<section class="inquiry-form-section clean-block">
	<div class="container">
		<div class="row">
			<div class="col-12">
				<h2 class="text-center">專業團隊度身訂製個人療程</h2>
				<p class="contact-us-summary">我們的專業團隊會根據個人需要，為您度身訂製個人療程，將客人塑造獨一無二的自然美。</p>
				<p class="contact-us-summary-1">立即登記塑造奇蹟！</p>
			</div>
		</div>
		<form class="contact-us-form" action="post">
			<div class="row contact-us-form-block">
				<div class="col-lg-6">
					<div class="form-group">
						<input type="text" class="form-control" placeholder="姓氏*"/>
					</div>
				</div>
				<div class="col-lg-6">
					<div class="form-group">
						<input type="text" class="form-control" placeholder="名字*"/>
					</div>
				</div>
				<div class="col-lg-6">
					<div class="form-group">
						<input type="text" class="form-control" placeholder="電話*"/>
					</div>
				</div>
				<div class="col-lg-3">
					<div class="form-group">
						<select class="form-control">
							<option value="" selected="selected">年齡組別</option>
							<option value="18-25">18-25</option>
							<option value="25-35">25-35</option>
							<option value="35-45">35-45</option>
							<option value="45-60">45-60</option>
							<option value="60+">60+</option>
						</select>
					</div>
				</div>
				<div class="col-lg-3">
					<div class="form-group">
						<select class="form-control">
							<option value="" selected="selected">性別</option>
							<option value="女">女</option>
							<option value="男">男</option>
						</select>
					</div>
				</div>
				<div class="col-lg-6">
					<div class="form-group">
						<input type="email" class="form-control" placeholder="電郵*"/>
					</div>
				</div>
				<div class="col-lg-6">
					<div class="form-group">
						<select class="form-control">
							<option value="" selected="selected">如何認識KEYSTOSYOUNG</option>
							<option value="Facebook">Facebook</option>
							<option value="Instagram">Instagram</option>
							<option value="搜尋器">搜尋器</option>
							<option value="朋友推介">朋友推介</option>
						</select>
					</div>
				</div>
				<div class="col-12">
					<div class="form-group last-item">
						<textarea class="form-control" placeholder="訊息"></textarea>
					</div>
				</div>
				<div class="col-12">
					<span class="small-font">*必需填寫</span>
				</div>
<!--				<div class="col-12 pt-3 pb-3">-->
<!--					<img style="width: 250px;" src="--><?//= base_url('assets/img/newCaptchaAnchor.gif?' . $hash); ?><!--"/>-->
<!--				</div>-->
				<div class="col-12">
					<div class="custom-control custom-checkbox">
						<input type="checkbox" class="custom-control-input" id="agreement"/>
						<label class="custom-control-label small-font" for="agreement">本人同意所提供的資料可按照本人已閱讀、理解及同意之法律聲明及私隱政策而作出持有及使用。</label>
					</div>
				</div>
				<div class="col-12">
					<div class="custom-control custom-checkbox">
						<input type="checkbox" class="custom-control-input" id="advertisement"/>
						<label class="custom-control-label small-font" for="advertisement">本人願意繼續收取KEYSTOYOUNG及其旗下品牌之禮品、產品資料、宣傳資訊及推廣優惠。</label>
					</div>
				</div>
				<div class="col-12 pt-3 text-center">
					<button class="btn btn-register"><img
							src="<?= base_url('assets/img/btn-register.png?' . $hash); ?>"/>
				</div>
			</div>
		</form>
	</div>
</section>
