<?php

$numbers = $_POST['ticket_form_number'];

$ticketForms = "";


$ticketForms.= '<div class="ticket_details" id="div_form_'.$numbers.'">		
		<div class="remove_ticket_forms"><a href="#" onClick="deleteForm('.$numbers.');" title="Click here to remove added form"><img src="remove.jpg" width="22" height="22" class="remove_forms" id="form_'.$numbers.'" alt=""></a></div>
		<div class="first_block">
			<table style="width:100%">
				<tr>
					<td width="30%">First Name<span class="error">*</span></td>
					<td width="70%"><input type="text" name="fname_'.$numbers.'" id="fname_'.$numbers.'"></td>
				</tr>
				<tr>						
					<td width="30%">Middle Name</td>
					<td width="70%"><input type="text" name="mname_'.$numbers.'" id="mname_'.$numbers.'"></td>						
				</tr>
				<tr>
					<td width="30%">Last Name<span class="error">*</span></td>
					<td width="70%"><input type="text" name="lname_'.$numbers.'" id="lname_'.$numbers.'"></td>
				</tr>
				<tr>
					<td width="30%">Age<span class="error">*</span></td>
					<td width="70%"><input type="text" name="age_'.$numbers.'" id="age_'.$numbers.'"></td>
</tr>
				<tr>
					<td width="30%">Email<span class="error">*</span></td>
					<td width="70%"><input type="text" name="email_'.$numbers.'" id="email_'.$numbers.'"></td>
				</tr>
				<tr>							
					<td width="40%">Category Selected<span class="error">*</span></td>
					<td width="60%">
						<select name="cat_'.$numbers.'" id="cat_'.$numbers.'" style="width:80%">
							<option value="">Select Cateory </option>	
							<option value="vvip">VVIP - $250/ticket</option>
							<option value="vip">VIP - $150/ticket</option>
							<option value="general">General - $100/ticket</option>
						</select>
					</td>						
				</tr>	
				<tr>
					<td width="40%">Select Event<span class="error">*</span></td>				
					<td width="60%"c>
						<select name="event_'.$numbers.'" id="event_'.$numbers.'" style="width:80%">
							<option value="">Select Event </option>
							<option value="26">A Night With Rabbi Shergill - DC (26th July 2014: 7:30pm)</option>
							<option value="27">A Night with Rabbi Shergill - NYC (27th July: 6:30pm)</option>
						</select>
					</td>
				</tr>					
			</table>
		</div>
		<div class="second_block">
			<table>
				<tr>
					<td width="30%">Address<span class="error">*</span></td>
					<td width="70%"><input type="text" name="address1_'.$numbers.'" id="address1_'.$numbers.'"></td>						
				</tr>		
				<tr>
					<td width="40%">Street Address</td>
					<td width="60%"><input type="text" name="address2_'.$numbers.'" id="address2_'.$numbers.'"></td>
</tr>
				<tr>
					<td width="40%">City<span class="error">*</span></td>
					<td width="60%"><input type="text" name="city_'.$numbers.'" id="city_'.$numbers.'"></td>
</tr>
				<tr>
					<td width="40%">Province<span class="error">*</span></td>
					<td width="60%"><input type="text" name="province_'.$numbers.'" id="province_'.$numbers.'"></td>
</tr>
				<tr>
					<td width="40%">Zip<span class="error">*</span></td>
					<td width="60%"><input type="text" name="zip_'.$numbers.'" id="zip_'.$numbers.'"></td>
				
				</tr>	
				<tr>
					<td width="40%">Telephone<span class="error">*</span></td>
					<td width="60%"><input type="text" name="telephone_'.$numbers.'" id="telephone_'.$numbers.'"></td>
</tr>	
							
				
			</table>
		</div>	

	</div>';
	


echo $ticketForms;


?>
