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form_wizard.html
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form_wizard.html
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<!DOCTYPE html>
<!--[if IE 8]> <html lang="en" class="ie8"> <![endif]-->
<!--[if IE 9]> <html lang="en" class="ie9"> <![endif]-->
<!--[if !IE]><!--> <html lang="en"> <!--<![endif]-->
<!-- BEGIN HEAD -->
<head>
<meta charset="utf-8" />
<title>Metronic | Form Stuff - Form Wizard</title>
<meta content="width=device-width, initial-scale=1.0" name="viewport" />
<meta content="" name="description" />
<meta content="" name="author" />
<!-- BEGIN GLOBAL MANDATORY STYLES -->
<link href="media/css/bootstrap.min.css" rel="stylesheet" type="text/css"/>
<link href="media/css/bootstrap-responsive.min.css" rel="stylesheet" type="text/css"/>
<link href="media/css/font-awesome.min.css" rel="stylesheet" type="text/css"/>
<link href="media/css/style-metro.css" rel="stylesheet" type="text/css"/>
<link href="media/css/style.css" rel="stylesheet" type="text/css"/>
<link href="media/css/style-responsive.css" rel="stylesheet" type="text/css"/>
<link href="media/css/default.css" rel="stylesheet" type="text/css" id="style_color"/>
<link href="media/css/uniform.default.css" rel="stylesheet" type="text/css"/>
<!-- END GLOBAL MANDATORY STYLES -->
<!-- BEGIN PAGE LEVEL STYLES -->
<link rel="stylesheet" type="text/css" href="media/css/select2_metro.css" />
<link rel="stylesheet" type="text/css" href="media/css/chosen.css" />
<!-- END PAGE LEVEL STYLES -->
<link rel="shortcut icon" href="media/image/favicon.ico" />
</head>
<!-- END HEAD -->
<!-- BEGIN BODY -->
<body class="page-header-fixed">
<!-- BEGIN HEADER -->
<div class="header navbar navbar-inverse navbar-fixed-top">
<!-- BEGIN TOP NAVIGATION BAR -->
<div class="navbar-inner">
<div class="container-fluid">
<!-- BEGIN LOGO -->
<a class="brand" href="index.html">
<img src="media/image/logo.png" alt="logo" />
</a>
<!-- END LOGO -->
<!-- BEGIN RESPONSIVE MENU TOGGLER -->
<a href="javascript:;" class="btn-navbar collapsed" data-toggle="collapse" data-target=".nav-collapse">
<img src="media/image/menu-toggler.png" alt="" />
</a>
<!-- END RESPONSIVE MENU TOGGLER -->
<!-- BEGIN TOP NAVIGATION MENU -->
<ul class="nav pull-right">
<!-- BEGIN NOTIFICATION DROPDOWN -->
<li class="dropdown" id="header_notification_bar">
<a href="#" class="dropdown-toggle" data-toggle="dropdown">
<i class="icon-warning-sign"></i>
<span class="badge">6</span>
</a>
<ul class="dropdown-menu extended notification">
<li>
<p>You have 14 new notifications</p>
</li>
<li>
<a href="#">
<span class="label label-success"><i class="icon-plus"></i></span>
New user registered.
<span class="time">Just now</span>
</a>
</li>
<li>
<a href="#">
<span class="label label-important"><i class="icon-bolt"></i></span>
Server #12 overloaded.
<span class="time">15 mins</span>
</a>
</li>
<li>
<a href="#">
<span class="label label-warning"><i class="icon-bell"></i></span>
Server #2 not respoding.
<span class="time">22 mins</span>
</a>
</li>
<li>
<a href="#">
<span class="label label-info"><i class="icon-bullhorn"></i></span>
Application error.
<span class="time">40 mins</span>
</a>
</li>
<li>
<a href="#">
<span class="label label-important"><i class="icon-bolt"></i></span>
Database overloaded 68%.
<span class="time">2 hrs</span>
</a>
</li>
<li>
<a href="#">
<span class="label label-important"><i class="icon-bolt"></i></span>
2 user IP blocked.
<span class="time">5 hrs</span>
</a>
</li>
<li class="external">
<a href="#">See all notifications <i class="m-icon-swapright"></i></a>
</li>
</ul>
</li>
<!-- END NOTIFICATION DROPDOWN -->
<!-- BEGIN INBOX DROPDOWN -->
<li class="dropdown" id="header_inbox_bar">
<a href="#" class="dropdown-toggle" data-toggle="dropdown">
<i class="icon-envelope"></i>
<span class="badge">5</span>
</a>
<ul class="dropdown-menu extended inbox">
<li>
<p>You have 12 new messages</p>
</li>
<li>
<a href="inbox.html?a=view">
<span class="photo"><img src="media/image/avatar2.jpg" alt="" /></span>
<span class="subject">
<span class="from">Lisa Wong</span>
<span class="time">Just Now</span>
</span>
<span class="message">
Vivamus sed auctor nibh congue nibh. auctor nibh
auctor nibh...
</span>
</a>
</li>
<li>
<a href="inbox.html?a=view">
<span class="photo"><img src="media/image/avatar3.jpg" alt="" /></span>
<span class="subject">
<span class="from">Richard Doe</span>
<span class="time">16 mins</span>
</span>
<span class="message">
Vivamus sed congue nibh auctor nibh congue nibh. auctor nibh
auctor nibh...
</span>
</a>
</li>
<li>
<a href="inbox.html?a=view">
<span class="photo"><img src="media/image/avatar1.jpg" alt="" /></span>
<span class="subject">
<span class="from">Bob Nilson</span>
<span class="time">2 hrs</span>
</span>
<span class="message">
Vivamus sed nibh auctor nibh congue nibh. auctor nibh
auctor nibh...
</span>
</a>
</li>
<li class="external">
<a href="inbox.html">See all messages <i class="m-icon-swapright"></i></a>
</li>
</ul>
</li>
<!-- END INBOX DROPDOWN -->
<!-- BEGIN TODO DROPDOWN -->
<li class="dropdown" id="header_task_bar">
<a href="#" class="dropdown-toggle" data-toggle="dropdown">
<i class="icon-tasks"></i>
<span class="badge">5</span>
</a>
<ul class="dropdown-menu extended tasks">
<li>
<p>You have 12 pending tasks</p>
</li>
<li>
<a href="#">
<span class="task">
<span class="desc">New release v1.2</span>
<span class="percent">30%</span>
</span>
<span class="progress progress-success ">
<span style="width: 30%;" class="bar"></span>
</span>
</a>
</li>
<li>
<a href="#">
<span class="task">
<span class="desc">Application deployment</span>
<span class="percent">65%</span>
</span>
<span class="progress progress-danger progress-striped active">
<span style="width: 65%;" class="bar"></span>
</span>
</a>
</li>
<li>
<a href="#">
<span class="task">
<span class="desc">Mobile app release</span>
<span class="percent">98%</span>
</span>
<span class="progress progress-success">
<span style="width: 98%;" class="bar"></span>
</span>
</a>
</li>
<li>
<a href="#">
<span class="task">
<span class="desc">Database migration</span>
<span class="percent">10%</span>
</span>
<span class="progress progress-warning progress-striped">
<span style="width: 10%;" class="bar"></span>
</span>
</a>
</li>
<li>
<a href="#">
<span class="task">
<span class="desc">Web server upgrade</span>
<span class="percent">58%</span>
</span>
<span class="progress progress-info">
<span style="width: 58%;" class="bar"></span>
</span>
</a>
</li>
<li>
<a href="#">
<span class="task">
<span class="desc">Mobile development</span>
<span class="percent">85%</span>
</span>
<span class="progress progress-success">
<span style="width: 85%;" class="bar"></span>
</span>
</a>
</li>
<li class="external">
<a href="#">See all tasks <i class="m-icon-swapright"></i></a>
</li>
</ul>
</li>
<!-- END TODO DROPDOWN -->
<!-- BEGIN USER LOGIN DROPDOWN -->
<li class="dropdown user">
<a href="#" class="dropdown-toggle" data-toggle="dropdown">
<img alt="" src="media/image/avatar1_small.jpg" />
<span class="username">Bob Nilson</span>
<i class="icon-angle-down"></i>
</a>
<ul class="dropdown-menu">
<li><a href="extra_profile.html"><i class="icon-user"></i> My Profile</a></li>
<li><a href="page_calendar.html"><i class="icon-calendar"></i> My Calendar</a></li>
<li><a href="inbox.html"><i class="icon-envelope"></i> My Inbox(3)</a></li>
<li><a href="#"><i class="icon-tasks"></i> My Tasks</a></li>
<li class="divider"></li>
<li><a href="extra_lock.html"><i class="icon-lock"></i> Lock Screen</a></li>
<li><a href="login.html"><i class="icon-key"></i> Log Out</a></li>
</ul>
</li>
<!-- END USER LOGIN DROPDOWN -->
</ul>
<!-- END TOP NAVIGATION MENU -->
</div>
</div>
<!-- END TOP NAVIGATION BAR -->
</div>
<!-- END HEADER -->
<!-- BEGIN CONTAINER -->
<div class="page-container row-fluid">
<!-- BEGIN SIDEBAR -->
<div class="page-sidebar nav-collapse collapse">
<!-- BEGIN SIDEBAR MENU -->
<ul class="page-sidebar-menu">
<li>
<!-- BEGIN SIDEBAR TOGGLER BUTTON -->
<div class="sidebar-toggler hidden-phone"></div>
<!-- BEGIN SIDEBAR TOGGLER BUTTON -->
</li>
<li>
<!-- BEGIN RESPONSIVE QUICK SEARCH FORM -->
<form class="sidebar-search">
<div class="input-box">
<a href="javascript:;" class="remove"></a>
<input type="text" placeholder="Search..." />
<input type="button" class="submit" value=" " />
</div>
</form>
<!-- END RESPONSIVE QUICK SEARCH FORM -->
</li>
<li class="start ">
<a href="index.html">
<i class="icon-home"></i>
<span class="title">Dashboard</span>
</a>
</li>
<li class="">
<a href="javascript:;">
<i class="icon-cogs"></i>
<span class="title">Layouts</span>
<span class="arrow "></span>
</a>
<ul class="sub-menu">
<li >
<a href="layout_horizontal_sidebar_menu.html">
Horzontal & Sidebar Menu</a>
</li>
<li >
<a href="layout_horizontal_menu1.html">
Horzontal Menu 1</a>
</li>
<li >
<a href="layout_horizontal_menu2.html">
Horzontal Menu 2</a>
</li>
<li >
<a href="layout_promo.html">
Promo Page</a>
</li>
<li >
<a href="layout_email.html">
Email Templates</a>
</li>
<li >
<a href="layout_ajax.html">
Content Loading via Ajax</a>
</li>
<li >
<a href="layout_sidebar_closed.html">
Sidebar Closed Page</a>
</li>
<li >
<a href="layout_blank_page.html">
Blank Page</a>
</li>
<li >
<a href="layout_boxed_page.html">
Boxed Page</a>
</li>
<li >
<a href="layout_boxed_not_responsive.html">
Non-Responsive Boxed Layout</a>
</li>
</ul>
</li>
<li class="">
<a href="javascript:;">
<i class="icon-bookmark-empty"></i>
<span class="title">UI Features</span>
<span class="arrow "></span>
</a>
<ul class="sub-menu">
<li >
<a href="ui_general.html">
General</a>
</li>
<li >
<a href="ui_buttons.html">
Buttons</a>
</li>
<li >
<a href="ui_modals.html">
Enhanced Modals</a>
</li>
<li >
<a href="ui_tabs_accordions.html">
Tabs & Accordions</a>
</li>
<li >
<a href="ui_jqueryui.html">
jQuery UI Components</a>
</li>
<li >
<a href="ui_sliders.html">
Sliders</a>
</li>
<li >
<a href="ui_tiles.html">
Tiles</a>
</li>
<li >
<a href="ui_typography.html">
Typography</a>
</li>
<li >
<a href="ui_tree.html">
Tree View</a>
</li>
<li >
<a href="ui_nestable.html">
Nestable List</a>
</li>
</ul>
</li>
<li class="active ">
<a href="javascript:;">
<i class="icon-table"></i>
<span class="title">Form Stuff</span>
<span class="selected"></span>
<span class="arrow open"></span>
</a>
<ul class="sub-menu">
<li >
<a href="form_layout.html">
Form Layouts</a>
</li>
<li >
<a href="form_samples.html">
Advance Form Samples</a>
</li>
<li >
<a href="form_component.html">
Form Components</a>
</li>
<li class="active">
<a href="form_wizard.html">
Form Wizard</a>
</li>
<li >
<a href="form_validation.html">
Form Validation</a>
</li>
<li >
<a href="form_fileupload.html">
Multiple File Upload</a>
</li>
<li >
<a href="form_dropzone.html">
Dropzone File Upload</a>
</li>
</ul>
</li>
<li class="">
<a href="javascript:;">
<i class="icon-briefcase"></i>
<span class="title">Pages</span>
<span class="arrow "></span>
</a>
<ul class="sub-menu">
<li >
<a href="page_timeline.html">
<i class="icon-time"></i>
Timeline</a>
</li>
<li >
<a href="page_coming_soon.html">
<i class="icon-cogs"></i>
Coming Soon</a>
</li>
<li >
<a href="page_blog.html">
<i class="icon-comments"></i>
Blog</a>
</li>
<li >
<a href="page_blog_item.html">
<i class="icon-font"></i>
Blog Post</a>
</li>
<li >
<a href="page_news.html">
<i class="icon-coffee"></i>
News</a>
</li>
<li >
<a href="page_news_item.html">
<i class="icon-bell"></i>
News View</a>
</li>
<li >
<a href="page_about.html">
<i class="icon-group"></i>
About Us</a>
</li>
<li >
<a href="page_contact.html">
<i class="icon-envelope-alt"></i>
Contact Us</a>
</li>
<li >
<a href="page_calendar.html">
<i class="icon-calendar"></i>
Calendar</a>
</li>
</ul>
</li>
<li class="">
<a href="javascript:;">
<i class="icon-gift"></i>
<span class="title">Extra</span>
<span class="arrow "></span>
</a>
<ul class="sub-menu">
<li >
<a href="extra_profile.html">
User Profile</a>
</li>
<li >
<a href="extra_lock.html">
Lock Screen</a>
</li>
<li >
<a href="extra_faq.html">
FAQ</a>
</li>
<li >
<a href="inbox.html">
Inbox</a>
</li>
<li >
<a href="extra_search.html">
Search Results</a>
</li>
<li >
<a href="extra_invoice.html">
Invoice</a>
</li>
<li >
<a href="extra_pricing_table.html">
Pricing Tables</a>
</li>
<li >
<a href="extra_image_manager.html">
Image Manager</a>
</li>
<li >
<a href="extra_404_option1.html">
404 Page Option 1</a>
</li>
<li >
<a href="extra_404_option2.html">
404 Page Option 2</a>
</li>
<li >
<a href="extra_404_option3.html">
404 Page Option 3</a>
</li>
<li >
<a href="extra_500_option1.html">
500 Page Option 1</a>
</li>
<li >
<a href="extra_500_option2.html">
500 Page Option 2</a>
</li>
</ul>
</li>
<li>
<a class="active" href="javascript:;">
<i class="icon-sitemap"></i>
<span class="title">3 Level Menu</span>
<span class="arrow "></span>
</a>
<ul class="sub-menu">
<li>
<a href="javascript:;">
Item 1
<span class="arrow"></span>
</a>
<ul class="sub-menu">
<li><a href="#">Sample Link 1</a></li>
<li><a href="#">Sample Link 2</a></li>
<li><a href="#">Sample Link 3</a></li>
</ul>
</li>
<li>
<a href="javascript:;">
Item 1
<span class="arrow"></span>
</a>
<ul class="sub-menu">
<li><a href="#">Sample Link 1</a></li>
<li><a href="#">Sample Link 1</a></li>
<li><a href="#">Sample Link 1</a></li>
</ul>
</li>
<li>
<a href="#">
Item 3
</a>
</li>
</ul>
</li>
<li>
<a href="javascript:;">
<i class="icon-folder-open"></i>
<span class="title">4 Level Menu</span>
<span class="arrow "></span>
</a>
<ul class="sub-menu">
<li>
<a href="javascript:;">
<i class="icon-cogs"></i>
Item 1
<span class="arrow"></span>
</a>
<ul class="sub-menu">
<li>
<a href="javascript:;">
<i class="icon-user"></i>
Sample Link 1
<span class="arrow"></span>
</a>
<ul class="sub-menu">
<li><a href="#"><i class="icon-remove"></i> Sample Link 1</a></li>
<li><a href="#"><i class="icon-pencil"></i> Sample Link 1</a></li>
<li><a href="#"><i class="icon-edit"></i> Sample Link 1</a></li>
</ul>
</li>
<li><a href="#"><i class="icon-user"></i> Sample Link 1</a></li>
<li><a href="#"><i class="icon-external-link"></i> Sample Link 2</a></li>
<li><a href="#"><i class="icon-bell"></i> Sample Link 3</a></li>
</ul>
</li>
<li>
<a href="javascript:;">
<i class="icon-globe"></i>
Item 2
<span class="arrow"></span>
</a>
<ul class="sub-menu">
<li><a href="#"><i class="icon-user"></i> Sample Link 1</a></li>
<li><a href="#"><i class="icon-external-link"></i> Sample Link 1</a></li>
<li><a href="#"><i class="icon-bell"></i> Sample Link 1</a></li>
</ul>
</li>
<li>
<a href="#">
<i class="icon-folder-open"></i>
Item 3
</a>
</li>
</ul>
</li>
<li class="">
<a href="javascript:;">
<i class="icon-user"></i>
<span class="title">Login Options</span>
<span class="arrow "></span>
</a>
<ul class="sub-menu">
<li >
<a href="login.html">
Login Form 1</a>
</li>
<li >
<a href="login_soft.html">
Login Form 2</a>
</li>
</ul>
</li>
<li class="">
<a href="javascript:;">
<i class="icon-th"></i>
<span class="title">Data Tables</span>
<span class="arrow "></span>
</a>
<ul class="sub-menu">
<li >
<a href="table_basic.html">
Basic Tables</a>
</li>
<li >
<a href="table_responsive.html">
Responsive Tables</a>
</li>
<li >
<a href="table_managed.html">
Managed Tables</a>
</li>
<li >
<a href="table_editable.html">
Editable Tables</a>
</li>
<li >
<a href="table_advanced.html">
Advanced Tables</a>
</li>
</ul>
</li>
<li class="">
<a href="javascript:;">
<i class="icon-file-text"></i>
<span class="title">Portlets</span>
<span class="arrow "></span>
</a>
<ul class="sub-menu">
<li >
<a href="portlet_general.html">
General Portlets</a>
</li>
<li >
<a href="portlet_draggable.html">
Draggable Portlets</a>
</li>
</ul>
</li>
<li class="">
<a href="javascript:;">
<i class="icon-map-marker"></i>
<span class="title">Maps</span>
<span class="arrow "></span>
</a>
<ul class="sub-menu">
<li >
<a href="maps_google.html">
Google Maps</a>
</li>
<li >
<a href="maps_vector.html">
Vector Maps</a>
</li>
</ul>
</li>
<li class="last ">
<a href="charts.html">
<i class="icon-bar-chart"></i>
<span class="title">Visual Charts</span>
</a>
</li>
</ul>
<!-- END SIDEBAR MENU -->
</div>
<!-- END SIDEBAR -->
<!-- BEGIN PAGE -->
<div class="page-content">
<!-- BEGIN SAMPLE PORTLET CONFIGURATION MODAL FORM-->
<div id="portlet-config" class="modal hide">
<div class="modal-header">
<button data-dismiss="modal" class="close" type="button"></button>
<h3>portlet Settings</h3>
</div>
<div class="modal-body">
<p>Here will be a configuration form</p>
</div>
</div>
<!-- END SAMPLE PORTLET CONFIGURATION MODAL FORM-->
<!-- BEGIN PAGE CONTAINER-->
<div class="container-fluid">
<!-- BEGIN PAGE HEADER-->
<div class="row-fluid">
<div class="span12">
<!-- BEGIN STYLE CUSTOMIZER -->
<div class="color-panel hidden-phone">
<div class="color-mode-icons icon-color"></div>
<div class="color-mode-icons icon-color-close"></div>
<div class="color-mode">
<p>THEME COLOR</p>
<ul class="inline">
<li class="color-black current color-default" data-style="default"></li>
<li class="color-blue" data-style="blue"></li>
<li class="color-brown" data-style="brown"></li>
<li class="color-purple" data-style="purple"></li>
<li class="color-grey" data-style="grey"></li>
<li class="color-white color-light" data-style="light"></li>
</ul>
<label>
<span>Layout</span>
<select class="layout-option m-wrap small">
<option value="fluid" selected>Fluid</option>
<option value="boxed">Boxed</option>
</select>
</label>
<label>
<span>Header</span>
<select class="header-option m-wrap small">
<option value="fixed" selected>Fixed</option>
<option value="default">Default</option>
</select>
</label>
<label>
<span>Sidebar</span>
<select class="sidebar-option m-wrap small">
<option value="fixed">Fixed</option>
<option value="default" selected>Default</option>
</select>
</label>
<label>
<span>Footer</span>
<select class="footer-option m-wrap small">
<option value="fixed">Fixed</option>
<option value="default" selected>Default</option>
</select>
</label>
</div>
</div>
<!-- END BEGIN STYLE CUSTOMIZER -->
<h3 class="page-title">
Form Wizard
<small>form wizard sample</small>
</h3>
<ul class="breadcrumb">
<li>
<i class="icon-home"></i>
<a href="index.html">Home</a>
<span class="icon-angle-right"></span>
</li>
<li>
<a href="#">Form Stuff</a>
<span class="icon-angle-right"></span>
</li>
<li><a href="#">Form Wizard</a></li>
</ul>
</div>
</div>
<!-- END PAGE HEADER-->
<!-- BEGIN PAGE CONTENT-->
<div class="row-fluid">
<div class="span12">
<div class="portlet box blue" id="form_wizard_1">
<div class="portlet-title">
<div class="caption">
<i class="icon-reorder"></i> Form Wizard - <span class="step-title">Step 1 of 4</span>
</div>
<div class="tools hidden-phone">
<a href="javascript:;" class="collapse"></a>
<a href="#portlet-config" data-toggle="modal" class="config"></a>
<a href="javascript:;" class="reload"></a>
<a href="javascript:;" class="remove"></a>
</div>
</div>
<div class="portlet-body form">
<form action="#" class="form-horizontal" id="submit_form">
<div class="form-wizard">
<div class="navbar steps">
<div class="navbar-inner">
<ul class="row-fluid">
<li class="span3">
<a href="#tab1" data-toggle="tab" class="step active">
<span class="number">1</span>
<span class="desc"><i class="icon-ok"></i> Account Setup</span>
</a>
</li>
<li class="span3">
<a href="#tab2" data-toggle="tab" class="step">
<span class="number">2</span>
<span class="desc"><i class="icon-ok"></i> Profile Setup</span>
</a>
</li>
<li class="span3">
<a href="#tab3" data-toggle="tab" class="step">
<span class="number">3</span>
<span class="desc"><i class="icon-ok"></i> Billing Setup</span>
</a>
</li>
<li class="span3">
<a href="#tab4" data-toggle="tab" class="step">
<span class="number">4</span>
<span class="desc"><i class="icon-ok"></i> Confirm</span>
</a>
</li>
</ul>
</div>
</div>
<div id="bar" class="progress progress-success progress-striped">
<div class="bar"></div>
</div>
<div class="tab-content">
<div class="alert alert-error hide">
<button class="close" data-dismiss="alert"></button>
You have some form errors. Please check below.
</div>
<div class="alert alert-success hide">
<button class="close" data-dismiss="alert"></button>
Your form validation is successful!
</div>
<div class="tab-pane active" id="tab1">
<h3 class="block">Provide your account details</h3>
<div class="control-group">
<label class="control-label">Username<span class="required">*</span></label>
<div class="controls">
<input type="text" class="span6 m-wrap" name="username"/>
<span class="help-inline">Provide your username</span>
</div>
</div>
<div class="control-group">
<label class="control-label">Password<span class="required">*</span></label>
<div class="controls">
<input type="password" class="span6 m-wrap" name="password" id="submit_form_password"/>
<span class="help-inline">Provide your username</span>
</div>
</div>
<div class="control-group">
<label class="control-label">Confirm Password<span class="required">*</span></label>
<div class="controls">
<input type="password" class="span6 m-wrap" name="rpassword"/>
<span class="help-inline">Confirm your password</span>
</div>
</div>
<div class="control-group">
<label class="control-label">Email<span class="required">*</span></label>
<div class="controls">
<input type="text" class="span6 m-wrap" name="email"/>
<span class="help-inline">Provide your email address</span>
</div>
</div>
</div>
<div class="tab-pane" id="tab2">
<h3 class="block">Provide your profile details</h3>
<div class="control-group">
<label class="control-label">Fullname<span class="required">*</span></label>
<div class="controls">
<input type="text" class="span6 m-wrap" name="fullname"/>
<span class="help-inline">Provide your fullname</span>
</div>
</div>
<div class="control-group">
<label class="control-label">Phone Number<span class="required">*</span></label>
<div class="controls">
<input type="text" class="span6 m-wrap" name="phone"/>
<span class="help-inline">Provide your phone number</span>
</div>
</div>
<div class="control-group">
<label class="control-label">Gender<span class="required">*</span></label>
<div class="controls">
<label class="radio">
<input type="radio" name="gender" value="M" data-title="Male" />
Male
</label>
<div class="clearfix"></div>
<label class="radio">
<input type="radio" name="gender" value="F" data-title="Female"/>
Female
</label>
<div id="form_gender_error"></div>
</div>
</div>
<div class="control-group">
<label class="control-label">Address<span class="required">*</span></label>
<div class="controls">
<input type="text" class="span6 m-wrap" name="address" />
<span class="help-inline">Provide your street address</span>
</div>
</div>
<div class="control-group">
<label class="control-label">City/Town<span class="required">*</span></label>
<div class="controls">
<input type="text" class="span6 m-wrap" name="city"/>
<span class="help-inline">Provide your city or town</span>
</div>
</div>
<div class="control-group">
<label class="control-label">Country</label>
<div class="controls">
<select name="country" id="country_list" class="span6">
<option value="">Select</option>
<option value="AF">Afghanistan</option>
<option value="AL">Albania</option>
<option value="DZ">Algeria</option>
<option value="AS">American Samoa</option>
<option value="AD">Andorra</option>
<option value="AO">Angola</option>
<option value="AI">Anguilla</option>
<option value="AQ">Antarctica</option>
<option value="AR">Argentina</option>
<option value="AM">Armenia</option>
<option value="AW">Aruba</option>
<option value="AU">Australia</option>
<option value="AT">Austria</option>
<option value="AZ">Azerbaijan</option>
<option value="BS">Bahamas</option>
<option value="BH">Bahrain</option>
<option value="BD">Bangladesh</option>
<option value="BB">Barbados</option>
<option value="BY">Belarus</option>
<option value="BE">Belgium</option>
<option value="BZ">Belize</option>
<option value="BJ">Benin</option>
<option value="BM">Bermuda</option>
<option value="BT">Bhutan</option>
<option value="BO">Bolivia</option>
<option value="BA">Bosnia and Herzegowina</option>
<option value="BW">Botswana</option>
<option value="BV">Bouvet Island</option>
<option value="BR">Brazil</option>
<option value="IO">British Indian Ocean Territory</option>
<option value="BN">Brunei Darussalam</option>
<option value="BG">Bulgaria</option>
<option value="BF">Burkina Faso</option>
<option value="BI">Burundi</option>
<option value="KH">Cambodia</option>
<option value="CM">Cameroon</option>
<option value="CA">Canada</option>
<option value="CV">Cape Verde</option>
<option value="KY">Cayman Islands</option>
<option value="CF">Central African Republic</option>
<option value="TD">Chad</option>
<option value="CL">Chile</option>
<option value="CN">China</option>
<option value="CX">Christmas Island</option>
<option value="CC">Cocos (Keeling) Islands</option>
<option value="CO">Colombia</option>
<option value="KM">Comoros</option>
<option value="CG">Congo</option>
<option value="CD">Congo, the Democratic Republic of the</option>
<option value="CK">Cook Islands</option>
<option value="CR">Costa Rica</option>
<option value="CI">Cote d'Ivoire</option>
<option value="HR">Croatia (Hrvatska)</option>
<option value="CU">Cuba</option>