{% trans_default_domain 'FOSUserBundle' %}
  <div id="page-autenticacion" class="col-md-5 col-md-push-1">
    <div class="page-content">
      <div id="tab-general">
        <div class="row">
          <br>
          <div class="col-md-10 col-md-push-1">
            <div class="panel">
              <div class="panel-body">
                <h1 class="block-heading">Registro</h1>
                <form action="{{ path('fos_user_registration_register') }}" {{ form_enctype(form) }} method="POST" class="fos_user_registration_register">
                  <div class="row mbl">
                    <div class="col-md-6">
                      {{ form_label(form.username) }}
                      <div class="input-icon">
                        <i class="fa fa-user"></i>
                        {% if form.username.vars.errors[0].message is defined %}
                          <span class="help-block">
                            {{ form.username.vars.errors[0].message }}
                          </span>
                        {% endif %}
                        {{ form_widget(form.username, {'attr': {'class': 'form-control','placeholder':'Nombre de Usuario'}}) }}
                      </div>  
                    </div>
                    
                  </div>
                  <div class="row mbl">
                      <div class="col-md-6">
                        {{ form_label(form.primerNombre) }}
                        {% if form.primerNombre.vars.errors[0].message is defined %}
                          <span class="help-block">
                            {{ form.primerNombre.vars.errors[0].message }}
                          </span>
                        {% endif %}
                        {{ form_widget(form.primerNombre, {'attr': {'class': 'form-control','placeholder':'Primer Nombre'}}) }}  
                      </div>
                      <div class="col-md-6">
                        {{ form_label(form.segundoNombre) }}
                        {% if form.segundoNombre.vars.errors[0].message is defined %}
                          <span class="help-block">
                            {{ form.segundoNombre.vars.errors[0].message }}
                          </span>
                        {% endif %}
                        {{ form_widget(form.segundoNombre, {'attr': {'class': 'form-control','placeholder':'Segundo Nombre'}}) }}  
                      </div>
                  </div>
                  <div class="row mbl">
                      <div class="col-md-6">
                        {{ form_label(form.primerApellido) }}
                        {% if form.primerApellido.vars.errors[0].message is defined %}
                          <span class="help-block">
                            {{ form.primerApellido.vars.errors[0].message }}
                          </span>
                        {% endif %}
                        {{ form_widget(form.primerApellido, {'attr': {'class': 'form-control','placeholder':'Primer Apellido'}}) }}  
                      </div>
                      <div class="col-md-6">
                        {{ form_label(form.segundoApellido) }}
                        {% if form.segundoApellido.vars.errors[0].message is defined %}
                          <span class="help-block">
                            {{ form.segundoApellido.vars.errors[0].message }}
                          </span>
                        {% endif %}
                        {{ form_widget(form.segundoApellido, {'attr': {'class': 'form-control','placeholder':'Segundo Apellido'}}) }}  
                      </div>
                  </div>
                  
                  <div class="input-icon mbl">
                    {{ form_label(form.email) }}
                    <i class="fa fa-envelope"></i>
                      {% if form.email.vars.errors[0].message is defined %}
                        <span class="help-block">
                          {{ form.email.vars.errors[0].message }}
                        </span>
                      {% endif %}
                    {{ form_widget(form.email, {'attr': {'class': 'form-control','placeholder':'correo@ubv.edu.ve'}}) }}
                  </div>
                  
                  <div class="row mbl">
                    <div class="col-md-6">
                      {{ form_label(form.plainPassword.first) }}
                      <div class="input-icon">
                        <i class="fa fa-key"></i>
                        {% if form.plainPassword.first.vars.errors[0].message is defined %}
                          <span class="help-block">
                            {{ form.plainPassword.first.vars.errors[0].message }}
                          </span>
                        {% endif %}
                        {{ form_widget(form.plainPassword.first, {'attr': {'class': 'form-control','placeholder':'Contraseña'}}) }}
                      </div>  
                    </div>
                    <div class="col-md-6">
                      {{ form_label(form.plainPassword.second) }}
                      <div class="input-icon">
                        <i class="fa fa-key"></i>
                        {% if form.plainPassword.second.vars.errors[0].message is defined %}
                          <span class="help-block">
                            {{ form.plainPassword.second.vars.errors[0].message }}
                          </span>
                        {% endif %}
                        {{ form_widget(form.plainPassword.second, {'attr': {'class': 'form-control','placeholder':'Contraseña'}}) }}
                      </div>  
                    </div>
                  </div>
                  {{ form_widget(form) }}
                  <button type="submit" class="btn btn-lg btn-primary btn-block">Crear Cuenta</button>
                </form>
              </div>
            </div>
          </div>
        </div>
      </div>
    </div>
  </div>