{include file="../application/h5/view/wx_book_dinner/header.html"}

<style>
    .weui_btn_primary{
        background-color: #6eb7ff;
    }
    .weui-vcode-btn {
        color: #6eb7ff;
    }
</style>
<div class="weui-header bg-blue">
    <div class="weui-header-left"> 
    </div>
    <h1 class="weui-header-title">特殊人群申请</h1>
    <div class="weui-header-right"></div>
</div>
<form action="{:url('userapply')}" enctype="multipart/form-data" class="ajax-form" method="post">
    <div class="weui_cells weui_cells_form">
        <div class="weui_cell">
            <div class="weui_cell_hd">
                <label class="weui_label">姓名</label>
            </div>
            <div class="weui_cell_bd">
                <input class="weui_input" placeholder="请输入姓名" type="text" name="name">
            </div>
        </div>
        <div class="weui_cell">
            <div class="weui_cell_hd">
                <label class="weui_label">手机号</label>
            </div>
            <div class="weui_cell_bd">
                <input class="weui_input" placeholder="请输入手机号" type="tel" name="TEL">
            </div>
        </div>


        <div class="weui_cell">
            <div class="weui_cell_hd">
                <label class="weui_label">证明图片</label>
            </div>
            <div class="weui_cell_bd">
                <input class="weui_input" style="height: auto!important;" multiple="true" type="file" accept="image/png,image/jpeg" name="files[]">
            </div>
        </div>
    </div>

   <div class="weui_btn_area">
        <button type="submit" class="weui_btn weui_btn_primary">确定</button>
    </div>
</form>
<div style="height: 30px;"></div>
<script type="text/javascript">

</script>