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

Pendaftaran User Monev

{{ csrf_field() }}
{!! Form::select('fltrprovinsi',[],null,['class'=>'form-control fltrprovinsi','id'=>'fltrprovinsi', 'disabled', 'required']) !!}
{!! Form::select('fltrkabupaten',[],null,['class'=>'form-control fltrkabupaten','id'=>'fltrkabupaten', 'disabled', 'required']) !!}
{!! Form::select('fltrpuskesmas',[],null,['class'=>'form-control fltrpuskesmas','id'=>'fltrpuskesmas', 'disabled', 'required']) !!}
@if ($errors->has('username')) {{ $errors->first('username') }} @endif
@if ($errors->has('name')) {{ $errors->first('name') }} @endif
@if ($errors->has('email')) {{ $errors->first('email') }} @endif
@if ($errors->has('password')) {{ $errors->first('password') }} @endif
@if ($errors->has('password_confirmation')) {{ $errors->first('password_confirmation') }} @endif
{{ Form::hidden('hnamaprovinsi',null, array('id' => 'hnamaprovinsi')) }} {{ Form::hidden('hnamakabupaten',null, array('id' => 'hnamakabupaten')) }} {{ Form::hidden('hnamapuskesmas',null, array('id' => 'hnamapuskesmas')) }}
kembali ke login
@endsection @section('scripts') @endsection