
<form id="formInscriptionActipageAlertesSMS" name="formInscriptionActipageAlertesSMS" method="post" title="Inscription aux alertes SMS">
    <input type="hidden" name="action" value="inscription"/>
    <div class="well well-xs"><strong>{{ 'label.form_mention-obligatoire'|trans }}</strong></div>

    <fieldset>
        <legend>Inscription</legend>     
        <div class="form-group">
            <label for="nom">Nom <abbr tabindex="0" title="{{ 'label.obligatoire'|trans }}">*</abbr></label>

                        <input class="form-control"  name="nom" type="text" id="nom"  value="{{ data.nom }}" required autocomplete="family-name"/>

        </div>
        <div class="form-group">
            <label for="prenom">Prénom <abbr tabindex="0" title="{{ 'label.obligatoire'|trans }}">*</abbr></label>

                        <input class="form-control"  name="prenom" type="text" id="prenom"  value="{{ data.prenom }}" required autocomplete="given-name" />

        </div>
        {% if params.allowNewsletterInscription %}
            <div class="form-group">
                <label for="mail">Email</label>

                            <input class="form-control"  name="mail" type="text" id="mail"  value="{{ data.mail }}" autocomplete="email"/>

            </div>
        {% endif %}
        <div class="form-group">
            <label for="tel">Numéro de téléphone <abbr tabindex="0" title="{{ 'label.obligatoire'|trans }}">*</abbr></label>

                        <input class="form-control"  name="tel" type="text" id="tel"  value="{{ data.tel }}" autocomplete="tel-national"/>

        </div>
                <div class="form-group">
                    <label for="ligne">Lignes <abbr tabindex="0" title="{{ 'label.obligatoire'|trans }}">*</abbr></label>

        <div class="row">
            <div class="col-md-9">
                        <select name="ligne" id="ligne" class="form-control" >
                            {% if lignes|length > 0 %}
                                {% for ligne in lignes %}
                                    <option value="{{ ligne.lineexternalcode }}">{{ ligne.linename }}</option>
                                {% endfor %}
                            {% endif %}
                        </select>
                </div>

            <div class="col-md-3">
                <a href="#" class="btn btn-primary btn-block addLigne">Ajouter &agrave; ma liste</a>
            </div>
        </div>
            </div>
        <div class="zonelignes" style="display:none">
                <div class="well well-xs">
            <h3 class="label">Mes lignes :</h3>

                    <ul class="list-group">
                    </ul>

        </div>
        </div>
        {% if params.allowNewsletterInscription %}
            <div class="checkbox">
                    <label >
                        <input type="checkbox" name="newsletter" id="newsletter" value="1"> Je souhaite recevoir la lettre d'information
                    </label>
            </div>
        {% endif %}
        {{ GetRgpdForModule(8)|raw}}
        {{ CaptchaService.getHtmlCaptcha|raw }}
    </fieldset>
        <div class="text-right">
                <input type="button" id="submitFormInscriptionActipageAlertesSMS" class="btn btn-primary btn-lg submit" value="Envoyer">

        </div>
</form>
<hr>
<form id="formDesinscriptionActipageAlertesSMS" name="formDesinscriptionActipageAlertesSMS" method="post" title="Désinscription aux alertes SMS">
    <input type="hidden" name="action" value="desinscription"/>
    <fieldset>
        <legend>Désinscription</legend>  
        <div class="form-group">
            <label for="tel2">Numéro de téléphone <abbr tabindex="0" title="{{ 'label.obligatoire'|trans }}">*</abbr></label>

                        <input class="form-control"  name="tel2" type="text" id="tel2"  value="{{ data.tel }}" autocomplete="tel-national" required />

        </div>
        <div class="row">
            <div class="col-md-6">{{ CaptchaService.getHtmlCaptcha|raw }}</div>
            <div class="col-md-6">
            <div class="well well-warning well-xs text-center">Pour vous désinscrire,<br> vous devez valider <strong><u>les deux captchas</u></strong><br> présents sur cette page.</div></div>
        </div>
        


    </fieldset>
        <div class="text-right">
                <input type="button" id="submitFormDesinscriptionActipageAlertesSMS" class="btn btn-primary btn-lg submit" value="Envoyer">
        </div>
</form>