%PDF-
%PDF-
Mini Shell
Mini Shell
<div class="uk-container">
<div class="uk-child-width-1-2@s uk-child-width-1-2@m" uk-grid>
<div class="uk-flex uk-flex-middle">
<div>
<div class="firstBlock">
<small>Vacina da Gripe 2023</small>
<h1 class="uk-text-uppercase">Agende <br> sua vacina</h1>
<p><mark>DOSES LIMITADAS</mark></p>
</div>
</div>
</div>
<div>
<div class="uk-card uk-card-default uk-card-body formBlock">
<div class="content">
<h3 class="uk-text-left uk-text-uppercase">Quero fazer minha reserva</h3>
<form action="https://script.google.com/macros/s/AKfycbzahjAQ2TGsLkaP1HfbuBBTTODIU7nJ2u_elOtLzIomZsDer7NociT9C78Z1uUa018xzQ/exec" method="POST" class="formMailer">
<div class="form-elements">
<div class="uk-margin">
<label class="uk-form-label" for="inputNome">Nome</label>
<div class="uk-form-controls">
<input class="uk-input" id="inputNome" type="text" name="Nome" required>
</div>
</div>
<div class="uk-margin">
<label class="uk-form-label" for="inputEmpresa">Empresa</label>
<div class="uk-form-controls">
<input class="uk-input" id="inputEmpresa" type="text" name="Empresa" required>
</div>
</div>
<div class="uk-margin">
<label class="uk-form-label" for="inputCelular">Celular</label>
<div class="uk-form-controls">
<input class="uk-input" id="inputCelular" type="text" name="Celular" required>
</div>
</div>
<div class="uk-margin">
<label class="uk-form-label" for="inputEmail">E-mail</label>
<div class="uk-form-controls">
<input class="uk-input" id="inputEmail" type="text" name="Email" required>
</div>
</div>
<div class="uk-margin">
<label class="uk-form-label" for="inputCidade">Cidade/Estado</label>
<div class="uk-form-controls">
<input class="uk-input" id="inputCidade" type="text" name="Cidade/Estado" required>
</div>
</div>
<fieldset class="pure-group honeypot-field">
<label for="honeypot">To help avoid spam, utilize a Honeypot technique with a hidden text field; must be empty to submit the form! Otherwise, we assume the user is a spam bot.</label>
<input id="honeypot" type="text" name="honeypot" value="" />
</fieldset>
<div class="uk-margin">
<label class="uk-form-label" for="inputDoses">Número de Doses</label>
<div class="uk-form-controls">
<input class="uk-input" id="inputDoses" type="text" name="Doses" required>
</div>
</div>
<label class="uk-form-label"><input class="uk-checkbox" type="checkbox" name="Aceito" id="TermosFooter" value="Aceito" required> Aceito receber as comunicações da Vacivitta</label>
<div class="uk-margin">
<button class="uk-button uk-button-default uk-width-1-1" type="submit">QUERO GARANTIR MINHA DOSE</button>
</div>
<!-- Customize the Thankyou Message People See when they submit the form: -->
<div class="thankyou_message" style="display:none;">
<h6>Obrigado! Em breve, entraremos em contato</h6>
</div>
</div>
</form>
</div>
</div>
</div>
</div>
</div>
Zerion Mini Shell 1.0