templates/registration/_formSenior.html.twig line 1

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  1.                                     <div class="col-md-6 col-12">
  2.                                     <label for="nom" class="text-muted">{{ '%nom%'|trans|capitalize }} (*)</label>
  3.                                         <input name="nom" class="form-control" required/>
  4.                                     </div>
  5.                                     <div class="col-md-6 col-12">
  6.                                         <div class="form-group">
  7.                                         <label for="prenom" class="text-muted">{{ '%prenom%'|trans|capitalize }} (*)</label>
  8.                                             <input type="text" name="prenom" class="form-control" required/>
  9.                                         </div>
  10.                                     </div>
  11.                                     <div class="col-md-6 col-12">
  12.                                         <div class="form-group">
  13.                                         <label for="tel" class="text-muted">{{ '%Phone%'|trans|capitalize }} (*)</label>
  14.                                             <input type="tel" name="tel" class="form-control" required onkeyup="this.value = this.value.replace(/[^0-9-]/g, '');"/>
  15.                                         </div>
  16.                                     </div>
  17.                                     <div class="col-md-6 col-12">
  18.                                         <div class="form-group">
  19.                                         <label for="email" class="text-muted">{{ '%E-mail%'|trans|capitalize }} (*)</label>
  20.                                             <input type="email" name="email" class="form-control" required/>
  21.                                         </div>
  22.                                     </div>
  23.                                     <div class="col-md-6 col-12">
  24.                                         <div class="form-group">
  25.                                         <label for="password" class="text-muted">{{ '%Password%'|trans|capitalize }} (*)</label>
  26.                                             <input type="password" name="plainPassword" class="form-control" minlength="6" required/>
  27.                                         </div>
  28.                                     </div>
  29.                                     <div class="col-md-6">
  30.                                         <label for="photoUser" class="text-muted">{{ '%uploadphotoUser%'|trans }}</label>
  31.                                         <input type="file" name="photoUser" value="photoUser" placeholder="{{ '%uploadphotoUser%'|trans }}" class="form-control"/>
  32.                                     </div>
  33.                                     <div class="col-md-6 col-12">
  34.                                         <div class="form-group">
  35.                                         <label for="civilite" class="text-muted">{{ '%civilite%'|trans|capitalize }} (*)</label>
  36.                                             <select name="civilite" id="civilite-select" class="form-control">
  37.                                                 <option value="Madame">{{'%Madame%'|trans}}</option>
  38.                                                 <option value="Mademoiselle">{{'%Mademoiselle%'|trans}}</option>
  39.                                                 <option value="Monsieur">{{'%Monsieur%'|trans}}</option>
  40.                                             </select>
  41.                                         </div>
  42.                                     </div>
  43.                                     <div class="col-md-6 col-12">
  44.                                         <div class="form-group">
  45.                                             {{ include('registration/_specialite.html.twig') }}
  46.                                         </div>
  47.                                     </div>
  48.                                     <div class="col-md-6">
  49.                                         <label for="addressPro" class="text-muted">{{'%AddressPro%'|trans|capitalize }}</label>
  50.                                         <input type="text" name="addressPro" class="form-control"/>
  51.                                     </div>
  52.                                     <div class="col-md-6 col-12">
  53.                                         <div class="form-group">
  54.                                         <label for="addresse" class="text-muted">{{ '%AddressPerso%'|trans|capitalize }} (*)</label>
  55.                                             <input type="text" name="addresse" class="form-control" required/>
  56.                                         </div>
  57.                                     </div>
  58.                                     
  59.                                     <div class="col-md-6">
  60.                                         <label for="pays" class="text-muted">{{'%pays%'|trans|capitalize }} (*)</label>
  61.                                         <input type="text" name="pays" class="form-control" required/>
  62.                                     </div>
  63.                                     <div class="col-md-6 col-12">
  64.                                         <div class="form-group">
  65.                                         <label for="ville" class="text-muted">{{ '%Ville%'|trans|capitalize }}</label>
  66.                                             <input type="text" name="ville" class="form-control"/>
  67.                                         </div>
  68.                                     </div>
  69.                                     <div class="col-md-6 col-12">
  70.                                         <div class="form-group">
  71.                                         <label for="code_postal" class="text-muted">{{ '%CodePostal%'|trans|capitalize }}</label>
  72.                                             <input type="number" name="code_postal" class="form-control" />
  73.                                         </div>
  74.                                     </div>
  75.                                     {# <div class="col-lg-6 col-12">
  76.                                         <div class="form-group">
  77.                                             <select name="activite" id="activite-select">
  78.                                                 <option value="Privé">{{'%Privé%'|trans}}</option>
  79.                                                 <option value="Public">{{'%Public%'|trans}}</option>
  80.                                             </select>
  81.                                         </div>
  82.                                     </div> #}
  83.                                     
  84.                                 <div class="col-md-6">
  85.                                     <label for="titre" class="text-muted">{{ '%titre%'|trans|capitalize }} (*)</label>
  86.                                         <select name="titre" id="titre-select">
  87.                                             <option value="Résident">{{'%Résident%'|trans}}</option>
  88.                                             <option value="Spécialiste médical">{{'%Spécialistemédical%'|trans}}</option>
  89.                                             <option value="Assistant hospitalo universitaire">{{'%AssistantHospitaloUniversitaire%'|trans}}</option>
  90.                                             <option value="Professeur agrégé">{{'%Professeuragrégé%' |trans}}</option>
  91.                                             <option value="Professeur">{{'%Professeur%' |trans}}</option>
  92.                                             {# <option value="Libre pratique">{{'%Librepratique%'|trans}}</option> #}
  93.                                             {# <option value="Retraité(e)">{{'%Retraité%'|trans}}</option> #}
  94.                                         </select>
  95.                                     </div>
  96.                                 <div class="col-md-6">
  97.                                     <div class="form-group">
  98.                                     <label for="activite" class="text-muted">{{ '%activite%'|trans|capitalize }} (*)</label>
  99.                                         <select name="activite" id="activite-select">
  100.                                             <option value="Privé">{{'%Privé%'|trans}}</option>
  101.                                             <option value="Public">{{'%Public%'|trans}}</option>
  102.                                             <option value="Retraité(e)">{{'%Retraité%'|trans}}</option>
  103.                                         </select>
  104.                                     </div>
  105.                                 </div>
  106.                                 <div class="col-md-6">
  107.                                     <label for="numOrdre" class="text-muted">{{ '%numOrdre%'|trans|capitalize }} (*)</label>
  108.                                     <input type="number" name="numOrdre" class="form-control" required/>
  109.                                 </div>
  110.                                 <div class="col-md-6">
  111.                                     <label for="fieldOfInterest" class="text-muted">{{'%fieldOfInterest%'|trans|capitalize }}</label>
  112.                                     <input type="text" name="fieldOfInterest" class="form-control" />
  113.                                 </div>
  114.                                 <div class="col-md-6">
  115.                                     <label for="sousSpecialite" class="text-muted">{{'%sousSpecialite%'|trans|capitalize }}</label>
  116.                                     <input type="text" name="sousSpecialite" class="form-control"/>
  117.                                 </div>
  118.                                 <div class="col-md-6 offset-md-3">
  119.                                     <label for="biographie" class="text-muted">{{'%biographie%'|trans|capitalize }}</label><br>
  120.                                     <input type="file" name="biographie" class="form-control"/>
  121.                                     {# <button onclick="biographie.click()">{{'%btnBiographyRegister%'|trans}}</button> #}
  122.                                 </div>