<form class="form-horizontal">
<fieldset>
<!-- Form Name -->
<legend>สมัครสมาชิก</legend>
<!-- Text input-->
<div class="form-group">
<label class="col-md-4 control-label" for="username">ชื่อผู้ใช้</label>
<div class="col-md-4">
<input id="username" name="username" type="text" placeholder="ชื่อผู้ใช้" class="form-control input-md" required="">
</div>
</div>
<!-- Password input-->
<div class="form-group">
<label class="col-md-4 control-label" for="password">รหัสผ่าน</label>
<div class="col-md-4">
<input id="password" name="password" type="password" placeholder="รหัสผ่าน" class="form-control input-md" required="">
</div>
</div>
<!-- Password input-->
<div class="form-group">
<label class="col-md-4 control-label" for="passwordแนื">ยืนยันรหัสผ่าน</label>
<div class="col-md-4">
<input id="passwordแนื" name="passwordแนื" type="password" placeholder="ยืนยันรหัสผ่าน" class="form-control input-md">
</div>
</div>
<!-- Text input-->
<div class="form-group">
<label class="col-md-4 control-label" for="namำ">ชื่อ-สกุล</label>
<div class="col-md-4">
<input id="namำ" name="namำ" type="text" placeholder="ชื่อ-สกุล" class="form-control input-md" required="">
</div>
</div>
<!-- Text input-->
<div class="form-group">
<label class="col-md-4 control-label" for="tel">โทรศัพท์</label>
<div class="col-md-4">
<input id="tel" name="tel" type="text" placeholder="โทรศัพท์" class="form-control input-md" required="">
</div>
</div>
<!-- Text input-->
<div class="form-group">
<label class="col-md-4 control-label" for="email">E-Mail</label>
<div class="col-md-4">
<input id="email" name="email" type="text" placeholder="E-Mail" class="form-control input-md" required="">
</div>
</div>
<!-- Button Drop Down -->
<div class="form-group">
<label class="col-md-4 control-label" for="gred">เพศ</label>
<div class="col-md-4">
<div class="input-group">
<input id="gred" name="gred" class="form-control" placeholder="เพศ" type="text" required="">
<div class="input-group-btn">
<button type="button" class="btn btn-default dropdown-toggle" data-toggle="dropdown">
เลือกเพส
<span class="caret"></span>
</button>
<ul class="dropdown-menu pull-right">
<li><a href="#">ชาย</a></li>
<li><a href="#">หญิง</a></li>
</ul>
</div>
</div>
</div>
</div>
<!-- Text input-->
<div class="form-group">
<label class="col-md-4 control-label" for="birth">วันกิด</label>
<div class="col-md-4">
<input id="birth" name="birth" type="text" placeholder="วันเกิด" class="form-control input-md" required="">
</div>
</div>
<!-- Textarea -->
<div class="form-group">
<label class="col-md-4 control-label" for="address">ที่อยู่</label>
<div class="col-md-4">
<textarea class="form-control" id="address" name="address">ที่อยู่</textarea>
</div>
</div>
<!-- Button -->
<div class="form-group">
<label class="col-md-4 control-label" for="regis"></label>
<div class="col-md-4">
<button id="regis" name="regis" class="btn btn-success">สมัครสมาชิก</button>
</div>
</div>
</fieldset>
</form>
