"Form By Number"
Bootstrap 3.3.0 Snippet by fairyhunter13

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<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>
<!------ Include the above in your HEAD tag ---------->
<form class="form-horizontal">
<fieldset>
<!-- Form Name -->
<legend>Registrasi By Number</legend>
<!-- Text input-->
<div class="form-group">
<label class="col-md-4 control-label" for="txtDojo">PERKEMI PengDo</label>
<div class="col-md-4">
<input id="txtDojo" name="txtDojo" type="text" placeholder="Nama Dojo" class="form-control input-md" required="">
<span class="help-block">*Isi nama dojo.</span>
</div>
</div>
<!-- Text input-->
<div class="form-group">
<label class="col-md-4 control-label" for="txtKota">Kota</label>
<div class="col-md-4">
<input id="txtKota" name="txtKota" type="text" placeholder="Kota" class="form-control input-md" required="">
<span class="help-block">*Isi kota tempat dojo.</span>
</div>
</div>
<!-- Text input-->
<div class="form-group">
<label class="col-md-4 control-label" for="txtJumlahKenshi">Jumlah Kenshi</label>
<div class="col-md-4">
<input id="txtJumlahKenshi" name="txtJumlahKenshi" type="text" placeholder="ex: 10" class="form-control input-md" required="">
<span class="help-block">*Isi jumlah kenshi yang mengikuti kejuaraan.</span>
</div>
</div>
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