<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>
<form class="form-horizontal">
<fieldset>
<legend>Form Name</legend>
<div class="form-group">
<label class="col-md-4 control-label" for="selectbasic">Pilihan Premi</label>
<div class="col-md-4">
<select id="selectbasic" name="selectbasic" class="form-control">
<option value="1">Rp. 350.000,-</option>
<option value="2">Rp. 700.000,-</option>
<option value="3">Rp. 1.000.000,-</option>
</select>
</div>
</div>
<div class="form-group">
<label class="col-md-4 control-label" for="namasponsor">Nama Sponsor *</label>
<div class="col-md-4">
<input id="namasponsor" name="namasponsor" placeholder="Jawaban Anda" class="form-control input-md" required="" type="text">
</div>
</div>
<div class="form-group">
<label class="col-md-4 control-label" for="noidsponsor">No. ID Sponsor *</label>
<div class="col-md-4">
<input id="noidsponsor" name="noidsponsor" placeholder="Jawaban Anda" class="form-control input-md" required="" type="text">