app/template/default/SampleMagazine/index.twig line 1

Open in your IDE?
  1. {% extends 'default_frame.twig' %}
  3. {% form_theme form 'Form/form_div_layout.twig' %}
  5. {% block javascript %}
  6.     <script src="//yubinbango.github.io/yubinbango/yubinbango.js" charset="UTF-8"></script>
  7. {% endblock javascript %}
  9. {% block main %}
  11. <div class="ec-contactRole">
  12.   <div class="ec-pageHeader">
  13.     <h2 class="title">{{ '健康教室「見本誌」申込み(入力ページ)'|trans }}</h2>
  14.   </div>
  15.   <div class="ec-contactRole__header">
  16.     <p class="ec-para-normal">{{ '見本誌は無料でお届けいたします。見本誌（月号）の指定はできません。
  17.     休業日は翌営業日以降の対応となりますのでご了承ください。
  18.     '|trans|nl2br }}</p>
  19.   </div>
  20.   <form method="post" action="{{ url('apply_for_sample_magazine') }}" class="h-adr" novalidate>
  21.     <span class="p-country-name" style="display:none;">Japan</span>
  22.     {{ form_widget(form._token) }}
  23.     <div class="ec-borderedDefs table-layout">
  24.       <div class="tr">
  25.         <div class="th w3">
  26.           {{ form_label(form.name, 'お名前', { 'label_attr': { 'class': 'ec-label' }}) }}
  27.         </div>
  28.         <div class="td w9">
  29.           <div class="ec-halfInput{{ has_errors(form.name.name01, form.name.name02) ? ' error' }}">
  30.             {{ form_widget(form.name.name01, {'attr': { 'placeholder': '姓' }}) }}
  31.             {{ form_widget(form.name.name02, {'attr': { 'placeholder': '名' }}) }}
  32.             {{ form_errors(form.name.name01) }}
  33.             {{ form_errors(form.name.name02) }}
  34.           </div>
  35.         </div>
  36.       </div>
  37.       <div class="tr">
  38.         <div class="th w3">
  39.           {{ form_label(form.kana, 'お名前(カナ)', {'label_attr': {'class': 'ec-label'}}) }}
  40.         </div>
  41.         <div class="td w9">
  42.           <div class="ec-halfInput{{ has_errors(form.kana.kana01, form.kana.kana02) ? ' error' }}">
  43.             {{ form_widget(form.kana.kana01, {'attr': { 'placeholder': 'セイ' }}) }}
  44.             {{ form_widget(form.kana.kana02, {'attr': { 'placeholder': 'メイ' }}) }}
  45.             {{ form_errors(form.kana.kana01) }}
  46.             {{ form_errors(form.kana.kana02) }}
  47.           </div>
  48.         </div>
  49.       </div>
  50.       <div class="tr">
  51.         <div class="th w3">
  52.           {{ form_label(form.shipping_type, 'お届け先種別', { 'label_attr': { 'class': 'ec-label' }}) }}
  53.         </div>
  54.         <div class="td w9">
  55.           <div class="ec-radio{{ has_errors(form.shipping_type) ? ' error' }}">
  56.             {{ form_widget(form.shipping_type) }}
  57.             {{ form_errors(form.shipping_type) }}
  58.           </div>
  59.         </div>
  60.       </div>
  61.       <div class="tr">
  62.         <div class="th w3">
  63.           {{ form_label(form.address, 'お届け先住所', { 'label_attr': { 'class': 'ec-label' }}) }}
  64.         </div>
  65.         <div class="td w9">
  66.           <div class="ec-zipInput{{ has_errors(form.postal_code) ? ' error' }}">
  67.             <span>{{ '〒'|trans }}</span>
  68.             {{ form_widget(form.postal_code) }}
  69.             <div class="ec-zipInputHelp">
  70.               <div class="ec-zipInputHelp__icon">
  71.                 <div class="ec-icon"><img
  72.                         src="{{ asset('assets/icon/question-white.svg') }}" alt="">
  73.                 </div>
  74.               </div><a href="https://www.post.japanpost.jp/zipcode/" target="_blank"><span>{{ '郵便番号検索'|trans }}</span></a>
  75.             </div>
  76.             {{ form_errors(form.postal_code) }}
  77.           </div>
  78.           <div class="ec-select{{ has_errors(form.address.pref) ? ' error' }}">
  79.             {{ form_widget(form.address.pref) }}
  80.             {{ form_errors(form.address.pref) }}
  81.           </div>
  82.           <div class="ec-input{{ has_errors(form.address.addr01) ? ' error' }}">
  83.             {{ form_widget(form.address.addr01, { 'attr': { 'placeholder': '市区町村名(例：京都市中京区西ノ京小堀池町)' }}) }}
  84.             {{ form_errors(form.address.addr01) }}
  85.           </div>
  86.           <div class="ec-input{{ has_errors(form.address.addr02) ? ' error' }}">
  87.             {{ form_widget(form.address.addr02,  { 'attr': { 'placeholder': '番地・ビル名(例：8-2)' }}) }}
  88.             {{ form_errors(form.address.addr02) }}
  89.           </div>
  90.           <div class="attention-area">
  91.               <p class="attention">マンション名は必ずご入力ください。</p>
  92.           </div>
  93.           <div class="ec-input{{ has_errors(form.company_name) ? ' error' }}">
  94.               {{ form_widget(form.company_name,  { 'attr': { 'placeholder': '学校名/勤務先名' }}) }}
  95.               {{ form_errors(form.company_name) }}
  96.           </div>
  97.           <div class="attention-area">
  98.               <p class="attention">ご入力の住所が、学校や勤務先の場合、学校名/勤務先名もご入力ください。</p>
  99.           </div>
  100.         </div>
  101.       </div>
  102.       <div class="tr">
  103.         <div class="th w3">
  104.           {{ form_label(form.phone_number, '電話番号', { 'label_attr': { 'class': 'ec-label' }}) }}
  105.         </div>
  106.         <div class="td w9">
  107.           <div class="ec-telInput{{ has_errors(form.phone_number) ? ' error' }}">
  108.             {{ form_widget(form.phone_number) }}
  109.             {{ form_errors(form.phone_number) }}
  110.           </div>
  111.         </div>
  112.       </div>
  113.       <div class="tr">
  114.         <div class="th w3">
  115.           {{ form_label(form.email, 'メールアドレス', { 'label_attr': { 'class': 'ec-label' }}) }}
  116.         </div>
  117.         <div class="td w9">
  118.           <div class="ec-input{{ has_errors(form.email) ? ' error' }}">
  119.             {{ form_widget(form.email) }}
  120.             {{ form_errors(form.email) }}
  121.           </div>
  122.         </div>
  123.       </div>
  124.       <div class="tr">
  125.         <div class="th w3">
  126.           {{ form_label(form.age, '年齢', { 'label_attr': { 'class': 'ec-label' }}) }}
  127.         </div>
  128.         <div class="td w9">
  129.           <div class="ec-radio{{ has_errors(form.age) ? ' error' }}">
  130.             {{ form_widget(form.age) }}
  131.             {{ form_errors(form.age) }}
  132.           </div>
  133.         </div>
  134.       </div>
  135.       <div class="tr">
  136.         <div class="th w3">
  137.           {{ form_label(form.company_school_name, '現在の勤務先', { 'label_attr': { 'class': 'ec-label' }}) }}
  138.         </div>
  139.         <div class="td w9">
  140.           <div class="ec-input{{ has_errors(form.company_school_name) ? ' error' }}">
  141.             {{ form_widget(form.company_school_name) }}
  142.             {{ form_errors(form.company_school_name) }}
  143.           </div>
  144.           <div class="attention-area">
  145.               <p class="attention">学生の方は「学生」と入力してください。</p>
  146.           </div>
  147.         </div>
  148.       </div>
  149.       <div class="tr">
  150.         <div class="th w3">
  151.           {{ form_label(form.contents1, '現在、ご購読中の雑誌はございますか？', { 'label_attr': { 'class': 'ec-label' }}) }}
  152.         </div>
  153.         <div class="td w9">
  154.           <div class="ec-input{{ has_errors(form.contents1) ? ' error' }}">
  155.             {{ form_widget(form.contents1) }}
  156.             {{ form_errors(form.contents1) }}
  157.           </div>
  158.         </div>
  159.       </div>
  160.       <div class="tr">
  161.         <div class="th w3">
  162.           {{ form_label(form.contents2, '備考', { 'label_attr': { 'class': 'ec-label' }}) }}
  163.         </div>
  164.         <div class="td w9">
  165.           <div class="ec-input{{ has_errors(form.contents2) ? ' error' }}">
  166.             {{ form_widget(form.contents2) }}
  167.             {{ form_errors(form.contents2) }}
  168.             <p>何かございましたらご記入ください。</p>
  169.           </div>
  170.         </div>
  171.       </div>
  172.     </div>
  173.     <div class="ec-RegisterRole__actions">
  174.       <p class="btn-area one-btn">
  175.         <button type="submit" class="ec-blockBtn--action orange-btn" name="mode" value="confirm">{{ '確認ページへ'|trans }}
  176.         </button>
  177.       </p>
  178.     </div>
  179.   </form>
  180. </div>
  182. {% endblock %}