<?php 
  require_once("../mainfile.php");
  include ("../config.php");
  require_once("../Conectarse.php");



?>
</table>


<table width="100%" height="75%" bgcolor="#FFFFFF" border="0" cellspacing="0" cellpadding="0">
         
  <tr>
    <td height="10" valign="top">
 
      <table width="70%" border="0" cellspacing="0" cellpadding="0">
 
      </table>
    </td>
  </tr>
 
  <tr>
    <td align="center">
 
      <table width="44%" bgcolor="#EFEFEF" align="center" border="5" cellspacing="0" cellpadding="6">
 <tr>
   <td align="center" bgcolor="#306090"><big style="color:#FFFFFF"><b>INGRESAR SUS DATOS</b></big></td>
  
 </tr>
 
 <tr>
   <td align="center" colspan="2">
 
<script>
function Verificar() {
	
	
if(document.frm.apellidos.value == "") {
  alert("Por Favor Escriba Los Apellidos");
  document.frm.apellidos.focus();
  return false;
 }	

 if(document.frm.nombre.value == "") {
  alert("Por Favor Escriba El Nombre");
  document.frm.nombre.focus();
  return false;
 }
 
 if(document.frm.ced.value == "") {
  alert("Por Favor Escriba El Numero De Cedula");
  document.frm.ced.focus();
  return false;
 }
 
 if(document.frm.ecivil.value == "") {
  alert("Por Favor Escriba El Estado Civil");
  document.frm.ecivil.focus();
  return false;
 } 
 
  if(document.frm.funcionario.value == "") {
  alert("Por Favor Seleccione El Funcionario");
  document.frm.funcionario.focus();
  return false;
 } 


 
 return true;
}
</script>
 
     <form method="post" name="frm" onSubmit="return Verificar()">
       <table border="0" bgcolor="#EFEFEF" cellspacing="5">
 <!--<td><div align="right"><strong> Fecha Registro</strong></div></td>
    <td><div align="left">
      <input name="dia2" type="text" id="dia2" value="<?php echo date("d"); ?>" size="2" maxlength="2" readonly>
      <input name="mes2" type="text" id="mes2" value="<?php echo date("m"); ?>" size="2" maxlength="2" readonly>
      <input name="ano2" type="text" id="ano2" value="<?php echo date("Y"); ?>" size="4" maxlength="4" readonly>
    </div></td> 
  </tr>  -->
 
     <form method="post" name="frm" onSubmit="return Verificar()">
       <table border="0" bgcolor="#EFEFEF" cellspacing="5">

       
       
        <tr>
  <td align="right"><b>Apellidos:</b></td>
  <td><input type="text" name="apellidos" value="<? echo $ape?>"size="50" maxlength="40"></td>
  
       </tr>
       
         <tr>
  <td align="right"><b>Nombres:</b></td> 
  <td><input type="text" name="nombre"  value="<? echo $nom?>"size="50" maxlength="40"></td>
       </tr>
           
           
            <tr>
  <td align="right"><b>Profesion:</b></td> 
  <td><input type="text" name="Profesion"  value="<? echo $nom?>"size="50" maxlength="40"></td>
       </tr>
 
 
   <tr>
  <td align="right"><b>Cedula de Ciudadania:</b></td>
  <td><input type="text" name="ced" value="<? echo $cedu ?>"size="50" maxlength="40"></td>
   </tr>
  
  
  <tr>
  <td align="right"><b>Celular:</b></td>
  <td><input type="text" name="celu" value="<? echo $celular ?>"size="15" maxlength="15"></td>
       </tr>
       
         <tr>
  <td align="right"><b>Celular Personal:</b></td>
  <td><input type="text" name="celular" value="<? echo $celularalt ?>"size="15" maxlength="15"></td>
       </tr>
 
 
 
       <tr>
  <td align="right"><b>Correo Electronico:</b></td>
  <td><input type="text" name="email"  value="<? echo $email?>"size="50"></td>
       </tr>
          <tr>
  <td align="right"><b>Correo Personal:</b></td>
  <td><input type="text" name="emailalt"  value="<? echo $correoalt?>"size="50"></td>
       </tr>
       
  
       
   </table><br>
 
     <b>Gestion De Telemercadeo</b><br>
     <textarea name="mensaje" cols="100" rows="10"></textarea><br><br>
 	 
     
     
     <input name="guardar5" type="submit" class="Estilo53" id="guardar" value="Sin Contacto " />    
     <input name="guardar" type="submit" class="Estilo53" id="guardar" value="Afiliado" />
     <input name="guardar4" type="submit" class="Estilo53" id="guardar" value="Interesado " />
     <input name="guardar6" type="submit" class="Estilo53" id="guardar" value="Enviar Contrato" />   
     <input name="guardar2" type="submit" class="Estilo53" id="guardar" value="Sin Interes " />
     <input name="guardar3" type="submit" class="Estilo53" id="guardar" value="Pendiente " />
     <input name="guardar7" type="submit" class="Estilo53" id="guardar" value="Volver A Llamar " />
 
     </form>
 
   </td>
 </tr>
      </table><br>
 
    </td>
  </tr>
 
 
  <td height="22" colspan="2" bgcolor="#EFEFEF" class="fecha"><div align="center">
  
  <input name="button" type="button" onClick="javascript:window.close()" value="REGRESAR AL LISTADO">
    </div></td> 
 <br>
  <tr>
    <td height="60" align="center" bgcolor="#000052"><b style="font-size:7.5p;color:#FFFFFF">VERIFICACION ACTUACIONES</b></td>
  </tr>
</table>