Inscription

Je valide mon inscription pour être partie prenante de la campagne d’activation des Maîtres Boulangers-Pâtissiers 2018. En tant que participant, je recevrai gratuitement mon kit promotionnel avant le 30.09.2018. Ce kit comprend :

  • 1 affiche de format A3
  • 1 habillage vitrine
  • 1 vitrophanie de format A4
  • 1000 sacs à pains (2 formats différents)
  • 250 calendriers 2019

Pour bénéficier de cette offre, vous devez être en ordre de cotisation et votre inscription doit être enregistrée au plus tard pour le 31 mai 2018 à minuit.

{!! Form::open(array('url' => 'inscription', 'method' => 'POST', 'class' => 'form2check')) !!}

Les coordonnées de VOTRE POINT DE VENTE
(à ne pas confondre avec le siège social de votre société)

{{ Form::hidden('lang', 'fr') }}
{!! Form::label('name', 'Nom du point de vente : ') !!} {!! Form::text('name', '', array('class' => 'form-control', 'required')) !!} {!! $errors->first('name', ':message') !!}
{!! Form::label('lastname', 'Nom du responsable : ') !!} {!! Form::text('lastname', '', array('class' => 'form-control', 'required')) !!} {!! $errors->first('lastname', ':message') !!}
{!! Form::label('firstname', 'Prénom du responsable : ') !!} {!! Form::text('firstname', '', array('class' => 'form-control', 'required')) !!} {!! $errors->first('firstname', ':message') !!}
{!! Form::label('street', 'Rue et N° : ') !!} {!! Form::text('street', '', array('class' => 'form-control', 'required')) !!} {!! $errors->first('street', ':message') !!}
{!! Form::label('zip', 'Code postal : ') !!} {!! Form::text('zip', '', array('class' => 'form-control', 'required')) !!} {!! $errors->first('zip', ':message') !!}
{!! Form::label('city', 'Localité : ') !!} {!! Form::text('city', '', array('class' => 'form-control', 'required')) !!} {!! $errors->first('city', ':message') !!}
{!! Form::label('phone', 'Téléphone : ') !!} {!! Form::text('phone', '', array('class' => 'form-control', 'required')) !!} {!! $errors->first('phone', ':message') !!}
{!! Form::label('mobile', 'GSM :') !!} {!! Form::text('mobile', '', array('class' => 'form-control')) !!} {!! $errors->first('mobile', ':message') !!}
{!! Form::label('website', 'Site web :') !!} {!! Form::text('website', '', array('class' => 'form-control')) !!} {!! $errors->first('website', ':message') !!}
{!! Form::label('email', 'E-mail : ') !!} {!! Form::email('email', '', array('class' => 'form-control', 'required')) !!} {!! $errors->first('email', ':message') !!}
{!! Form::label('email_confirmation', 'E-mail (confirmation) : ') !!} {!! Form::email('email_confirmation', '', array('class' => 'form-control', 'required')) !!} {!! $errors->first('email_confirmation', ':message') !!}
{!! Form::label('tva', 'N° de TVA : ') !!} {!! Form::text('tva', '', array('class' => 'form-control', 'placeholder' => 'BE0XXX XXX XXX', 'required')) !!} {!! $errors->first('tva', ':message') !!}

Veuillez indiquer les jours d’ouverture et de fermeture de votre établissement :

{!! Form::select("mon_morning_in", $select_hours_am, '7:00', ['class'=>'form-control required']) !!} {!! $errors->first('mon_morning_in', ':message') !!}
{!! Form::select("mon_morning_out", $select_hours_am, '12:00', ['class'=>'form-control required']) !!} {!! $errors->first('mon_morning_out', ':message') !!}
{!! Form::select("mon_afternoon_in", $select_hours_pm, '13:00', ['class'=>'form-control required']) !!} {!! $errors->first('mon_afternoon_in', ':message') !!}
{!! Form::select("mon_afternoon_out", $select_hours_pm, '18:00', ['class'=>'form-control required']) !!} {!! $errors->first('mon_afternoon_out', ':message') !!}
{!! Form::select("tue_morning_in", $select_hours_am, '7:00', ['class'=>'form-control required']) !!} {!! $errors->first('tue_morning_in', ':message') !!}
{!! Form::select("tue_morning_out", $select_hours_am, '12:00', ['class'=>'form-control required']) !!} {!! $errors->first('tue_morning_out', ':message') !!}
{!! Form::select("tue_afternoon_in", $select_hours_pm, '13:00', ['class'=>'form-control required']) !!} {!! $errors->first('tue_afternoon_in', ':message') !!}
{!! Form::select("tue_afternoon_out", $select_hours_pm, '18:00', ['class'=>'form-control required']) !!} {!! $errors->first('tue_afternoon_out', ':message') !!}
{!! Form::select("wed_morning_in", $select_hours_am, '7:00', ['class'=>'form-control required']) !!} {!! $errors->first('wed_morning_in', ':message') !!}
{!! Form::select("wed_morning_out", $select_hours_am, '12:00', ['class'=>'form-control required']) !!} {!! $errors->first('wed_morning_out', ':message') !!}
{!! Form::select("wed_afternoon_in", $select_hours_pm, '13:00', ['class'=>'form-control required']) !!} {!! $errors->first('wed_afternoon_in', ':message') !!}
{!! Form::select("wed_afternoon_out", $select_hours_pm, '18:00', ['class'=>'form-control required']) !!} {!! $errors->first('wed_afternoon_out', ':message') !!}
{!! Form::select("thu_morning_in", $select_hours_am, '7:00', ['class'=>'form-control required']) !!} {!! $errors->first('thu_morning_in', ':message') !!}
{!! Form::select("thu_morning_out", $select_hours_am, '12:00', ['class'=>'form-control required']) !!} {!! $errors->first('thu_morning_out', ':message') !!}
{!! Form::select("thu_afternoon_in", $select_hours_pm, '13:00', ['class'=>'form-control required']) !!} {!! $errors->first('thu_afternoon_in', ':message') !!}
{!! Form::select("thu_afternoon_out", $select_hours_pm, '18:00', ['class'=>'form-control required']) !!} {!! $errors->first('thu_afternoon_out', ':message') !!}
{!! Form::select("fri_morning_in", $select_hours_am, '7:00', ['class'=>'form-control required']) !!} {!! $errors->first('fri_morning_in', ':message') !!}
{!! Form::select("fri_morning_out", $select_hours_am, '12:00', ['class'=>'form-control required']) !!} {!! $errors->first('fri_morning_out', ':message') !!}
{!! Form::select("fri_afternoon_in", $select_hours_pm, '13:00', ['class'=>'form-control required']) !!} {!! $errors->first('fri_afternoon_in', ':message') !!}
{!! Form::select("fri_afternoon_out", $select_hours_pm, '18:00', ['class'=>'form-control required']) !!} {!! $errors->first('fri_afternoon_out', ':message') !!}
{!! Form::select("sat_morning_in", $select_hours_am, '7:00', ['class'=>'form-control', 'required']) !!} {!! $errors->first('sat_morning_in', ':message') !!}
{!! Form::select("sat_morning_out", $select_hours_am, '12:00', ['class'=>'form-control', 'required']) !!} {!! $errors->first('sat_morning_out', ':message') !!}
{!! Form::select("sat_afternoon_in", $select_hours_pm, '13:00', ['class'=>'form-control', 'required']) !!} {!! $errors->first('sat_afternoon_in', ':message') !!}
{!! Form::select("sat_afternoon_out", $select_hours_pm, '18:00', ['class'=>'form-control', 'required']) !!} {!! $errors->first('sat_afternoon_out', ':message') !!}
{!! Form::select("sun_morning_in", $select_hours_am, '7:00', ['class'=>'form-control', 'required']) !!} {!! $errors->first('sun_morning_in', ':message') !!}
{!! Form::select("sun_morning_out", $select_hours_am, '12:00', ['class'=>'form-control', 'required']) !!} {!! $errors->first('sun_morning_out', ':message') !!}
{!! Form::select("sun_afternoon_in", $select_hours_pm, '13:00', ['class'=>'form-control', 'required']) !!} {!! $errors->first('sun_afternoon_in', ':message') !!}
{!! Form::select("sun_afternoon_out", $select_hours_pm, '18:00', ['class'=>'form-control', 'required']) !!} {!! $errors->first('sun_afternoon_out', ':message') !!}


A ce titre :






En option :

 
Si le nom est different de celui du responsable, veuillez nous communiquer les nom et prénom à indiquer sur la plaque :

{!! Form::label('mbp_lastname', 'Nom:') !!} {!! Form::text('mbp_lastname', '', array('class' => 'form-control')) !!} {!! $errors->first('mbp_lastname', ':message') !!}
{!! Form::label('mbp_firstname', 'Prénom:') !!} {!! Form::text('mbp_firstname', '', array('class' => 'form-control')) !!} {!! $errors->first('mbp_firstname', ':message') !!}


{!! Form::submit("Je valide mon inscription", array('class' => 'btn btn-baker')) !!}
{!! Form::close() !!}