"PB Registration"
Bootstrap 3.3.0 Snippet by abdulalimmasud

<link href="//maxcdn.bootstrapcdn.com/bootstrap/3.3.0/css/bootstrap.min.css" rel="stylesheet" id="bootstrap-css"> <script src="//maxcdn.bootstrapcdn.com/bootstrap/3.3.0/js/bootstrap.min.js"></script> <script src="//code.jquery.com/jquery-1.11.1.min.js"></script> <!------ Include the above in your HEAD tag ----------> <div class="container"> <div class="row"> <div class="col-md-6 col-md-offset-3"> <div class="panel panel-primary"> <div class="panel-heading">Thank you for Sign Up!</div> <div class="panel-body"> <form role="form" method="post" action="" accept-charset="UTF-8"> <label for="fname">First Name</label> <input type="text" id="fname" class="form-control" name="fname" placeholder="Example: John"> <label for="lname">Last Name</label> <input type="text" id="lname" class="form-control" name="lname" placeholder="Example: Smith"> <label for="states" class="m-t-10">Select your State</label> <select id="states" class="form-control" name="state"> <option value="unknown">Unknown</option> <option value="alabama">Alabama</option> <option value="alaska">Alaska</option> <option value="arizona">Arizona</option> <option value="arkansas">Arkansas</option> <option value="california">California</option> <option value="colorado">Colorado</option> <option value="connecticut">Connecticut</option> <option value="delaware">Delaware</option> <option value="florida">Florida</option> <option value="georgia">Georgia</option> <option value="hawaii">Hawaii</option> <option value="idaho">Idaho</option> <option value="illinois">Illinois</option> <option value="indiana">Indiana</option> <option value="iowa">Iowa</option> <option value="kansas">Kansas</option> <option value="kentucky">Kentucky</option> <option value="louisiana">Louisiana</option> <option value="maine">Maine</option> <option value="maryland">Maryland</option> <option value="massachusetts">Massachusetts</option> <option value="michigan">Michigan</option> <option value="minnesota">Minnesota</option> <option value="mississippi">Mississippi</option> <option value="missouri">Missouri</option> <option value="montana">Montana</option> <option value="nebraska">Nebraska</option> <option value="nevada">Nevada</option> <option value="new hampshire">New Hampshire</option> <option value="new jersey">New Jersey</option> <option value="new mexico">New Mexico</option> <option value="new york">New York</option> <option value="north carolina">North Carolina</option> <option value="north dakota">North Dakota</option> <option value="ohio">Ohio</option> <option value="oklahoma">Oklahoma</option> <option value="oregon">Oregon</option> <option value="pennsylvania">Pennsylvania</option> <option value="rhode island">Rhode Island</option> <option value="south carolina">South Carolina</option> <option value="south dakota">South Dakota</option> <option value="tennessee">Tennessee</option> <option value="texas">Texas</option> <option value="utah">Utah</option> <option value="vermont">Vermont</option> <option value="virginia">Virginia</option> <option value="washington">Washington</option> <option value="west virginia">West Virginia</option> <option value="wisconsin">Wisconsin</option> <option value="wyoming">Wyoming</option> </select> <label for="gender" class="m-t-10">Your Gender</label> <select id="gender" class="form-control" name="gender"> <option value="unknown">Unknown</option> <option value="alabama">Female</option> <option value="alaska">Male</option> </select> <label for="emailaddr" class="m-t-10">Email Address</label> <input type="text" id="emailaddr" class="form-control" name="email" placeholder="Example: john.smith@gmail.com"> <label for="password" class="m-t-10">Password</label> <input type="password" id="password" class="form-control" name="password" placeholder=""> <label for="verifypass" class="m-t-10">Verify Password</label> <input type="password" id="confirmpass" class="form-control" name="verifypass" placeholder=""> <center><input type="submit" class="btn btn-primary m-t-10" id="submitbtn" name="submit" value="Submit"></center> </form> </div> </div> </div> </div> </div>
.m-t-10 { margin-top: 10px; }

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