<link href="//netdna.bootstrapcdn.com/bootstrap/3.1.0/css/bootstrap.min.css" rel="stylesheet" id="bootstrap-css">
<script src="//netdna.bootstrapcdn.com/bootstrap/3.1.0/js/bootstrap.min.js"></script>
<script src="//code.jquery.com/jquery-1.11.1.min.js"></script>
<div class="container">
<div class="row">
<h3 class="col-sm-offset-3 col-sm-6">Signup</h3>
</div
<div class="row">
<div class="col-sm-offset-1 col-sm-2">
xxx
</div>
<div class="col-sm-6">
<form action="r" method="post" accept-charset="utf-8" class="form" role="form">
<div class="row">
<div class="col-xs-6 col-md-6">
<input type="text" name="firstname" value="" class="form-control input-lg" placeholder="First Name" /> </div>
<div class="col-xs-6 col-md-6">
<input type="text" name="lastname" value="" class="form-control input-lg" placeholder="Last Name" /> </div>
</div>
<input type="text" name="email" value="" class="form-control input-lg" placeholder="Your Email" /><input type="password" name="password" value="" class="form-control input-lg" placeholder="Password" /><input type="password" name="confirm_password" value="" class="form-control input-lg" placeholder="Confirm Password" />
<label>Birth Date</label>
<div class="row">
<div class="col-xs-4 col-md-4">
<select name="month" class = "form-control input-lg">
<option value="01">Jan</option><option value="02">Feb</option><option value="03">Mar</option>
<option value="04">Apr</option><option value="05">May</option><option value="06">Jun</option>
<option value="07">Jul</option><option value="08">Aug</option><option value="09">Sep</option>
<option value="10">Oct</option><option value="11">Nov</option><option value="12">Dec</option>
</select>
</div>
<div class="col-xs-4 col-md-4">
<select name="day" class = "form-control input-lg">
<option value="1">1</option><option value="2">2</option><option value="3">3</option><option value="4">4</option>
<option value="5">5</option><option value="6">6</option><option value="7">7</option><option value="8">8</option>
<option value="9">9</option><option value="10">10</option><option value="11">11</option><option value="12">12</option>