</option>
                                            <option value="veterinar">veterinar</option>
                                    </select>
                <div id="spec_medErr" style="color: #cc0000; display:none; font-size: 10px;">
                     Alege specialitate medicala.
                </div>
            </div>
            <div class="w-full md:max-w-auto md:w-1/2 lg:w-1/2 px-2 mx-auto mb-6 md:mx-0 border-box">
                 <label class="mb-2 text-sm text-gray-600 flex">Specialitate profesionala</label>
                 <select class="b-select form-select focus:border-primary rounded dark:bg-gray-800 dark:border-gray-700 dark:text-white bg-white w-full" id="grad_profesional" name="grad_profesional">
                                            <option value="altul">altul</option>
                                            <option value="primar">primar</option>
                                            <option value="rezident">rezident</option>
                                            <option value="specialist">specialist</option>
                                    </select>
                <div id="grad_profesionalErr" style="color: #cc0000; display:none; font-size: 10px;">
                     introdu grad profesional.
                </div>
            </div>

     </div>
     <!-- rand 6 -->
     <div class="container mx-auto mt-8 -mb-6 flex flex-col flex-wrap md:flex-row">
          <div class="w-full md:max-w-auto px-2 mx-auto mb-6 md:mx-0 border-box">
                    <label class="mb-2 text-sm text-gray-600 flex">Loc de munca</label>
                    <input class="b-input form-input focus:border-primary rounded dark:bg-gray-800 dark:border-gray-700 dark:text-white bg-white w-full" name="loc_munca" id="loc_munca" placeholder="" type="text" value="" onblur="validareForm()"/>
                    <div id="loc_muncaErr" style="color: #cc0000; display:none; font-size: 10px;">
                         Introdu loc de munca.
                    </div>
           </div>
     </div>
     <div class="container mx-auto mt-8 -mb-6 flex flex-col flex-wrap md:flex-row text-center">
          <div class="w-full md:max-w-auto px-2 mx-auto mb-6 md:mx-0 border-box">
               <input type="checkbox" id="accept" name="accept" value="0" class="form-checkbox" onclick="validareForm()">
               <label for="accept">Sunt de acord ca datele mele personale sa fie procesate conform <a style="color:#0000CC" href="https://www.edusontv.net/pages/politica-de-confidentialitate-1" target="_blank">Politicii de confidentialitate</a></label>
               <div id="acceptErr" style="color: #cc0000; display:none; font-size: 10px;">
                    Bifeaza pentru a continua.
               </div>
          </div>
     </div>
     <!-- rand 6 -->
     <div class="container mx-auto mt-8 -mb-6 flex flex-col flex-wrap md:flex-row">
      <div class="w-full md:max-w-auto px-2 mx-auto mb-6 md:mx-0 border-box text-center">
              <div>
                                 <button id="trimite" type="submit" class="b-button rounded" name="submitOp" style="background-color:#c0c0c0; padding:20px 20px;">Plateste&nbsp;250.00&nbsp;RON cu Ordin de Plata</button>
               &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                  <button id="plateste" type="submit" class="b-button rounded" name="submitStripe" style="background-color:#c0c0c0; padding:20px 20px;" disabled>Plateste&nbsp;250.00&nbsp;RON cu card bancar</button>
                                    <input type="hidden" id="titlu" name="titlu" value="">
                  <input type="hidden" id="cui" name="cui" value="">
                  <input type="hidden" id="cnp" name="cnp" value="">
                  <input type="hidden" id="tip" name="tip" value="CURSANT">
                  <input type="hidden" id="nr_reg_com" name="nr_reg_com" value="">
                  <input type="hidden" id="id_cursant" name="id_cursant" value="">
                  <input type="hidden" id="user_eduson" name="user_eduson" value="uscreen3">
                  <input type="hidden" id="linkstripe" name="linkstripe" value="https://buy.stripe.com/00g6pRbo7f9UdkAg0f">
                  <input type="hidden" id="id_webinar" name="id_webinar" value="">
                  <input type="hidden" id="nume_produs" name="nume_produs" value="Utilizarea ecografiei pentru diagnosticul, tratamentul si monitorizarea pacientului cu boli inflamatorii si degenerative articulare">
              </div>
         </div>


</div>

</form>

<script>
     // function redirect(){
     //      console.log(document.getElementById('linkstripe').value);
     //      var linkredirect = document.getElementById('linkstripe').value;
     //      window.location.replace(linkredirect);

     // }
function validareForm(){
     var err = 0;
     if (validareMail() == false) {
          err += 1;
     }

     if (document.getElementById('nume').value.trim() == ""){
          err += 1;
          document.getElementById('numeErr').style.display = 'block';
     }else{
          document.getElementById('numeErr').style.display = 'none';
     }

     if (document.getElementById('prenume').value.trim() == ""){
          err += 1;
          document.getElementById('prenumeErr').style.display = 'block';
     }else{
          document.getElementById('prenumeErr').style.display = 'none';
     }


     if (document.getElementById('telefon').value.trim() == ""){
          err += 1;
          document.getElementById('telefonErr').style.display = 'block';
     }else{
          document.getElementById('telefonErr').style.display = 'none';
     }

     // if (document.getElementById('tara').value.trim() == ""){
     //      err += 1;
     //      document.getElementById('taraErr').style.display = 'block';
     // }else{
     //      document.getElementById('taraErr').style.display = 'none';
     // }

     if (document.getElementById('cuim').value.trim() == ""){
          err += 1;
          document.getElementById('cuimErr').style.display = 'block';
     }else{
          document.getElementById('cuimErr').style.display = 'none';
     }

     if (document.getElementById('spec_med').value.trim() == "" ){
          err += 1;
          document.getElementById('spec_medErr').style.display = 'block';
     }else{
          document.getElementById('spec_medErr').style.display = 'none';
     }

     if (document.getElementById('grad_profesional').value.trim() == ""){
          err += 1;
          document.getElementById('grad_profesionalErr').style.display = 'block';
     }else{
          document.getElementById('grad_profesionalErr').style.display = 'none';
     }


     if (document.getElementById('grad_profesional').value.trim() == ""){
          err += 1;
          document.getElementById('grad_profesionalErr').style.display = 'block';
     }else{
          document.getElementById('grad_profesionalErr').style.display = 'none';
     }

     if (document.getElementById('loc_munca').value.trim() == ""){
          err += 1;
          document.getElementById('loc_muncaErr').style.display = 'block';
     }else{
          document.getElementById('loc_muncaErr').style.display = 'none';
     }

     if (!document.getElementById('accept').checked){
          err += 1;
          document.getElementById('acceptErr').style.display = 'block';
     }else{
          document.getElementById('acceptErr').style.display = 'none';
     }
     //console.log(err);
     if (err == 0){
         //console.log(document.getElementById('linkstripe').value)
          if (document.getElementById('linkstripe').value!="") {
               document.getElementById('trimite').disabled = false;
               document.getElementById('trimite').style.backgroundColor = "#09b1bb";
               document.getElementById('trimite').style.color = "#ffffff";

               document.getElementById('plateste').disabled = false;
               document.getElementById('plateste').style.backgroundColor = "#3386FF";
               document.getElementById('plateste').style.color = "#ffffff";
          }else{
               document.getElementById('register').disabled = false;
               document.getElementById('register').style.backgroundColor = "#3386FF";
               document.getElementById('register').style.color = "#ffffff";       
          }

     }else{
           if (document.getElementById('linkstripe').value!="") {

               document.getElementById('trimite').disabled = true;
               document.getElementById('trimite').style.backgroundColor = "#c0c0c0;";

               document.getElementById('plateste').disabled = true;
               document.getElementById('plateste').style.backgroundColor = "#c0c0c0";
            }else{
               document.getElementById('register').disabled = true;
               document.getElementById('register').style.backgroundColor = "#c0c0c0";
          }
     }
}

function validareMail()
{
var email=document.getElementById('email').value;
var mailformat = /^\w+([\.-]?\w+)*@\w+([\.-]?\w+)*(\.\w{2,3})+$/;
     if(email.match(mailformat))
       {
         console.log("Valid email address!");
         document.getElementById('emailErr').style.display = 'none';
         return true;
       }
     else
       {
         console.log("Invalid email address!");
         document.getElementById('emailErr').style.display = 'block';
         return false;
  }
}
</script>
