Yu Watanabe
0b449c4c60
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47 lines
3.6 KiB
PHP
47 lines
3.6 KiB
PHP
@extends('layouts.general')
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@section('content')
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<main role="main" id="" class="">
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<section id="" class="container mt20 mb20">
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<div class="row">
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<div class="col-12 col-lg-10 offset-0 offset-lg-1 mt20 mb20">
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<div class="card border-success">
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<div class="card-header border-success">
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<h5 class="card-title text-success">新規会員登録</h5>
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</div>
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<div class="card-body mt30">
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<p class="h4">入力内容をご確認の上、登録ボタンを押して下さい。</p>
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<section id="" class="container mt50 mb50">
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<form class="row form" action="{{ route('member_regist_complete', ['management_code' => $management_code]) }}" method="post">
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@csrf
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<div class="col-12 col-md-3 offset-0 offset-md-1"><label>お名前</label></div>
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<div class="col-12 col-lg-6 mb10"><h3>{{ $input_data['name'] }}</h3><input type="hidden" name="name" value="{{ $input_data['name'] }}"></div>
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<div class="col-12 col-md-3 offset-0 offset-md-1"><label>フリガナ</label></div>
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<div class="col-12 col-lg-6 mb10"><h3>{{ $input_data['kana'] }}</h3><input type="hidden" name="kana" value="{{ $input_data['kana'] }}"></div>
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<div class="col-12 col-md-3 offset-0 offset-md-1"><label>自宅電話番号</label></div>
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<div class="col-12 col-lg-6 mb10"><h3>{{ implode('-', $input_data['phone']) }}</h3>
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<input type="hidden" name="phone[]" value="{{ $input_data['phone'][0] }}">
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<input type="hidden" name="phone[]" value="{{ $input_data['phone'][1] }}">
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<input type="hidden" name="phone[]" value="{{ $input_data['phone'][2] }}">
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</div>
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<div class="col-12 col-md-3 offset-0 offset-md-1"><label>携帯電話番号</label></div>
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<div class="col-12 col-lg-6 mb10"><h3>{{ implode('-', $input_data['mobile']) }}</h3>
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<input type="hidden" name="mobile[]" value="{{ $input_data['mobile'][0] }}">
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<input type="hidden" name="mobile[]" value="{{ $input_data['mobile'][1] }}">
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<input type="hidden" name="mobile[]" value="{{ $input_data['mobile'][2] }}">
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</div>
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<div class="col-12 col-md-3 offset-0 offset-md-1"><label>生年月日</label></div>
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<div class="col-12 col-lg-6 mb10"><h3>{{ $input_data['birthdate'] }}</h3><input type="hidden" name="birthdate" value="{{ $input_data['birthdate'] }}"></div>
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<div class="col-12 col-md-3 offset-0 offset-md-1"><label>メールアドレス</label></div>
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<div class="col-12 col-lg-6 mb10"><h3>{{ $input_data['email'] }}</h3><input type="hidden" name="email" value="{{ $input_data['email'] }}"></div>
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<div class="col-12 col-md-5 offset-0 offset-md-1 mt10"><button type="submit" class="btn btn-block btn-lg btn-success" name='submit' value="complete">登録</button></div>
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<div class="col-12 col-md-5 mt10"><button type="submit" class="btn btn-lg btn-block btn-outline-success" name='submit' value="back">戻る</button></div>
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<div class="col-12 col-md-4 offset-0 offset-md-4 mt50 mb50"></div>
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</form>
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</section>
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</div>
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</div>
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</div>
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</div>
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</section>
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</main>
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@endsection |