<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 ----------> <div class="container"> <div class="row"> <div class="col-xs-12 col-sm-12 col-md-4 well well-sm"> <legend><a href="http://www.jquery2dotnet.com"><i class="glyphicon glyphicon-globe"></i></a> Sign up!</legend> <form action="#" method="post" class="form" role="form"> <input class="form-control" name="enrollno" placeholder="Your refference number" type="number" /> <div class="row"> <div class="col-xs-6 col-md-6"> <input class="form-control" name="firstname" placeholder="First Name" type="text" required autofocus /> </div> <div class="col-xs-6 col-md-6"> <input class="form-control" name="lastname" placeholder="Last Name" type="text" required /> </div> </div> <input class="form-control" name="youremail" placeholder="Your Email" type="email" /> <input class="form-control" name="reenteremail" placeholder="Re-enter Email" type="email" /> <input class="form-control" name="password" placeholder="New Password" type="password" /> <select class="form-control"> <option value="Department">department</option> <option value="Month">Cardiologist</option> <option value="Month"> ENT</option> <option value="Month">Dental</option> <option value="Month">Neurologist</option> <option value="Month">Orthologist</option> <option value="Month">Spine</option> </select> <label for=""> Birth Date</label> <div class="row"> <div class="col-xs-4 col-md-4"> <select class="form-control"> <option value="Month">Month</option> <option value="Month">january</option> <option value="Month">feburary</option> <option value="Month">march</option> <option value="Month">april</option> <option value="Month">may</option> <option value="Month">june</option> <option value="Month">july</option> <option value="Month">august</option> <option value="Month">september</option> <option value="Month">october</option> <option value="Month">november</option> <option value="Month">december</option> </select> </div> <div class="col-xs-4 col-md-4"> <select class="form-control"> <option value="Day">Day</option> <option value="Month">monday</option> <option value="Month">tuesday</option> <option value="Month">wednesday</option> <option value="Month">thursday</option> <option value="Month">friday</option> <option value="Month">saturday</option> <option value="Month">sunday</option> </select> </div> <div class="col-xs-4 col-md-4"> <select class="form-control"> <option value="Year">Year</option> <option value="Month">1960</option> <option value="Month">1961</option> <option value="Month">1963</option> <option value="Month">1964</option> <option value="Month">1965</option> <option value="Month">1966</option> <option value="Month">1967</option> <option value="Month">1968</option> <option value="Month">1969</option> <option value="Month">1970</option> <option value="Month">1971</option> <option value="Month">1972</option> </select> </div> </div> <label class="radio-inline"> <input type="radio" name="sex" id="inlineCheckbox1" value="male" /> Male </label> <label class="radio-inline"> <input type="radio" name="sex" id="inlineCheckbox2" value="female" /> Female </label> <br /> <br /> <button class="btn btn-lg btn-primary btn-block" type="submit"> Sign up</button> </form> </div>

body { padding-top:30px; } .form-control { margin-bottom: 10px; }