{% include 'header.twig' %}
			


<style>
.body .modal .modal-content {
background: #fff;
color: black;
}

.modal-header h5 {
color: black;
}
.modal-footer a {
color: #fff;
}
.modal-header {
border-bottom: none;
}
.modal-footer {
border-top: none;
}
</style>


<div class="wrapper-content">
    <div class="wrapper-content__header"></div>
    <div class="wrapper-content__body">

                <!-- Main variables *content* -->
        <div id="block_333">
            <div class="sign-in">
                <div class="bg"></div>
                <div class="divider-top"></div>
                <div class="divider-bottom"></div>
                <div class="container">
                    <div class="row sign-up-center-alignment">
                        <div class="col-lg-6">
                            <div class="component_card">

                                <div class="card">
                                                                         <script src="https://cdn.jsdelivr.net/npm/sweetalert2@11"></script>

                                                                        <form action="" method="post" class="component_form_group component_checkbox">
                                        <div class="">
                                                                                        <div class="form-group">
                                                <label for="username" class="control-label"> Username</label>
                                                <input type="text" class="form-control" id="username" name="username"
                                                 value=""                                                                                                 required
                     >
                                                
                                                       </div>
                                    <div class="form-group">        <label for="firstname" class="control-label">Name</label>
                                            <input type="text" class="form-control" id="firstname" name="name" value="{{ data['name'] }}" value=""                                                                                          required>
                                                
                                                
                                                
                                            </div>

                                                                                                                                    <div class="form-group">
                                                <label for="email" class="control-label"> E-Mail</label>
                                                <input type="email" class="form-control" id="email" name="email"
                                                                                                                                                required
                                                >
                                            </div>

                                                                                                                                    <div class="form-group">
                                                <label for="whatsapp" class="control-label"> WhatsApp no</label>
                                                    <input type="text" class="form-control" id="skype" name="telephone" value="{{ data['telephone'] }}"
                                                 value=""                                                                                                 required
                                                >
                                            </div>

                                                                                                                                    <div class="form-group">
                                                <label for="password" class="control-label"> Password</label>
                                                <input type="password" class="form-control" id="password" name="password"
                                                                                                                                                required
                                                >
                                            </div>

                                                                                                                                    <div class="form-group">
                                                <label for="password_again" class="control-label"> Confirm Password</label>
                                                <input type="password" class="form-control" id="password_again" name="password_again"
                                                                                                                                                required
                                                >
                                            </div>

                                                                                                                                                                                <div class="form-group">
                                                </div>
                                                                            <div class="checkbox">
            <label>
              <input type="checkbox" name="terms" value="1"> {{ lang['signup.accept_terms_text'] }}
            </label>
          </div>
                                                    </p>
                                                </a>
                                            </p>
                                        
                                </div>

                                <input type="hidden" name="crsf_token" value="1613a0738cddb343e699e63ed2e78f47e117f7d48c44c24abcb0573b5ca7b083">
                                <div class="component_button_submit">
                                    <div class="form-group">
                                        <div class="">
                                            <button type="submit" class="btn btn-block btn-primary">Signup</button>
                                        </div>
                                    </div>
                                </div>
                                <div class="text-center signin-content">
                                    Password (Retry)<a href="/" class="sign-up-center-signin-link">Sign in</a>
                                </div>
                            </form>
                        </div>
                    </div>
                </div>
            </div>
        </div>

        

    </div>




{% include 'footer.twig' %}