{% trans_default_domain 'FOSUserBundle' %}

 <div class="appointment-form no-pad dept-form">

     <div class="subtitle notViewed " style="margin-bottom: 0px!important; background: transparent !important;">
         <span class="iconlist-mid-title">sign </span> up
     </div>

     {{ form_start(form, {'method': 'post', 'action': path('fos_user_registration_register'), 'attr': {'class': 'fos_user_registration_register appt-form','id': 'validateForm'}}) }}

     <div class="form-group">
         <div  class="col-md-12 {% if  form.civility.vars.errors|length > 0 %} has-error {% endif %}">
             {{ form_widget(form.civility, { 'attr': {'class': 'clip-radio radio-primary'} }) }}
             {% if  form.civility.vars.errors|length > 0 %}
                 <div class="text-orange text-large"> {{ form_errors(form.civility) }}</div>
             {% endif %}
         </div>
     </div>

     <div class="form-group">
         <div  class="col-md-12 {% if  form.civility.vars.errors|length > 0 %} has-error {% endif %}">
             {{ form_widget(form.title, { 'attr': { 'class': 'appt-form-txt','placeholder': 'Title' } }) }}
             {% if  form.title.vars.errors|length > 0 %}
                 <div class="text-orange text-large"> {{ form_errors(form.title) }}</div>
             {% endif %}
         </div>
     </div>

     <div class="form-group">
         <div  class="col-md-6 {% if  form.firstname.vars.errors|length > 0 %} has-error {% endif %}">
             {{ form_widget(form.firstname, { 'attr': {'class': 'appt-form-txt', 'placeholder': 'First Name *' } }) }}
             {% if  form.firstname.vars.errors|length > 0 %}
                 <div class="text-orange text-large"> {{ form_errors(form.firstname) }}</div>
             {% endif %}
         </div>

         <div  class="col-md-6 {% if  form.lastname.vars.errors|length > 0 %} has-error {% endif %}">
             {{ form_widget(form.lastname, { 'attr': {'class': 'appt-form-txt', 'placeholder': 'Last Name *' } }) }}
             {% if  form.lastname.vars.errors|length > 0 %}
                 <div class="text-orange text-large"> {{ form_errors(form.lastname) }}</div>
             {% endif %}
         </div>
     </div>

     <div class="form-group">
         <div  class="col-md-12 {% if  form.organism.vars.errors|length > 0 %} has-error {% endif %}">
             {{ form_widget(form.organism, { 'attr': {'class': 'appt-form-txt', 'placeholder': 'Organism' } }) }}
             {% if  form.organism.vars.errors|length > 0 %}
                 <div class="text-orange text-large"> {{ form_errors(form.organism) }}</div>
             {% endif %}
         </div>
     </div>

     <div class="form-group">
         <div  class="col-md-12 {% if  form.resume.vars.errors|length > 0 %} has-error {% endif %}">
             {{ form_widget(form.resume, { 'attr': {'class': 'appt-form-txt textarea ', 'placeholder': 'Resume' } }) }}
             {% if  form.resume.vars.errors|length > 0 %}
                 <div class="text-orange text-large"> {{ form_errors(form.resume) }}</div>
             {% endif %}
         </div>
     </div>

                    <div class="form-group">
                        <div  class="col-md-12">
                             {{ form_widget(form.address1, { 'attr': {'class': 'appt-form-txt', 'placeholder': 'Address 1 ...' } }) }}
                             {{ form_errors(form.address1) }}
                          </div>
                    </div>

                    <div class="form-group">
                        <div  class="col-md-12">
                             {{ form_widget(form.address2, { 'attr': {'class': 'appt-form-txt', 'placeholder': 'Address 2 ...' } }) }}
                             {{ form_errors(form.address2) }}
                          </div>
                    </div>

                     <div class="form-group">
                        <div  class="col-md-4">
                             {{ form_widget(form.country, { 'attr': {'class': 'appt-form-txt', 'placeholder': 'Country' } }) }}
                             {{ form_errors(form.country) }}
                          </div>
                           <div  class="col-md-4">
                             {{ form_widget(form.city, { 'attr': {'class': 'appt-form-txt', 'placeholder': 'City' } }) }}
                             {{ form_errors(form.city) }}
                          </div>
                           <div  class="col-md-4">
                             {{ form_widget(form.zipcode, { 'attr': {'class': 'appt-form-txt', 'placeholder': 'Zipcode ' } }) }}
                             {{ form_errors(form.zipcode) }}
                          </div>
                    </div>

                    <div class="form-group">
                        <div  class="col-md-6">
                            {{ form_widget(form.email, { 'attr': {'class': 'appt-form-txt', 'placeholder': 'E-mail *' } }) }}
                            {{ form_errors(form.email, { 'attr': {'class': 'appt-form-error' } }) }}
                         </div>   
						<div  class="col-md-6">
                           <input id="confirm-email" type='email' class='appt-form-txt' placeholder= 'Confirm E-mail *' onPaste="this.value = '';return false;" required />
                            {{ form_errors(form.email, { 'attr': {'class': 'appt-form-error'} }) }}
                        </div>
                    </div>
                              
                    <div class="form-group">
                        <div  class="col-md-6">
                            {{ form_widget(form.phone, { 'attr': {'class': 'appt-form-txt', 'placeholder': 'Phone' } }) }}
                            {{ form_errors(form.phone) }}
                         </div>
                        <div  class="col-md-6">
                            {{ form_widget(form.fax, { 'attr': {'class': 'appt-form-txt', 'placeholder': 'Fax' } }) }}
                            {{ form_errors(form.fax) }}
                         </div>
                    </div>

                     <div class="form-group">
                        <div  class="col-md-12">
                             {{ form_widget(form.plainPassword.first, { 'attr': {'class': 'appt-form-txt', 'placeholder': 'Password *' } }) }}
                             {{ form_errors(form.plainPassword.first) }}
                           </div>   
                    </div>

                    <div class="form-group">
                        <div  class="col-md-12">
                             {{ form_widget(form.plainPassword.second, { 'attr': {'class': 'appt-form-txt', 'placeholder': 'Confirm Password *' } }) }}
                             {{ form_errors(form.plainPassword.second) }}
                          </div>   
                    </div>

                    <section class="color-7" id="btn-click">
                        <button id="btn-register"  type="submit"  class="news-button pull-right">&nbsp;&nbsp;
                            <strong>Register</strong>
                        </button>
                    </section>
                  
     {{ form_end(form) }}
                        
 </div>
<br>