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<!DOCTYPE html>
<html>
<head>
<title>Gym Membership Form</title>
<link href="https://fonts.googleapis.com/css?family=Roboto:300,400,500,700" rel="stylesheet">
<link rel="stylesheet" href="https://use.fontawesome.com/releases/v5.5.0/css/all.css" integrity="sha384-B4dIYHKNBt8Bc12p+WXckhzcICo0wtJAoU8YZTY5qE0Id1GSseTk6S+L3BlXeVIU" crossorigin="anonymous">
<style>
html, body {
min-height: 100%;
}
body, div, form, input, select, p {
padding: 0;
margin: 0;
outline: none;
font-family: Roboto, Arial, sans-serif;
font-size: 14px;
color: #666;
line-height: 22px;
}
h1 {
position: absolute;
margin: 0;
font-size: 36px;
color: #fff;
z-index: 2;
}
span.required {
color: red;
}
.testbox {
display: flex;
justify-content: center;
align-items: center;
height: inherit;
padding: 20px;
}
form {
width: 100%;
padding: 20px;
border-radius: 6px;
background: #fff;
box-shadow: 0 0 30px 0 #095484;
}
.banner {
position: relative;
height: 180px;
background-image: url("/uploads/media/default/0001/01/9e07ce3a601795a5ac09a66a0c1fc8978e0ee51a.jpeg");
background-size: cover;
display: flex;
justify-content: center;
align-items: center;
text-align: center;
}
.banner::after {
content: "";
background-color: rgba(0, 0, 0, 0.4);
position: absolute;
width: 100%;
height: 100%;
}
p.top-info {
margin: 10px 0;
}
input, select {
margin-bottom: 10px;
border: 1px solid #ccc;
border-radius: 3px;
}
input {
width: calc(100% - 10px);
padding: 5px;
}
select {
width: 100%;
padding: 7px 0;
background: transparent;
}
.item:hover p, .question:hover p, .question label:hover, input:hover::placeholder {
color: #095484;
}
.item input:hover, .item select:hover {
border: 1px solid transparent;
box-shadow: 0 0 5px 0 #095484;
color: #095484;
}
.item {
position: relative;
margin: 10px 0;
}
.question input {
width: auto;
margin: 0;
border-radius: 50%;
}
.question input, .question span {
vertical-align: middle;
}
.question label {
display: inline-block;
margin: 5px 20px 15px 0;
}
.btn-block {
margin-top: 10px;
text-align: center;
}
button {
width: 150px;
padding: 10px;
border: none;
border-radius: 5px;
background: #095484;
font-size: 16px;
color: #fff;
cursor: pointer;
}
button:hover {
background: #0666a3;
}
@media (min-width: 568px) {
.name-item, .city-item {
display: flex;
flex-wrap: wrap;
justify-content: space-between;
}
.name-item input, .city-item input {
width: calc(50% - 20px);
}
.city-item select {
width: calc(50% - 8px);
}
}
</style>
</head>
<body>
<div class="testbox">
<form action="/">
<div class="banner">
<h1>Gym Membership Form</h1>
</div>
<p class="top-info">Want to become a member of our Gym? Then start by filling our form to complete registration. We will contact you shortly to notify you about your membership card.</p>
<div class="item">
<p>Name<span class="required">*</span></p>
<div class="name-item">
<input type="text" name="name" placeholder="First" required/>
<input type="text" name="name" placeholder="Last" required/>
</div>
</div>
<div class="question">
<p>Gender<span class="required">*</span></p>
<div class="question-answer">
<label><input type="radio" value="none" name="gender" required/> <span>Male</span></label>
<label><input type="radio" value="none" name="gender" required/> <span>Female</span></label>
</div>
</div>
<div class="item">
<p>Your current weight (lbs)<span class="required">*</span></p>
<input type="text" name="name"/>
</div>
<div class="item">
<p>Desired weight (lbs)<span class="required">*</span></p>
<input type="text" name="name" required/>
</div>
<div class="item">
<p>Height<span class="required">*</span></p>
<input type="text" name="name" required/>
</div>
<div class="item">
<p>BMI<span class="required">*</span></p>
<input type="text" name="name" required/>
</div>
<div class="item">
<p>Home Address<span class="required">*</span></p>
<input type="text" name="name" placeholder="Street address" required/>
<div class="city-item">
<input type="text" name="name" placeholder="City" required/>
<input type="text" name="name" placeholder="Region" required/>
<input type="text" name="name" placeholder="Postal / Zip code" required/>
<select>
<option value="">Country</option>
<option value="1">Russia</option>
<option value="2">Germany</option>
<option value="3">France</option>
<option value="4">Armenia</option>
<option value="5">USA</option>
</select>
</div>
</div>
<div class="item">
<p>Email<span class="required">*</span></p>
<input type="text" name="name" required/>
</div>
<div class="item">
<p>Phone</p>
<input type="text" name="name"/>
</div>
<div class="question">
<p>Do you require a personal trainer?<span class="required">*</span></p>
<div class="question-answer">
<label><input type="radio" value="none" name="personal-trainer" required/> <span>Yes</span></label>
<label><input type="radio" value="none" name="personal-trainer" required/> <span>No</span></label>
</div>
</div>
<div class="question">
<p>Have you been in a Gym before?<span class="required">*</span></p>
<div class="question-answer">
<label><input type="radio" value="none" name="gym-before" required/> <span>Yes</span></label>
<label><input type="radio" value="none" name="gym-before" required/> <span>No</span></label>
</div>
</div>
<div class="question">
<p>Membership Type<span class="required">*</span></p>
<div class="question-answer">
<label><input type="radio" value="none" name="membership" required/> <span>Regular</span></label>
<label><input type="radio" value="none" name="membership" required/> <span>Pro</span></label>
<label><input type="radio" value="none" name="membership" required/> <span>VIP</span></label>
</div>
</div>
<div class="btn-block">
<button type="submit" href="/">Apply</button>
</div>
</form>
</div>
</body>
</html>