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<head>
	

</head>
		

<div class="main-content">
	<div class="breadcrumbs" id="breadcrumbs">
		

		<ul class="breadcrumb">
			<li>
				<i class="icon-home home-icon"></i>
				<a href="#">首页</a>
			</li>
			<li class="active">用户管理</li>
			<li class="active">新增</li>
		</ul><!-- .breadcrumb -->

		
	</div>
	<div class="page-content">
		<div class="row">
		
			<div class="col-xs-12">
				
				
				<div class="page-header">
							<h1>
								新增用户
								<small>
									<i class="icon-double-angle-right"></i>
									请填写用户基本信息
								</small>
							</h1>
						</div><!-- /.page-header -->
				<form action="#" id="reg_form" name="reg_form" method="post" onsubmit="return false" class="form-horizontal" role="form">
				
				<div class="col-xs-6">
					<div class="form-group">
						<label class="col-sm-3 control-label no-padding-right" for="form-field-1"> 姓名 </label>

						<div class="col-sm-9">
							<input type="text" id="name" name="name" placeholder="" class="col-xs-10 col-sm-5" />
						</div>
					</div>

					<div class="space-4"></div>

					<div class="form-group">
						<label class="col-sm-3 control-label no-padding-right" for="form-field-2"> 性别 </label>

						<div class="col-sm-9">
							<input type="text" id="gender" name="gender" placeholder="" class="col-xs-10 col-sm-5" />
						</div>
					</div>

					<div class="space-4"></div>

					<div class="form-group">
						<label class="col-sm-3 control-label no-padding-right" for="form-input-readonly"> 出生日期 </label>

						<div class="col-sm-9">
							<input class="col-xs-10 col-sm-5" id="birthday" name="birthday" type="text" data-date-format="yyyy-mm-dd" />
							
						</div>
					</div>

					<div class="space-4"></div>

					<div class="form-group">
						<label class="col-sm-3 control-label no-padding-right" for="form-input-readonly"> 证件类型 </label>

						<div class="col-sm-9">
							<select class="col-xs-10 col-sm-5" id="paperType" name="paperType">
								<option value="1">身份证</option>
							</select>
							
						</div>
					</div>

					<div class="space-4"></div>
					
					<div class="form-group">
						<label class="col-sm-3 control-label no-padding-right" for="form-input-readonly"> 证件号码 </label>

						<div class="col-sm-9">
							<input type="text" id="paperId" name="paperId" placeholder="" class="col-xs-10 col-sm-5" />
							
						</div>
					</div>

					<div class="space-4"></div>
					
					<div class="form-group">
						<label class="col-sm-3 control-label no-padding-right" for="form-input-readonly"> 民族 </label>

						<div class="col-sm-9">
							<select name="nation" id="nation" class="col-xs-10 col-sm-5">  
							    <option value="1">汉族</option>  
							    <option value="2">蒙古族</option>  
							    <option value="3">回族</option>  
							    <option value="4">藏族</option>  
							    <option value="5">维吾尔族</option>  
							    <option value="6">苗族</option>  
							    <option value="7">彝族</option>  
							    <option value="8">壮族</option>  
							    <option value="9">布依族</option>  
							    <option value="10">朝鲜族</option>  
							    <option value="11">满族</option>  
							    <option value="12">侗族</option>  
							    <option value="13">瑶族</option>  
							    <option value="14">白族</option>  
							    <option value="15">土家族</option>  
							    <option value="16">哈尼族</option>  
							    <option value="17">哈萨克族</option>  
							    <option value="18">傣族</option>  
							    <option value="19">黎族</option>  
							    <option value="20">傈僳族</option>  
							    <option value="21">佤族</option>  
							    <option value="22">畲族</option>  
							    <option value="23">高山族</option>  
							    <option value="24">拉祜族</option>  
							    <option value="25">水族</option>  
							    <option value="26">东乡族</option>  
							    <option value="27">纳西族</option>  
							    <option value="28">景颇族</option>  
							    <option value="29">柯尔克孜族</option>  
							    <option value="30">土族</option>  
							    <option value="31">达斡尔族</option>  
							    <option value="32">仫佬族</option>  
							    <option value="33">羌族</option>  
							    <option value="34">布朗族</option>  
							    <option value="35">撒拉族</option>  
							    <option value="36">毛南族</option>  
							    <option value="37">仡佬族</option>  
							    <option value="38">锡伯族</option>  
							    <option value="39">阿昌族</option>  
							    <option value="40">普米族</option>  
							    <option value="41">塔吉克族</option>  
							    <option value="42">怒族</option>  
							    <option value="43">乌孜别克族</option>  
							    <option value="44">俄罗斯族</option>  
							    <option value="45">鄂温克族</option>  
							    <option value="46">德昂族</option>  
							    <option value="47">保安族</option>  
							    <option value="48">裕固族</option>  
							    <option value="49">京族</option>  
							    <option value="50">塔塔尔族</option>  
							    <option value="51">独龙族</option>  
							    <option value="52">鄂伦春族</option>  
							    <option value="53">赫哲族</option>  
							    <option value="54">门巴族</option>  
							    <option value="55">珞巴族</option>  
							    <option value="56">基诺族</option>  
							 </select>  
							
						</div>
					</div>
					
					<div class="form-group">
						<label class="col-sm-3 control-label no-padding-right" for="form-input-readonly"> 国籍 </label>

						<div class="col-sm-9">
							<select class="col-xs-10 col-sm-5" id="nationality" name="nationality">
								<option value="CN">中国</option>
								<option value="AL">阿尔巴尼亚</option>
								<option value="DZ">阿尔及利亚</option>
								<option value="AF">阿富汗</option>
								<option value="AR">阿根廷</option>
								<option value="AE">阿拉伯联合酋长国</option>
								<option value="AW">阿鲁巴</option>
								<option value="OM">阿曼</option>
								<option value="AZ">阿塞拜疆</option>
								<option value="EG">埃及</option>
								<option value="ET">埃塞俄比亚</option>
								<option value="IE">爱尔兰</option>
								<option value="EE">爱沙尼亚</option>
								<option value="AD">安道尔</option>
								<option value="AO">安哥拉</option>
								<option value="AI">安圭拉岛</option>
								<option value="AG">安提瓜和巴布达</option>
								<option value="AT">奥地利</option>
								<option value="AX">奥兰岛</option>
								<option value="AU">澳大利亚</option>
								<option value="MO">澳门特别行政区</option>
								<option value="BB">巴巴多斯</option>
								<option value="PG">巴布亚新几内亚</option>
								<option value="BS">巴哈马</option>
								<option value="PK">巴基斯坦</option>
								<option value="PY">巴拉圭</option>
								<option value="PS">巴勒斯坦民族权力机构</option>
								<option value="BH">巴林</option>
								<option value="PA">巴拿马</option>
								<option value="BR">巴西</option>
								<option value="BY">白俄罗斯</option>
								<option value="BM">百慕大群岛</option>
								<option value="BG">保加利亚</option>
								<option value="MP">北马里亚纳群岛</option>
								<option value="BJ">贝宁</option>
								<option value="BE">比利时</option>
								<option value="IS">冰岛</option>
								<option value="PR">波多黎各</option>
								<option value="PL">波兰</option>
								<option value="BA">波斯尼亚和黑塞哥维那</option>
								<option value="BO">玻利维亚</option>
								<option value="BZ">伯利兹</option>
								<option value="BW">博茨瓦纳</option>
								<option value="BQ">博内尔</option>
								<option value="BT">不丹</option>
								<option value="BF">布基纳法索</option>
								<option value="BI">布隆迪</option>
								<option value="BV">布韦岛</option>
								<option value="KP">朝鲜</option>
								<option value="GQ">赤道几内亚</option>
								<option value="DK">丹麦</option>
								<option value="DE">德国</option>
								<option value="TL">东帝汶</option>
								<option value="TG">多哥</option>
								<option value="DO">多米尼加共和国</option>
								<option value="DM">多米尼克</option>
								<option value="RU">俄罗斯</option>
								<option value="EC">厄瓜多尔</option>
								<option value="ER">厄立特里亚</option>
								<option value="FR">法国</option>
								<option value="FO">法罗群岛</option>
								<option value="PF">法属波利尼西亚</option>
								<option value="GF">法属圭亚那</option>
								<option value="TF">法属南极地区</option>
								<option value="VA">梵蒂冈城</option>
								<option value="PH">菲律宾</option>
								<option value="FJ">斐济群岛</option>
								<option value="FI">芬兰</option>
								<option value="CV">佛得角</option>
								<option value="FK">福克兰群岛(马尔维纳斯群岛)</option>
								<option value="GM">冈比亚</option>
								<option value="CD">刚果(DRC)</option>
								<option value="CG">刚果共和国</option>
								<option value="CO">哥伦比亚</option>
								<option value="CR">哥斯达黎加</option>
								<option value="GG">格恩西岛</option>
								<option value="GD">格林纳达</option>
								<option value="GL">格陵兰</option>
								<option value="GE">格鲁吉亚</option>
								<option value="CU">古巴</option>
								<option value="GP">瓜德罗普岛</option>
								<option value="GU">关岛</option>
								<option value="GY">圭亚那</option>
								<option value="KZ">哈萨克斯坦</option>
								<option value="HT">海地</option>
								<option value="KR">韩国</option>
								<option value="NL">荷兰</option>
								<option value="HM">赫德和麦克唐纳群岛</option>
								<option value="ME">黑山共和国</option>
								<option value="HN">洪都拉斯</option>
								<option value="KI">基里巴斯</option>
								<option value="DJ">吉布提</option>
								<option value="KG">吉尔吉斯斯坦</option>
								<option value="GN">几内亚</option>
								<option value="GW">几内亚比绍</option>
								<option value="CA">加拿大</option>
								<option value="GH">加纳</option>
								<option value="GA">加蓬</option>
								<option value="KH">柬埔寨</option>
								<option value="CZ">捷克共和国</option>
								<option value="ZW">津巴布韦</option>
								<option value="CM">喀麦隆</option>
								<option value="QA">卡塔尔</option>
								<option value="KY">开曼群岛</option>
								<option value="CC">科科斯群岛(基灵群岛)</option>
								<option value="KM">科摩罗联盟</option>
								<option value="CI">科特迪瓦共和国</option>
								<option value="KW">科威特</option>
								<option value="HR">克罗地亚</option>
								<option value="KE">肯尼亚</option>
								<option value="CK">库可群岛</option>
								<option value="CW">库拉索</option>
								<option value="LV">拉脱维亚</option>
								<option value="LS">莱索托</option>
								<option value="LA">老挝</option>
								<option value="LB">黎巴嫩</option>
								<option value="LT">立陶宛</option>
								<option value="LR">利比里亚</option>
								<option value="LY">利比亚</option>
								<option value="LI">列支敦士登</option>
								<option value="RE">留尼汪岛</option>
								<option value="LU">卢森堡</option>
								<option value="RW">卢旺达</option>
								<option value="RO">罗马尼亚</option>
								<option value="MG">马达加斯加</option>
								<option value="IM">马恩岛</option>
								<option value="MV">马尔代夫</option>
								<option value="MT">马耳他</option>
								<option value="MW">马拉维</option>
								<option value="MY">马来西亚</option>
								<option value="ML">马里</option>
								<option value="MK">马其顿, 前南斯拉夫共和国</option>
								<option value="MH">马绍尔群岛</option>
								<option value="MQ">马提尼克岛</option>
								<option value="YT">马约特岛</option>
								<option value="MU">毛里求斯</option>
								<option value="MR">毛利塔尼亚</option>
								<option value="US">美国</option>
								<option value="AS">美属萨摩亚</option>
								<option value="UM">美属外岛</option>
								<option value="VI">美属维尔京群岛</option>
								<option value="MN">蒙古</option>
								<option value="MS">蒙特塞拉特</option>
								<option value="BD">孟加拉国</option>
								<option value="PE">秘鲁</option>
								<option value="FM">密克罗尼西亚</option>
								<option value="MM">缅甸</option>
								<option value="MD">摩尔多瓦</option>
								<option value="MA">摩洛哥</option>
								<option value="MC">摩纳哥</option>
								<option value="MZ">莫桑比克</option>
								<option value="MX">墨西哥</option>
								<option value="NA">纳米比亚</option>
								<option value="ZA">南非</option>
								<option value="AQ">南极洲</option>
								<option value="GS">南乔治亚和南德桑威奇群岛</option>
								<option value="NR">瑙鲁</option>
								<option value="NP">尼泊尔</option>
								<option value="NI">尼加拉瓜</option>
								<option value="NE">尼日尔</option>
								<option value="NG">尼日利亚</option>
								<option value="NU">纽埃</option>
								<option value="NO">挪威</option>
								<option value="NF">诺福克岛</option>
								<option value="PW">帕劳群岛</option>
								<option value="PN">皮特凯恩群岛</option>
								<option value="PT">葡萄牙</option>
								<option value="JP">日本</option>
								<option value="SE">瑞典</option>
								<option value="CH">瑞士</option>
								<option value="SV">萨尔瓦多</option>
								<option value="WS">萨摩亚</option>
								<option value="RS">塞尔维亚共和国</option>
								<option value="SL">塞拉利昂</option>
								<option value="SN">塞内加尔</option>
								<option value="CY">塞浦路斯</option>
								<option value="SC">塞舌尔</option>
								<option value="XS">沙巴岛</option>
								<option value="SA">沙特阿拉伯</option>
								<option value="BL">圣巴泰勒米岛</option>
								<option value="CX">圣诞岛</option>
								<option value="ST">圣多美和普林西比</option>
								<option value="SH">圣赫勒拿岛</option>
								<option value="KN">圣基茨和尼维斯</option>
								<option value="LC">圣卢西亚</option>
								<option value="MF">法属圣马丁岛</option>
								<option value="SX">荷属圣马丁岛</option>
								<option value="SM">圣马力诺</option>
								<option value="PM">圣皮埃尔岛和密克隆岛</option>
								<option value="VC">圣文森特和格林纳丁斯</option>
								<option value="XE">圣尤斯特歇斯岛</option>
								<option value="LK">斯里兰卡</option>
								<option value="SK">斯洛伐克</option>
								<option value="SI">斯洛文尼亚</option>
								<option value="SZ">斯威士兰</option>
								<option value="SD">苏丹</option>
								<option value="SR">苏里南</option>
								<option value="SB">所罗门群岛</option>
								<option value="SO">索马里</option>
								<option value="TJ">塔吉克斯坦</option>
								<option value="TW">台湾</option>
								<option value="TH">泰国</option>
								<option value="TZ">坦桑尼亚</option>
								<option value="TO">汤加</option>
								<option value="TC">特克斯和凯科斯群岛</option>
								<option value="TT">特立尼达和多巴哥</option>
								<option value="TN">突尼斯</option>
								<option value="TV">图瓦卢</option>
								<option value="TR">土耳其</option>
								<option value="TM">土库曼斯坦</option>
								<option value="TK">托克劳</option>
								<option value="WF">瓦利斯和富图纳</option>
								<option value="VU">瓦努阿图</option>
								<option value="GT">危地马拉</option>
								<option value="VG">维尔京群岛(英属)</option>
								<option value="VE">委内瑞拉</option>
								<option value="BN">文莱</option>
								<option value="UG">乌干达</option>
								<option value="UA">乌克兰</option>
								<option value="UY">乌拉圭</option>
								<option value="UZ">乌兹别克斯坦</option>
								<option value="ES">西班牙</option>
								<option value="GR">希腊</option>
								<option value="HK">香港特别行政区</option>
								<option value="SG">新加坡</option>
								<option value="NC">新喀里多尼亚</option>
								<option value="NZ">新西兰</option>
								<option value="HU">匈牙利</option>
								<option value="SY">叙利亚</option>
								<option value="JM">牙买加</option>
								<option value="AM">亚美尼亚</option>
								<option value="SJ">扬马延岛</option>
								<option value="YE">也门</option>
								<option value="IQ">伊拉克</option>
								<option value="IR">伊朗</option>
								<option value="IL">以色列</option>
								<option value="IT">意大利</option>
								<option value="IN">印度</option>
								<option value="ID">印度尼西亚</option>
								<option value="UK">英国</option>
								<option value="IO">英属印度洋领地</option>
								<option value="JO">约旦</option>
								<option value="VN">越南</option>
								<option value="ZM">赞比亚</option>
								<option value="JE">泽西</option>
								<option value="TD">乍得</option>
								<option value="GI">直布罗陀</option>
								<option value="CL">智利</option>
								<option value="CF">中非共和国</option>

							</select>
							
						</div>
					</div>
					
					<div class="form-group">
						<label class="col-sm-3 control-label no-padding-right" for="form-input-readonly"> 籍贯 </label>

						<div class="col-sm-9">
							<div id="nativePlace" class="col-xs-10 col-sm-5"></div>
							
						</div>
					</div>
					
					<div class="form-group">
						<label class="col-sm-3 control-label no-padding-right" for="form-input-readonly"> 户籍所在地 </label>

						<div class="col-sm-9">
							<div id="domicilePlace" class="col-xs-10 col-sm-5"></div>
							
						</div>
					</div>
					
					<div class="form-group">
						<label class="col-sm-3 control-label no-padding-right" for="form-field-1"> 经常居住地</label>

						<div class="col-sm-9">
							<input type="text" id="addr" name="addr" placeholder="" class="col-xs-10 col-sm-5" />
						</div>
					</div>
					
					
					<div class="form-group">
						<label class="col-sm-3 control-label no-padding-right" for="form-input-readonly"> 学历</label>

						<div class="col-sm-9">
							<select class="col-xs-10 col-sm-5" id="education" name="education">
								<option value="0"></option>
								<option value="1">中专</option>
								<option value="2">大专</option>
								<option value="3">本科</option>
								<option value="5">硕士</option>
								<option value="6">博士</option>
							</select>
							
						</div>
					</div>
					
					<div class="form-group">
						<label class="col-sm-3 control-label no-padding-right" for="form-field-1"> 工作单位/学校 </label>

						<div class="col-sm-9">
							<input type="text" id="unit" name="unit" placeholder="" class="col-xs-10 col-sm-5" />
						</div>
					</div>
					
					<div class="form-group">
						<label class="col-sm-3 control-label no-padding-right" for="form-field-1"> 职业 </label>

						<div class="col-sm-9">
							<input type="text" id="profession" name="profession" placeholder="" class="col-xs-10 col-sm-5" />
						</div>
					</div>
					
					
				</div>
				
				
				<div class="col-xs-6">
				
					<div class="form-group">
						<label class="col-sm-3 control-label no-padding-right" for="form-field-1"> 单位/学校地址 </label>

						<div class="col-sm-9">
							<input type="text" id="unitAddr" name="unitAddr" placeholder="" class="col-xs-10 col-sm-5" />
						</div>
					</div>
					
					
					<div class="form-group">
						<label class="col-sm-3 control-label no-padding-right" for="form-field-1"> 单位/学校电话 </label>

						<div class="col-sm-9">
							<input type="text" id="unitTel" name="unitTel" placeholder="" class="col-xs-10 col-sm-5" />
						</div>
					</div>
					
					
					<div class="form-group">
						<label class="col-sm-3 control-label no-padding-right" for="form-field-1"> 本人手机 </label>

						<div class="col-sm-9">
							<input type="text" id="mobile" name="mobile" placeholder="" class="col-xs-10 col-sm-5" />
						</div>
					</div>
					
					<div class="form-group">
						<label class="col-sm-3 control-label no-padding-right" for="form-field-1"> 固定电话 </label>

						<div class="col-sm-9">
							<input type="text" id="tel" name="tel" placeholder="" class="col-xs-10 col-sm-5" />
						</div>
					</div>
					
					<div class="form-group">
						<label class="col-sm-3 control-label no-padding-right" for="form-field-1"> QQ号码 </label>

						<div class="col-sm-9">
							<input type="text" id="qq" name="qq" placeholder="" class="col-xs-10 col-sm-5" />
						</div>
					</div>
					
					<div class="form-group">
						<label class="col-sm-3 control-label no-padding-right" for="form-field-1"> 邮箱 </label>

						<div class="col-sm-9">
							<input type="text" id="email" name="email" placeholder="" class="col-xs-10 col-sm-5" />
						</div>
					</div>
					
					<div class="form-group">
						<label class="col-sm-3 control-label no-padding-right" for="form-field-1"> 微信号 </label>

						<div class="col-sm-9">
							<input type="text" id="weixin" name="weixin" placeholder="" class="col-xs-10 col-sm-5" />
						</div>
					</div>
					
					
					<div class="form-group">
						<label class="col-sm-3 control-label no-padding-right" for="form-field-1"> 无偿献血次数 </label>

						<div class="col-sm-9">
							<input type="text" id="donateBloodCount" name="donateBloodCount" placeholder="" class="col-xs-10 col-sm-5" />
						</div>
					</div>
					
					
					<div class="form-group">
						<label class="col-sm-3 control-label no-padding-right" for="form-field-1"> 无偿献血次数 </label>

						<div class="col-sm-9">
							<input type="text" id="donateBloodCount" name="donateBloodCount" placeholder="" class="col-xs-10 col-sm-5" />
						</div>
					</div>
					
					
					<div class="form-group">
						<label class="col-sm-3 control-label no-padding-right" for="form-field-1"> 血型 </label>

						<div class="col-sm-9">
							<input type="text" id="bloodType" name="bloodType" placeholder="" class="col-xs-10 col-sm-5" />
						</div>
					</div>
					
					<div class="form-group">
						<label class="col-sm-3 control-label no-padding-right" for="form-field-1"> 身高 </label>

						<div class="col-sm-9">
							<input type="text" id="height" name="height" placeholder="" class="col-xs-10 col-sm-5" />
						</div>
					</div>
					
					<div class="form-group">
						<label class="col-sm-3 control-label no-padding-right" for="form-field-1"> 体重 </label>

						<div class="col-sm-9">
							<input type="text" id="weight" name="weight" placeholder="" class="col-xs-10 col-sm-5" />
						</div>
					</div>
					
					<div class="form-group">
						<label class="col-sm-3 control-label no-padding-right" for="form-field-1"> 备注 </label>

						<div class="col-sm-9">
							<textarea rows="5" class="col-xs-10 col-sm-5" id="remark" name="remark"></textarea>
						</div>
					</div>
					
					
				
				</div>
				
				
				
				
				<div class="clearfix form-actions">
					<div class="col-md-offset-3 col-md-9">
						<button class="btn btn-sm btn-success">
							<i class="icon-save bigger-110"></i>
							保存
						</button>

						&nbsp; &nbsp; &nbsp;
						<button class="btn btn-sm btn-success">
							<i class="icon-reply bigger-110"></i>
							返回
						</button>
					</div>
				</div>
				
			</form>
			
			
											
											
										
			</div>
			
		</div>
	</div>
	
	
	
	
	
	
</div>
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