<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> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="txtJumlahManager">Jumlah Manager</label> <div class="col-md-4"> <input id="txtJumlahManager" name="txtJumlahManager" type="text" placeholder="ex: 2" class="form-control input-md" required=""> <span class="help-block">*Isi jumlah manager, maksimal 2.</span> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="txtJumlahKelasPertandingan">Jumlah Kelas Pertandingan</label> <div class="col-md-4"> <input id="txtJumlahKelasPertandingan" name="txtJumlahKelasPertandingan" type="text" placeholder="ex: 11" class="form-control input-md" required=""> <span class="help-block">*Isi jumlah kelas pertandingan yang akan diikuti.</span> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="txtEmail">E-mail</label> <div class="col-md-4"> <input id="txtEmail" name="txtEmail" type="text" placeholder="alamat@email.com" class="form-control input-md" required=""> <span class="help-block">*Isi alamat e-mail yang dapat dihubungi.</span> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="txtNomorTelepon1">Nomor Telepon 1</label> <div class="col-md-4"> <input id="txtNomorTelepon1" name="txtNomorTelepon1" type="text" placeholder="ex: 08193121199" class="form-control input-md" required=""> <span class="help-block">*Isi nomor telepon utama yang dapat dihubungi.</span> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="txtNomorTelepon2">Nomor Telepon 2</label> <div class="col-md-4"> <input id="txtNomorTelepon2" name="txtNomorTelepon2" type="text" placeholder="ex: 08193121235" class="form-control input-md"> <span class="help-block">*Isi nomor telepon cadangan yang dapat dihubungi.</span> </div> </div> <!-- File Button --> <div class="form-group"> <label class="col-md-4 control-label" for="fbLampiranA">Lampiran A</label> <div class="col-md-4"> <input id="fbLampiranA" name="fbLampiranA" class="input-file" type="file"> </div> </div> <!-- File Button --> <div class="form-group"> <label class="col-md-4 control-label" for="fbBuktiPembayaran">Bukti Pembayaran</label> <div class="col-md-4"> <input id="fbBuktiPembayaran" name="fbBuktiPembayaran" class="input-file" type="file"> </div> </div> <!-- Button --> <div class="form-group"> <label class="col-md-4 control-label" for="btnSubmit"></label> <div class="col-md-4"> <button id="btnSubmit" name="btnSubmit" class="btn btn-primary">Submit</button> </div> </div> </fieldset> </form>