apply.html 3.6 KB
<div id="myModal" class="modal fade" aria-hidden="true">
    <div class="modal-dialog">
        <div class="modal-content">
            <div class="modal-header">
                <h4>文化之旅报名表</h4>
            </div>
            <div class="modal-body">
                <form action="" method="post" id="train">
                    <input type="hidden" name="tid" value=""/>
                    <div class="row">
                        <div class="row-title">
                            <h5>个人信息</h5>
                        </div>
                        <div class="row-con cf">
                            <div class="ipt-container lf">
                                <input type="text" name="name" placeholder="培训人姓名">
                            </div>
                            <div class="slt-list lf" id="city">
                                <div class="slt-container lf">
                                    <select name="province" class="mm-select prov">
                                        <option value="天津"></option>
                                    </select>
                                </div>
                                <div class="slt-container lf">
                                    <select name="city" class="mm-select city"><option value="天津"></option></select>
                                </div>
                            </div>
                            <div class="ipt-container lf">
                                <input id="d11" type="text" placeholder="出生年月" name="birth" onClick="WdatePicker({skin:'twoer'})"/>
                            </div>
                            <div class="ipt-container lf">
                                <input type="text" name="mobile" placeholder="手机号">
                            </div>
                            <div class="radio-container lf">
                                <label>性别:</label>
                                <input type="radio" name="sex" value="1" checked>
                                <input type="radio" name="sex" value="2">
                            </div>
                            <div class="ipt-container lf">
                                <input type="text" name="email" placeholder="邮箱">
                            </div>
                        </div>
                    </div>
                    <div class="row">
                        <div class="row-title">
                            <h5>个人兴趣</h5>
                        </div>
                        <div class="row-con">
                            <div class="textarea-container">
                                <textarea name="lesson" maxlength="500" placeholder="个人感兴趣的文化之旅目的地简要描述"></textarea>
                            </div>
                            <div class="textarea-container">
                                <textarea name="experience" maxlength="500" placeholder="个人感兴趣的文化项目简要描述"></textarea>
                            </div>
                            <div class="textarea-container">
                                <textarea name="travel" maxlength="500" placeholder="个人感兴趣的旅行方式简要描述"></textarea>
                            </div>
                        </div>
                    </div>
                    <div class="row">
                        <div class="sub-container">
                            <input type="button" name="submit" value="确认提交">
                        </div>
                    </div>
                </form>
            </div>
        </div>
    </div>
</div>