@extends( 'layouts.master' ) @section( 'content' )

User Registration

To use many features of the web-based Ontae VAE case report and analysis system, you will need to first register for an Ontae account. Note that the Ontae registration form is secure. We would suggest you to use a password that is not easy to guess.

Please use the following user registration form to register:

{!! csrf_field() !!}

User Registration Form

E-mail address* @if ( $errors->has( 'email' ) ) {{ $errors->first( 'email' ) }} @endif
Password* @if ( $errors->has( 'password' ) ) {{ $errors->first( 'password' ) }} @endif
Retype Password* @if ( $errors->has( 'password_confirmation' ) ) {{ $errors->first( 'password_confirmation' ) }} @endif
Title @if ( $errors->has( 'title' ) ) {{ $errors->first( 'title' ) }} @endif
First Name* @if ( $errors->has( 'firstname' ) ) {{ $errors->first( 'firstname' ) }} @endif
Last Name* @if ( $errors->has( 'lastname' ) ) {{ $errors->first( 'lastname' ) }} @endif
Mailing Address @if ( $errors->has( 'address' ) ) {{ $errors->first( 'address' ) }} @endif
City @if ( $errors->has( 'city' ) ) {{ $errors->first( 'city' ) }} @endif
state @if ( $errors->has( 'state' ) ) {{ $errors->first( 'state' ) }} @endif
Zip Code @if ( $errors->has( 'zip' ) ) {{ $errors->first( 'zip' ) }} @endif
Country/Region
Phone @if ( $errors->has( 'phone' ) ) {{ $errors->first( 'phone' ) }} @endif
Fax @if ( $errors->has( 'fax' ) ) {{ $errors->first( 'fax' ) }} @endif

 
@endsection