{include file="file:$templatedir/header.mb.html"}
退会依頼
{include file="file:$templatedir/notice.mb.html"}
{csrf} {html_session_hidden}
{l}退会します。{/l}
{l}よろしいですか?{/l}

{l}■退会理由選択:{/l}
{$form.flg|local_word:$reason}

{l}■退会理由(任意):{/l}
{$form.body|nl2br}


{include file="file:$templatedir/footer.mb.html"}