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<div id="submit-header" data-role="header">
<h1>Your details</h1>
</div>
<div data-role="content">
<div id="errors"></div>
<div class="inputcard">
<% if ( typeof model.title_list !== 'undefined' ) { %>
<div>
<select data-role="none" placeholder="Title" id="form_title" name="title" required>
<option value="">Title</option>
<% for ( var i = 0; i < model.title_list.length; i++ ) { var title = model.title_list[i]; print( '<option value="' + title + '">' + title + '</option>' ); } %>
</select>
</div>
<% } %>
<div>
<input data-role="none" type="text" value="<%= user.name %>" name="name" id="form_name" placeholder="Please enter your name" required>
</div>
<div>
<input data-role="none" type="tel" value="<%= user.phone %>" name="name" id="form_phone" placeholder="Please enter your phone number">
</div>
<div data-role="fieldcontain">
<fieldset data-role="controlgroup">
<input type="checkbox" name="may_show_name" id="form_may_show_name" value="1" checked>
<label for="form_may_show_name">Show my name publicly</label>
</fieldset>
</div>
</div>
<input data-role="button" data-theme="a" type="button" id="send_confirm" name="send_confirm" value="Send confirmation email">
</div>
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