<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>
<form class="form-horizontal">
<fieldset>
<legend>Basileia International Membership Application</legend>
<div class="form-group">
<label class="col-md-4 control-label" for="textinput">First Name</label>
<div class="col-md-4">
<input id="textinput" name="textinput" type="text" placeholder="placeholder" class="form-control input-md" required="">
<span class="help-block">enter first name</span>
</div>
</div>
<div class="form-group">
<label class="col-md-4 control-label" for="textinput">Last Name</label>
<div class="col-md-4">
<input id="textinput" name="textinput" type="text" placeholder="placeholder" class="form-control input-md" required="">
<span class="help-block">enter last name</span>
</div>
</div>
<div class="form-group">
<label class="col-md-4 control-label" for="textinput">Title</label>
<div class="col-md-4">
<div class="input-group">
<input id="textinput" name="textinput" class="form-control" placeholder="placeholder" type="text" required="">
<div class="input-group-btn">
<button type="button" class="btn btn-default dropdown-toggle" data-toggle="dropdown">
