75 lines
3.0 KiB
HTML
75 lines
3.0 KiB
HTML
{{extend 'layout.html'}}
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<link rel="stylesheet" href="{{=URL('static', 'css/edda_vitte.css')}}">
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<div class="row align-items-center bg-edda-paper">
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<div class="col-8">
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<img src="{{=URL('static', 'images/eddaPsd.png')}}" class="img-fluid" alt="">
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</div>
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<div class="col-4">
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<img src="{{=URL('static', 'images/logo_edda_vitte.png')}}" class="img-fluid" alt="">
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</div>
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</div>
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<div class="row">
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<div class="col-12 bg-edda-dpurple pt-2">
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<h2 class="text-center">QUIERO LEER Y SABER MÁS DE TI, ESCRIBEME</h2>
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</div>
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</div>
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<div class="row div-edda-form bg-edda-lpurple">
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<div class="col-12 mx-auto" style="max-width: 1280px;">
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<div class="row mb-4">
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<div class="col-12">
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<h2 class="text-center" style="color: #47398e; letter-spacing: 0.15rem;">REGÍSTRATE Y CONVERSEMOS</h2>
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</div>
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</div>
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<form class="" enctype="multipart/form-data" method="post">
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<div class="row mb-4">
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<div class="col-12 col-lg-6 form-group">
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<label for="formularioNombre"><h3>NOMBRE(S) *</h3></label>
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<input type="text" class="form-control" id="formularioNombre" placeholder="">
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</div>
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<div class="col-12 col-lg-3 form-group">
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<label for="formularioApellidoP"><h3>APELLIDO PATERNO *</h3></label>
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<input type="text" class="form-control" id="formularioApellidoP" placeholder="">
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</div>
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<div class="col-12 col-lg-3 form-group">
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<label for="formularioApellidoM"><h3>APELLIDO MATERNO *</h3></label>
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<input type="text" class="form-control" id="formularioApellidoM" placeholder="">
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</div>
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</div>
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<div class="row mb-4">
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<div class="col-12 col-lg-4 form-group">
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<label for="formularioNacimiento"><h3>FECHA DE CUMPLEAÑOS *</h3></label>
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<div class="row" id="formularioNacimiento">
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<div class="col-3">
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<input type="numeric" class="form-control" placeholder="">
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</div>
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<div class="col-3">
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<input type="numeric" class="form-control" placeholder="">
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</div>
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<div class="col-6">
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<input type="numeric" class="form-control" placeholder="">
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</div>
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</div>
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</div>
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<div class="col-12 col-lg-3 form-group">
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<label for="formularioCelular"><h3>CELULAR *</h3></label>
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<input type="numeric" class="form-control" id="formularioCelular" placeholder="">
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</div>
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<div class="col-12 col-lg-5 form-group">
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<label for="formularioCorreo"><h3>CORREO ELECTRÓNICO *</h3></label>
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<input type="email" class="form-control" id="formularioCorreo" placeholder="">
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</div>
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</div>
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<div class="row mb-4">
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<div class="col-12">
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<h4 class="text-center">Los campos marcados con * son obligatorios.</h4>
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</div>
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</div>
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<div class="text-center">
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<input class="btn btn-edda" type="submit" value="CONVERSEMOS">
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<input type="hidden" name="_formname" value="enviarFormulario">
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</div>
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</form>
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</div>
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</div>
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