<link href="//netdna.bootstrapcdn.com/twitter-bootstrap/2.3.2/css/bootstrap-combined.min.css" rel="stylesheet" id="bootstrap-css">
<script src="//netdna.bootstrapcdn.com/twitter-bootstrap/2.3.2/js/bootstrap.min.js"></script>
<script src="//code.jquery.com/jquery-1.11.1.min.js"></script>
<a class="btn btn-primary btn-large" data-toggle="modal" href="#betaModal">Join the Beta</a>
<div id="betaModal" class="modal hide fade">
<div class="modal-header">
<button class="close" data-dismiss="modal">×</button>
<h3>Join the Beta</h3>
</div>
<div class="modal-body">
<div class="row-fluid">
<div class="span12">
<div class="span6">
<div class="logowrapper">
<img class="logoicon" src="http://placehold.it/300x300/bbb/&text=Your%20Logo" alt="App Logo"/>
</div>
</div>
<div class="span6">
<form class="form-horizontal">
<p class="help-block">Name</p>
<div class="input-prepend">
<span class="add-on">*</span><input class="prependedInput" size="16" type="text">
</div>
<p class="help-block">Email</p>
<div class="input-prepend">
<span class="add-on">@</span><input class="prependedInput" size="16" type="email">
</div>
<hr>
<div class="help-block">
<button type="submit" class="btn btn-large btn-info">Request an Invite</button>
</div>
</form>
</div>
</div>
</div>
