<link href="//netdna.bootstrapcdn.com/bootstrap/3.2.0/css/bootstrap.min.css" rel="stylesheet" id="bootstrap-css"> <script src="//netdna.bootstrapcdn.com/bootstrap/3.2.0/js/bootstrap.min.js"></script> <script src="//code.jquery.com/jquery-1.11.1.min.js"></script> <!------ Include the above in your HEAD tag ----------> <link href="//maxcdn.bootstrapcdn.com/font-awesome/4.1.0/css/font-awesome.min.css" rel="stylesheet"> <div id="login-overlay" class="modal-dialog"> <div class="modal-content"> <div class="modal-header"> <button type="button" class="close" data-dismiss="modal"><span aria-hidden="true">×</span><span class="sr-only">Close</span></button> <h4 class="modal-title" id="myModalLabel">Kostenlose Registrierung</h4> </div> <div class="modal-body"> <div class="row"> <div class="col-xs-6"> <p class="lead">engelCARD <span class="text-info">Basic</span></p> <p>Nutzen Sie den engelCARD-Schutzengelservice bereits in der kostenlosen Version mit vielen Vorteilen und Funktionen. Werbefrei und gratis. </p> <ul class="list-unstyled" style="line-height: 2"> <li><span class="fa fa-check text-success"></span> engelCARD APP für IOS und Android</li> <li><span class="fa fa-check text-success"></span> Gesundheits- und Notfallportal</li> <li><span class="fa fa-check text-success"></span> Dokumentensafe für 3 Uploads</li> <li><span class="fa fa-check text-success"></span> Werbefrei und ohne Verpflichtungen</li> </div> <div class="col-xs-6"> <div class="well"> <form id="loginForm" method="POST" action="/login/" novalidate="novalidate"> <div class="form-group"> <label for="username" class="control-label">Benutzername</label> <input type="text" class="form-control" id="username" name="username" value="" required="" title="Please enter you username" placeholder="Beispiel@gmail.com"> <span class="help-block"></span> </div> <div class="form-group"> <label for="password" class="control-label">Passwort</label> <input type="password" class="form-control" id="password" name="password" value="" required="" title="Please enter your password"> <span class="help-block"></span> </div> <div class="form-group"> <label for="password" class="control-label">Passwort wiederholen</label> <input type="password" class="form-control" id="password" name="password" value="" required="" title="Please enter your password"> <span class="help-block"></span> </div> <div id="loginErrorMsg" class="alert alert-error hide">Wrong username og password</div> <div class="form-group"> <input type="checkbox" value=""> Ich akzeptiere die AGB und Datenschutzbestimmungen. </label> <span class="help-block"></span></div> </div> <button type="submit" class="btn btn-info btn-block">Kostenlos registrieren</button> </form> </div> </div> </div> </div> </div> </div>