<form id="newsletterAvanceeInscription" name="newsletterAvanceeInscription" method="post" onsubmit="return checkInscriptionComplete()" title="Inscription à la lettre d'information">
    <input type="hidden" name="action" value="inscription"/>
    
        <div class="well well-xs"><p class="mb-0"><strong>{{ 'label.form_mention-obligatoire'|trans }}</strong></p></div>
    <fieldset>
        <legend>Vos coordonnées</legend>
        <div class="form-group">
            <label for="newsletterSimpleInscriptionNom">Votre nom <abbr tabindex="0" title="{{ 'label.obligatoire'|trans }}">*</abbr></label>
            <input class="form-control"  name="nom" type="text" id="newsletterSimpleInscriptionNom" value="" autocomplete="family-name" required/>
        </div>
        <div class="form-group">
            <label for="newsletterSimpleInscriptionPrenom">Votre prénom <abbr tabindex="0" title="{{ 'label.obligatoire'|trans }}">*</abbr></label>
            <input class="form-control" name="prenom" type="text" id="newsletterSimpleInscriptionPrenom" value="" autocomplete="given-name" required/>
        </div>
        <div class="form-group">
            <label for="newsletterSimpleInscriptionMail">Votre e-mail <abbr tabindex="0" title="{{ 'label.obligatoire'|trans }}">*</abbr> <small>{{ 'label.exemplemail'|trans }}</small></label>
            <input class="form-control" name="mail" type="email" id="newsletterSimpleInscriptionMail"  value="{{ mail }}" autocomplete="email" required/>
        </div>

    </fieldset>
    <fieldset>
         <legend>Pour mieux vous connaître</legend>
        {% for type in allTypes %}
            <div class="form-group">
                <strong>{{ type.type }}</strong>
                <div class="row">
                    {% for group in type.groupes%}
                        <div class="col-md-3">
                            <label class="checkbox">
                                <input type="checkbox" id="group.group_id" name="choix_groupe{{ group.groupe_id }}" value="{{ group.groupe_id }}">
                                {{ group.groupe_nom }}
                            </label>
                        </div>
                    {% endfor %}
                </div>
            </div>
        {% endfor %}
        <div class="form-group">
            <p class="mb-0"><strong>Date de naissance <abbr tabindex="0" title="{{ 'label.obligatoire'|trans }}">*</abbr></strong></p>
            <div class="row">
                <div class="col-sm-4">
                    <select name="date_jour" id="date_jour" class="form-control" autocomplete="bday-day" >
                        <option value="00">Jour</option>
                        {% for i in 1..31 %}
                            <option value="{{ "%02d"|format(i) }}">{{ "%02d"|format(i) }}</option>
                        {% endfor %}
                    </select>
                </div>
                <div class="col-sm-4">
                    <select name="date_mois" id="date_mois" class="form-control" autocomplete="bday-month" >
                        <option value="00">Mois</option>
                        {% for i in 1..12 %}
                            <option value="{{ "%02d"|format(i) }}">{{ "%02d"|format(i) }}</option>
                        {% endfor %}
                    </select>
                </div>
                {% set actualYear = "now"|date("Y") %}
                <div class="col-sm-4">
                    <select name="date_annees" id="date_annees" class="form-control" autocomplete="bday-year" >
                        <option value="00">Année</option>
                        {% for i in actualYear-100..actualYear %}
                            <option value="{{ i }}">{{ i }}</option>
                        {% endfor %}
                    </select>
                </div>
            </div>
        </div>
        {{ GetRgpdForModule(3)|raw}}
        {{ CaptchaService.getHtmlCaptcha|raw }}
    </fieldset>
    <div class="row">
        <div class="col-md-6 col-md-offset-6 offset-md-6">
            <button type="submit" class="btn btn-primary btn-lg btn-block submitInscription" name="button" id="button">S'inscrire</button>
        </div>
    </div>
</form>
<hr/>
<h2>Si vous ne souhaitez plus recevoir notre lettre d'information, désabonnez-vous :</h2>
<form id="newsletterSimpleDesinscription" class="form-horizontal" name="newsletterSimpleDesinscription" method="post" onsubmit="return checkDesinscriptionComplete()" title="Désinscription à la lettre d'information">
    <input type="hidden" name="action" value="desinscription"/>
    
        <div class="well well-xs"><p class="mb-0"><strong>{{ 'label.form_mention-obligatoire'|trans }}</strong></p></div>
    <fieldset>
        <legend>Désinscription</legend>
        <div class="form-group">
            <label for="newsletterSimpleDesinscriptionMail">Votre e-mail <abbr tabindex="0" title="{{ 'label.obligatoire'|trans }}">*</abbr> <small>{{ 'label.exemplemail'|trans }}</small></label>
            <input class="form-control" name="removeMail" type="email" id="newsletterSimpleDesinscriptionMail"  value="" autocomplete="email" required/>
        </div>
    </fieldset>
    <div class="row">
        <div class="col-md-6 col-md-offset-6 offset-md-6">
            <button type="submit" class="btn btn-primary btn-lg btn-block" name="button" id="button">Se désinscrire</button>
        </div>
    </div>
</form>