83 lines
4.2 KiB
PHP
83 lines
4.2 KiB
PHP
@extends('layouts.app')
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@section('content')
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<div class="container">
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<div class="row justify-content-center">
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<div class="col-md-8 main-area">
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<h1 style="text-align: center;">活動站</h1>
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<h3 style="text-align: center;"><hr style="width:2em; display: inline-block"></h3>
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<h2 style="text-align: center;">快問快答抽獎登記</h2>
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<form method="POST" action="?" style="font-size: 1.4em;">
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@csrf
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@if ($errors->any())
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<div class="text-left mt-3 alert alert-block alert-dismissible alert-danger">
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<span type="button" class="close" data-bs-dismiss="alert">×</span>
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<ul>
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@foreach ($errors->all() as $error)
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<li>{{ $error }}</li>
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@endforeach
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</ul>
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</div>
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@endif
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@if ($message = Session::get('success'))
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<div class="text-left mt-3 alert alert-block alert-dismissible alert-success ">
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<span type="button" class="close" data-bs-dismiss="alert">×</span>
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<strong>{{ $message }}</strong>
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</div>
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@endif
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<div class="card" style="display:none;">
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<div class="card-body">
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<div class="mb-3">
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<label for="regName" class="form-label">姓名</label>
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<input type="text" class="form-control" id="regName" name="name" required value="{{ old('name') }}">
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</div>
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<div class="mb-3">
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<label for="regIdNumber" class="form-label">身份證字號</label>
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<input type="text" class="form-control" id="regIdNumber" name="id_number" required value="{{ old('id_number') }}">
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</div>
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<div class="mb-3">
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<label for="regEmail" class="form-label">電子信箱</label>
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<input type="email" class="form-control" id="regEmail" name="email" required value="{{ old('email') }}">
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</div>
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<div class="mb-3">
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<label for="regPhone" class="form-label">手機</label>
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<input type="text" class="form-control" id="regPhone" name="phone" required value="{{ old('phone') }}" placeholder="範例：09xxxxxxxx">
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</div>
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<div class="mb-3">
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<label for="county_box" class="form-label">戶籍地(限設籍高雄市民參與)</label>
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<div class="dropdown">
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<select name="address" id="county_box1" class="form-select" required>
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<option value="" selected disabled>選擇縣市</option>
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<option value="高雄市">高雄市</option>
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</select>
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<select name="district" id="district_box" style="visibility:hidden;">
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<option value="">選擇鄉鎮市區</option>
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</select>
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<input type="text" id="zipcode_box" placeholder="郵遞區號" style="visibility:hidden;">
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</div>
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</div>
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<div class="mb-3">
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</div>
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<div class="mb-3">
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<input type="checkbox" class="form-check-input" id="regAgree" required>
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<label class="form-check-label" for="regAgree">我同意 <a href="/gdpr">個資法同意書</a></label>
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</div>
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<button type="submit" class="btn btn-primary">登記</button>
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</div>
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</div>
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</form>
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<p> </p>
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</div>
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</div>
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</div>
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@endsection
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