<?php
$page_title = "密碼重置申請";
include_once('site_config.php');
include_once('template/base_site_head.php');
?>
<wrapper class="mymain_container">
	<section class="container page-container">
		<div class="form_information">
		<div class="row page-title">
			<div class="col-sm-12">
				<h1 class="blue-line-ctr"><?php echo $page_title; ?></h1>
			</div>
		</div>
    <!-- メインエリア -->
    <div id="main" class="container">

      <form id="acForm" action="" method="post" class="form_list active">
		<div class="cont_steps s_step">
	       	 <div class="field_list">
	        		<div class="limit_width">
      <p>請點擊重置連結，在頁面輸入您的確認碼，出生日期和新密碼。<br></p>
		<?php $this -> dispMessagesCommon(); ?>
			        		<div class="cus_form">
			        			<div class="table_form table_form_list">
				        			<div class="form_elem ">
				        				<label class="title_txt">確認碼</label>
				        				<input type="password" name="conf_code" class="form-control verify_input" autocomplete="off" value="" /><i class="fa"></i>
				        			</div>
				        			<div class="form_elem ">
				        				<label class="title_txt">出生日期</label>
							<select name="birth_month" class="select">
								<?php $this -> dispMonth(); ?>
							</select>
							<select name="birth_day" class="select">
								<?php $this -> dispDay(); ?>
							</select>
							<select name="birth_year" class="select">
								<?php $this -> dispYear(); ?>
							</select>
				        			</div>
				        			<div class="form_elem ">
				        				<label class="title_txt">密碼<br><span class="note_s">密碼長度需為8-35位數字字母組合,字母區分大小寫。(例: Abcdefg1)</span></label>
				        				<input type="password" name="password" class="form-control verify_input" value="" /><i class="fa"></i>
				        			</div>
				        			<div class="form_elem ">
				        				<label class="title_txt">（再次輸入）<br><span class="note_s">請再次輸入密碼。</span></label>
				        				<input type="password" name="password_confirm" class="form-control verify_input" value="" /><i class="fa"></i>
				        			</div>
				        		</div>
			        		</div>
			<input type="hidden" id="type" name="type" value="" />
			<input type="hidden" id="id" name="id" value="<?php $this -> echoID(); ?>" />
				        		</div>
			        		</div>
	        		<div class="event_next1 event_custom">
	        			<input type="button" id="btnComplete" value="下一步" class="custom nxt_form">
	        		</div>
	        			</div>
      </form>
    </div>
    <script src="../js/register.js"></script>
    <!-- /メインエリア -->
    	</div>
	</section>
</wrapper>
<?php
include_once('template/base_site_foot.php');
echo $endscripts;
?>
</body>
</html>