{{ item = data.main[0];"" }}

<!-- default template -->
<article>
    <h1 class="border">Registreren</h1>

    <img class="framed float-right marginalize" src="https://www.classicfm.nl/cdn/musicpanel_classicfm_750x500-3892.jpg" alt="Music Panel" class="border right" />

    <p ng-bind-html='item.content.long'></p>
    
	<!-- start flashmessenger -->
	<!-- end flashmessenger -->        
	
	<form method="POST" name="myForm" class="form-inline" id="myForm" ng-submit="submit()" ng-controller="SubmitController">

		<input type="hidden" name="action" ng-value="inloggen" ng-model="form.action" ng-init="form.action='registreren'">

		<fieldset>

			<ol>
				<li>
					<label for="input-email">E-mailadres <em><em>*</em></em> </label>
					<input type="email" name="input-email" value="" ng-model="form.email" required>
				</li>
				<li>
					<label for="input-password">Wachtwoord <em>*</em> </label>
					<input type="password" name="input-password" value="" ng-model="form.password" required>
				</li>
				<li>
					<label for="input-repeat-password">Herhaal Wachtwoord <em>*</em> </label>
					<input type="password" name="input-repeat-password" value="" ng-model="form.repeat_password" required> 
					<div ng-if="form.repeat_password != form.password">
						<em><strong>Email en wachtwoord moeten overeen komen</strong></em>
					</div>
				</li>
				<li>
					<legend>Persoonsgegevens</legend>
					<label for="input-firstname">Voornaam <em>*</em> </label>
					<input type="text" name="input-firstname" value="" ng-model="form.firstname" required>
				</li>
				<li>
					<label for="input-lastname">Achternaam <em>*</em> </label>
					<input type="text" name="input-lastname" value="" ng-model="form.lastname" required>
				</li>
				<li>
					<label for="input-gender"  class="labelform" >Geslacht <em>*</em> </label>
					<label class="labelform">
						<input type="radio" name="input-gender" class="no-margin" value="M" ng-model="form.gender" required>Man
					</label>
					<label class="labelform">
						<input type="radio" name="input-gender" class="no-margin" value="V" ng-model="form.gender" required>Vrouw
					</label>
					<br /><br />
				</li>
				<li>
					<label for="input-dateofbirth">Geboortedatum <em>*</em> </label>
					<input type="date" name="input-dateofbirth" value="" ng-model="form.dateofbirth" placeholder="DD-MM-YYYY" required>
				</li>
				<li>
					<legend>Adresgegevens</legend>
					<label for="input-address">Adres <em>*</em> </label>
					<input type="text" name="input-address" value="" ng-model="form.address" required>
				</li>
				<li>
					<label for="input-zipcode">Postcode <em>*</em> </label>
					<input type="text" name="input-zipcode" value="" ng-model="form.zipcode" required>
				</li>
				<li>
					<label for="input-city">Woonplaats <em>*</em> </label>
					<input type="text" name="input-city" value="" ng-model="form.city" required>
				</li>
				<li>
					<label for="input-telephone">Telefoon <em>*</em> </label>
					<input type="text" name="input-telephone" value="" ng-model="form.telephone" required>
				</li>
				<li>
					<legend>Nieuwsbrieven</legend>
					<label for="input-opt-newsletter" class="checkbox">
						<input type="hidden" name="input-opt-newsletter" value="0" ng-model="form.newsletter" ng-init="form.newsletter=0">
						<input type="checkbox" name="input-opt-newsletter" value="1" ng-model="form.newsletter" ng-init="form.newsletter=0">Ik wil de tweewekelijkse nieuwsbrief van Classic FM ontvangen. 
					</label>
				</li>
				<li>
					<label for="input-opt-partners" class="checkbox">
						<input type="hidden" name="input-opt-partners" value="0" ng-model="form.partners" ng-init="form.partners=0">
						<input type="checkbox" name="input-opt-partners" value="1" ng-model="form.partners" ng-init="form.partners=0">Ik wil incidenteel (max. 2 x p/mnd) passende commerci&euml;le aanbiedingen ontvangen uit bijvoorbeeld de retail, telecom, en automotive branche, waar ik mij op elk gewenst moment voor kan afmelden. 
					</label>
				</li>
				<li>
				</li>
				<li>
				</li>
			</ol>
		</fieldset>

		<div class="form-actions">
			<small>Velden met een * zijn verplicht</small>
			<div ng-if="error!=''"><em>{{ error }}</em></div>
			<button type="submit" name="input-submit" ng-if="myForm.$valid"><span><i class="fa fa-check"></i> Registreer mij</span></button>
			<button ng-if="myForm.$invalid"><strong><em>Vul het formulier volledig in.</em></strong></button>			
			<button type="reset" name="reset"><span><i class="fa fa-check"></i> Wis velden</span></button>
			
		</div>
	</form>
</article>

<div ng-if="message!=''">{{ message }}</div>