<link href="//netdna.bootstrapcdn.com/bootstrap/3.2.0/css/bootstrap.min.css" rel="stylesheet" id="bootstrap-css">
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<script src="//code.jquery.com/jquery-1.11.1.min.js"></script>
<!------ Include the above in your HEAD tag ---------->
<form class="form-horizontal">
<fieldset>
<!-- Form Name -->
<legend>ISTE-2014 Registration Form</legend>
<!-- Text input-->
<div class="form-group">
<label class="col-md-4 control-label" for="textinput">Unique ID</label>
<div class="col-md-4">
<input id="textinput" name="textinput" placeholder="Enter ID" class="form-control input-md" type="text">
<span class="help-block">i.e AA-01</span>
</div>
</div>
<!-- Text input-->
<div class="form-group">
<label class="col-md-4 control-label" for="textinput">Name</label>
<div class="col-md-5">
<input id="textinput" name="textinput" placeholder="Enter Name" class="form-control input-md" required="" type="text">
<span class="help-block">i.e Jay Poojara</span>
</div>
</div>
<!-- Select Basic -->
<div class="form-group">
<label class="col-md-4 control-label" for="selectbasic">Education</label>
<div class="col-md-4">
<select id="selectbasic" name="selectbasic" class="form-control">
<option value="UG">UG</option>
<option value="Dip">Dip</option>
<option value="PG">PG</option>
</select>
</div>
</div>
<!-- Text input-->
<div class="form-group">
<label class="col-md-4 control-label" for="textinput">Branch Name</label>
<div class="col-md-5">
<input id="textinput" name="textinput" placeholder="Enter Branch Name" class="form-control input-md" type="text">
<span class="help-block">i.e I.T</span>
</div>
</div>
<!-- Select Basic -->
<div class="form-group">
<label class="col-md-4 control-label" for="selectbasic">Year</label>
<div class="col-md-4">
<select id="selectbasic" name="selectbasic" class="form-control">
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
</select>
</div>
</div>
<div class="form-group">
<label class="col-md-4 control-label" for="selectbasic">Institution Name</label>
<div class="col-md-4">
<select id="selectbasic" name="selectbasic" class="form-control">
<option value="Aarya-Veer, Rajkot">Aarya-Veer, Rajkot</option>
<option value="ADIT, Vallabh Vidhyanagar">ADIT, Vallabh Vidhyanagar</option>
<option value="Aditya, Ahmedabad">Aditya, Ahmedabad</option>
<option value="Agrawal, Navsari">Agrawal, Navsari</option>
<option value="Ahmedabad Institute, Ahmedabad">Ahmedabad Institute, Ahmedabad</option>
<option value="Alpha, Gandhinagar">Alpha, Gandhinagar</option>
<option value="Amiraj, Ahmedabad">Amiraj, Ahmedabad</option>
<option value="Apollo, Ahmedabad">Apollo, Ahmedabad</option>
<option value="ARC, Vadodara">ARC, Vadodara</option>
<option value="Arrdekta, Khedbrahma">Arrdekta, Khedbrahma</option>
<option value="Arun Munchhala, Dhari, Amreli">Arun Munchhala, Dhari, Amreli</option>
<option value="Asia Pacific, Ahmedabad">Asia Pacific, Ahmedabad</option>
<option value="Atmiya, Rajkot">Atmiya, Rajkot</option>
<option value="B.H.Gardi, Rajkot">B.H.Gardi, Rajkot</option>
<option value="Babaria, Vadodara">Babaria, Vadodara</option>
<option value="Balaji, Junagadh">Balaji, Junagadh</option>
<option value="Bhagwan Mahavir, Surat">Bhagwan Mahavir, Surat</option>
<option value="BVM GIA, Vallabh Vidhyanagar">BVM GIA, Vallabh Vidhyanagar</option>
<option value="BVM SFI, Vallabh Vidhyanagar">BVM SFI, Vallabh Vidhyanagar</option>
<option value="C.K.Pithawala, Surat">C.K.Pithawala, Surat</option>
<option value="C.U.Shah, Wadhwan">C.U.Shah, Wadhwan</option>
<option value="Central Institute, Ahmedabad">Central Institute, Ahmedabad</option>
<option value="Charotar Institute, Chanaga">Charotar Institute, Chanaga</option>
<option value="Chhottubhai, Surat">Chhottubhai, Surat</option>
<option value="D.A.Degree, Vadodara">D.A.Degree, Vadodara</option>
<option value="DAIICT, Gandhinagar">DAIICT, Gandhinagar</option>
<option value="Darshan, Rajkot">Darshan, Rajkot</option>
<option value="DDIT GIA, Nadiad">DDIT GIA, Nadiad</option>
<option value="DDIT SFI, Nadiad">DDIT SFI, Nadiad</option>
<option value="Engineering College, Godhra">Engineering College, Godhra</option>
<option value="FETR, Bardoli">FETR, Bardoli</option>
<option value="FOE, Waghodia">FOE, Waghodia</option>
<option value="G.K. Bharad, Rajkot">G.K. Bharad, Rajkot</option>
<option value="GCET, Vallabh Vidhyanagar">GCET, Vallabh Vidhyanagar</option>
<option value="GEC, Bharuch">GEC, Bharuch</option>
<option value="GEC, Bhavnagar">GEC, Bhavnagar</option>
<option value="GEC, Bhuj">GEC, Bhuj</option>
<option value="GEC, Dahod">GEC, Dahod</option>
<option value="GEC, Gandhinagar">GEC, Gandhinagar</option>
<option value="GEC, Godhra">GEC, Godhra</option>
<option value="GEC, Modasa">GEC, Modasa</option>
<option value="GEC, Palanpur">GEC, Palanpur</option>
<option value="GEC, Patan">GEC, Patan</option>
<option value="GEC, Rajkot">GEC, Rajkot</option>
<option value="GEC, Surat">GEC, Surat</option>
<option value="GEC, Valsad">GEC, Valsad</option>
<option value="GIDC, Navsari">GIDC, Navsari</option>
<option value="GIT, Gandhinagar">GIT, Gandhinagar</option>
<option value="GITS, Prantij">GITS, Prantij</option>
<option value="GPERI, Mehsana">GPERI, Mehsana</option>
<option value="Grow More, Himmatnagar">Grow More, Himmatnagar</option>
<option value="Hansaba, Sidhhpur">Hansaba, Sidhhpur</option>
<option value="Hasmukh Goswami, Ahmedabad">Hasmukh Goswami, Ahmedabad</option>
<option value="HJD, Kera">HJD, Kera</option>
<option value="ICCT for Women, Vallabh Vidhyanagar">ICCT for Women, Vallabh Vidhyanagar</option>
<option value="IICT, Ahmedabad">IICT, Ahmedabad</option>
<option value="IITRAM, Ahmedabad">IITRAM, Ahmedabad</option>
<option value="Indus, Kalol">Indus, Kalol</option>
<option value="Ipcowala, Petlad">Ipcowala, Petlad</option>
<option value="ITMUTC, Waghodia">ITMUTC, Waghodia</option>
<option value="J.M.Sabva, Botad">J.M.Sabva, Botad</option>
<option value="Jivraj Mehta, Anand">Jivraj Mehta, Anand</option>
<option value="K.J, Vadodara">K.J, Vadodara</option>
<option value="Kankesvaridevi, Jamnagar">Kankesvaridevi, Jamnagar</option>
<option value="KIT, Kalol">KIT, Kalol</option>
<option value="L.D, Ahmedabad">L.D, Ahmedabad</option>
<option value="L.E, Morbi">L.E, Morbi</option>
<option value="Labhubhai Trivedi, Rajkot">Labhubhai Trivedi, Rajkot</option>
<option value="Laxmi, Valsad">Laxmi, Valsad</option>
<option value="LCIT, Visnagar">LCIT, Visnagar</option>
<option value="LDRP, Gandhinagar">LDRP, Gandhinagar</option>
<option value="Leads, Bharuch">Leads, Bharuch</option>
<option value="LJIT, Ahmedabad">LJIT, Ahmedabad</option>
<option value="Mahavir Swami, Surat">Mahavir Swami, Surat</option>
<option value="Marwadi, FOE, Rajkot">Marwadi, FOE, Rajkot</option>
<option value="Marwadi, FOT, Rajkot">Marwadi, FOT, Rajkot</option>
<option value="Marwadi, PG Research, Rajkot">Marwadi, PG Research, Rajkot</option>
<option value="Merchant, Visnagar">Merchant, Visnagar</option>
<option value="MG Institute, Navasari">MG Institute, Navasari</option>
<option value="MSU, Vadodara">MSU, Vadodara</option>
<option value="Narnarayan Shastri, Daskroi">Narnarayan Shastri, Daskroi</option>
<option value="Navrachana, Vadodara">Navrachana, Vadodara</option>
<option value="Neotech, Vadodara">Neotech, Vadodara</option>
<option value="Nirma, Ahmedabad">Nirma, Ahmedabad</option>
<option value="Noble, Junagadh">Noble, Junagadh</option>
<option value="OM, Junagadh">OM, Junagadh</option>
<option value="OM, Panchmahal">OM, Panchmahal</option>
<option value="Pacific, Surat">Pacific, Surat</option>
<option value="Pandit Nathulal, Surendranagar">Pandit Nathulal, Surendranagar</option>
<option value="Parul New, Waghodia">Parul New, Waghodia</option>
<option value="Parul Old, Waghodia">Parul Old, Waghodia</option>
<option value="PDPU, Gandhinagar">PDPU, Gandhinagar</option>
<option value="R.K, Rajkot">R.K, Rajkot</option>
<option value="Rai University, Dholka">Rai University, Dholka</option>
<option value="S.R.Patel, Unjha">S.R.Patel, Unjha</option>
<option value="Sabar, Sabarkantha">Sabar, Sabarkantha</option>
<option value="Sadvidhyamandal, Bharuch">Sadvidhyamandal, Bharuch</option>
<option value="Saffrony, Mehsana">Saffrony, Mehsana</option>
<option value="SAL Engineering, Ahmedabad">SAL Engineering, Ahmedabad</option>
<option value="SAL Engineering, Sola, Ahmedabad">SAL Engineering, Sola, Ahmedabad</option>
<option value="SAL Institute, Ahmedabad">SAL Institute, Ahmedabad</option>
<option value="Samarth, Himatnagar">Samarth, Himatnagar</option>
<option value="Sanjaybhai Rajguru, Rajkot">Sanjaybhai Rajguru, Rajkot</option>
<option value="Sankalchand, Visnagar">Sankalchand, Visnagar</option>
<option value="Sardar Patel College, Bakrol">Sardar Patel College, Bakrol</option>
<option value="Sardar Patel, Mehsana">Sardar Patel, Mehsana</option>
<option value="Sarvjanik, Surat">Sarvjanik, Surat</option>
<option value="Satsangi, Mehsana">Satsangi, Mehsana</option>
<option value="Shankarsingh Vaghela, Gandhinagar">Shankarsingh Vaghela, Gandhinagar</option>
<option value="Shantilal Shah, Bhavnagar">Shantilal Shah, Bhavnagar</option>
<option value="Shree Saraswati, Kadi">Shree Saraswati, Kadi</option>
<option value="Shri Swami Atmanand, Surat">Shri Swami Atmanand, Surat</option>
<option value="Shroff Rotary, Valia">Shroff Rotary, Valia</option>
<option value="Sigma, Waghodia">Sigma, Waghodia</option>
<option value="Silver Oak, Ahmedabad">Silver Oak, Ahmedabad</option>
<option value="Subhash, Junagadh">Subhash, Junagadh</option>
<option value="SVIT, Vasad">SVIT, Vasad</option>
<option value="Swaminarayan College, Bhat, Gandhinagar">Swaminarayan College, Bhat, Gandhinagar</option>
<option value="Swaminarayan, Kalol">Swaminarayan, Kalol</option>
<option value="Takshashila, Rajkot">Takshashila, Rajkot</option>
<option value="Tatva, Modasa">Tatva, Modasa</option>
<option value="Universal, Kalol">Universal, Kalol</option>
<option value="UVPEC, Mehsana">UVPEC, Mehsana</option>
<option value="V.V.P, Rajkot">V.V.P, Rajkot</option>
<option value="Vadodara Institute, Waghodia">Vadodara Institute, Waghodia</option>
<option value="Veerayatan, Mandvi">Veerayatan, Mandvi</option>
<option value="Venus, Gandhinagar">Venus, Gandhinagar</option>
<option value="VGEC, Ahmedabad">VGEC, Ahmedabad</option>
<option value="Vidhyabharti, Bardoli">Vidhyabharti, Bardoli</option>
<option value="Vidhyadeep, Olpad">Vidhyadeep, Olpad</option>
<option value="VIT, Valia">VIT, Valia</option>
</select>
</div>
</div>
<!-- Text input-->
<div class="form-group">
<label class="col-md-4 control-label" for="textinput">Mailing Address</label>
<div class="col-md-4">
<input id="textinput" name="textinput" placeholder="Enter Mail Address" class="form-control input-md" type="text">
<span class="help-block">i.e xyz@abc.com</span>
</div>
</div>
<!-- Multiple Radios -->
<div class="form-group">
<label class="col-md-4 control-label" for="radios">Gender</label>
<div class="col-md-4">
<div class="radio">
<label for="radios-0">
<input name="radios" id="radios-0" value="1" checked="checked" type="radio">
Male
</label>
</div>
<div class="radio">
<label for="radios-1">
<input name="radios" id="radios-1" value="2" type="radio">
Female
</label>
</div>
</div>
</div>
<!-- Text input-->
<div class="form-group">
<label class="col-md-4 control-label" for="textinput">Phone</label>
<div class="col-md-5">
<input id="textinput" name="textinput" placeholder="Enter Phone No." class="form-control input-md" type="text">
<span class="help-block">i.e 0281-2584186</span>
</div>
</div>
<!-- Text input-->
<div class="form-group">
<label class="col-md-4 control-label" for="textinput">Fax</label>
<div class="col-md-4">
<input id="textinput" name="textinput" placeholder="Enter Fax No." class="form-control input-md" type="text">
<span class="help-block">i.e 0281-2584186</span>
</div>
</div>
<!-- Text input-->
<div class="form-group">
<label class="col-md-4 control-label" for="textinput">Mobile No.</label>
<div class="col-md-4">
<input id="textinput" name="textinput" placeholder="Enter Mobile No." class="form-control input-md" type="text">
<span class="help-block">i.e 1234567890</span>
</div>
</div>
<!-- Multiple Radios -->
<div class="form-group">
<label class="col-md-4 control-label" for="radios">ISTE Member</label>
<div class="col-md-4">
<div class="radio">
<label for="radios-0">
<input name="radios" id="radios-0" value="Y" checked="checked" type="radio">
Yes
</label>
</div>
<div class="radio">
<label for="radios-1">
<input name="radios" id="radios-1" value="N" type="radio">
No
</label>
</div>
</div>
</div>
<!-- Text input-->
<div class="form-group">
<label class="col-md-4 control-label" for="textinput">Membership Number</label>
<div class="col-md-5">
<input id="textinput" name="textinput" placeholder="Enter Membernship No." class="form-control input-md" type="text">
<span class="help-block">i.e </span>
</div>
</div>
<!-- Multiple Checkboxes (inline) -->
<div class="form-group">
<label class="col-md-4 control-label" for="checkboxes">Participation Type</label>
<div class="col-md-4">
<label class="checkbox-inline" for="checkboxes-0">
<input name="checkboxes" id="checkboxes-0" value="1" type="checkbox">
Robo Race
</label>
<label class="checkbox-inline" for="checkboxes-1">
<input name="checkboxes" id="checkboxes-1" value="2" type="checkbox">
Chem-o-tech
</label>
<label class="checkbox-inline" for="checkboxes-2">
<input name="checkboxes" id="checkboxes-2" value="3" type="checkbox">
Poster Exhibition
</label>
<label class="checkbox-inline" for="checkboxes-3">
<input name="checkboxes" id="checkboxes-3" value="4" type="checkbox">
Bridge the gap
</label>
<label class="checkbox-inline" for="checkboxes-4">
<input name="checkboxes" id="checkboxes-4" value="5" type="checkbox">
Quiz Program
</label>
<label class="checkbox-inline" for="checkboxes-5">
<input name="checkboxes" id="checkboxes-5" value="6" type="checkbox">
Lazer Made
</label>
<label class="checkbox-inline" for="checkboxes-6">
<input name="checkboxes" id="checkboxes-6" value="7" type="checkbox">
Code Jam
</label>
<label class="checkbox-inline" for="checkboxes-7">
<input name="checkboxes" id="checkboxes-7" value="8" type="checkbox">
Picasso
</label>
<label class="checkbox-inline" for="checkboxes-8">
<input name="checkboxes" id="checkboxes-8" value="9" type="checkbox">
Junk Yard
</label>
<label class="checkbox-inline" for="checkboxes-9">
<input name="checkboxes" id="checkboxes-9" value="10" type="checkbox">
Circuit Debugging
</label>
<label class="checkbox-inline" for="checkboxes-10">
<input name="checkboxes" id="checkboxes-10" value="11" type="checkbox">
E-treasure hunt
</label>
<label class="checkbox-inline" for="checkboxes-11">
<input name="checkboxes" id="checkboxes-11" value="12" type="checkbox">
paper presentation
</label>
<label class="checkbox-inline" for="checkboxes-12">
<input name="checkboxes" id="checkboxes-12" value="13" type="checkbox">
Robo Puzzle
</label>
</div>
</div>
<!-- Select Basic -->
<div class="form-group">
<label class="col-md-4 control-label" for="selectbasic">Two Days Registration</label>
<div class="col-md-4">
<select id="selectbasic" name="selectbasic" class="form-control">
<option value="0">--Select--</option>
<option value="1">ISTE Student Member:- Rs. 500</option>
<option value="2">Non-ISTE Student Member:-Rs. 520</option>
<option value="3">ISTE Delegates :- Rs.500</option>
<option value="4">Non ISTE Delegates:- Rs.500</option>
</select>
</div>
</div>
<!-- Select Basic -->
<div class="form-group">
<label class="col-md-4 control-label" for="selectbasic">One Days Registration</label>
<div class="col-md-4">
<select id="selectbasic" name="selectbasic" class="form-control">
<option value="0">--Select--</option>
<option value="1">ISTE Student Member:- Rs. 180</option>
<option value="2">Non-ISTE Student Member:-Rs. 200</option>
</select>
</div>
</div>
<!-- Text input-->
<div class="form-group">
<label class="col-md-4 control-label" for="textinput">No. of Events</label>
<div class="col-md-4">
<input id="textinput" name="textinput" placeholder="No. of events " class="form-control input-md" type="text">
<span class="help-block">i.e 3</span>
</div>
</div>
<!-- Text input-->
<div class="form-group">
<label class="col-md-4 control-label" for="textinput">Registration Fee (INR)</label>
<div class="col-md-4">
<input id="textinput" name="textinput" placeholder="Enter Fee" class="form-control input-md" type="text">
<span class="help-block">i.e 200</span>
</div>
</div>
<!-- Multiple Radios -->
<div class="form-group">
<label class="col-md-4 control-label" for="radios">Cash/DD</label>
<div class="col-md-4">
<div class="radio">
<label for="radios-0">
<input name="radios" id="radios-0" value="1" checked="checked" type="radio">
Cash
</label>
</div>
<div class="radio">
<label for="radios-1">
<input name="radios" id="radios-1" value="2" type="radio">
DD
</label>
</div>
</div>
</div>
<!-- Text input-->
<div class="form-group">
<label class="col-md-4 control-label" for="textinput">DD No.</label>
<div class="col-md-4">
<input id="textinput" name="textinput" placeholder="Enter DD No." class="form-control input-md" type="text">
</div>
</div>
<!-- Text input-->
<div class="form-group">
<label class="col-md-4 control-label" for="textinput">Dated</label>
<div class="col-md-4">
<input id="textinput" name="textinput" placeholder="Enter Date" class="form-control input-md" type="text">
<span class="help-block">i.e dd/mm/yyyy</span>
</div>
</div>
<!-- Text input-->
<div class="form-group">
<label class="col-md-4 control-label" for="textinput">Bank</label>
<div class="col-md-4">
<input id="textinput" name="textinput" placeholder="Eneter Bank Name" class="form-control input-md" type="text">
<span class="help-block">i.e SBI</span>
</div>
</div>
<!-- Text input-->
<div class="form-group">
<label class="col-md-4 control-label" for="textinput">Branch Name</label>
<div class="col-md-4">
<input id="textinput" name="textinput" placeholder="Enter Branch Name" class="form-control input-md" type="text">
<span class="help-block">i.e Rani Tower </span>
</div>
</div>
<!-- Multiple Radios -->
<div class="form-group">
<label class="col-md-4 control-label" for="radios">Accommodation</label>
<div class="col-md-4">
<div class="radio">
<label for="radios-0">
<input name="radios" id="radios-0" value="1" checked="checked" type="radio">
Yes
</label>
</div>
<div class="radio">
<label for="radios-1">
<input name="radios" id="radios-1" value="2" type="radio">
No
</label>
</div>
</div>
</div>
<!-- Button -->
<div class="form-group">
<label class="col-md-4 control-label" for="singlebutton"></label>
<div class="col-md-4">
<button id="singlebutton" name="singlebutton" class="btn btn-primary">Submit</button>
</div>
</div>
</fieldset>
</form>
