<!DOCTYPE html>
<html>
<head>
<title>Entertainment Booking 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, textarea, 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: 32px;
color: #fff;
z-index: 2;
}
.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 20px 0 #a82877;
}
.banner {
position: relative;
height: 210px;
background-image: url("/uploads/media/default/0001/02/8ca4045044162379597641472fa0bb5489ba418f.jpeg"); background-size: cover;
display: flex;
justify-content: center;
align-items: center;
text-align: center;
}
.banner::after {
content: "";
background-color: rgba(0, 0, 0, 0.5);
position: absolute;
width: 100%;
height: 100%;
}
input, textarea, 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;
}
textarea {
width: calc(100% - 12px);
padding: 5px;
}
.item:hover p, .item:hover i, .question:hover p, .question label:hover, input:hover::placeholder {
color: #a82877;
}
.item input:hover, .item select:hover, .item textarea:hover {
border: 1px solid transparent;
box-shadow: 0 0 6px 0 #a82877;
color: #a82877;
}
.item {
position: relative;
margin: 10px 0;
}
input[type="date"]::-webkit-inner-spin-button {
display: none;
}
.item i, input[type="date"]::-webkit-calendar-picker-indicator {
position: absolute;
font-size: 20px;
color: #a9a9a9;
}
.item i {
right: 1%;
top: 30px;
z-index: 1;
}
[type="date"]::-webkit-calendar-picker-indicator {
right: 0;
z-index: 2;
opacity: 0;
cursor: pointer;
}
input[type="time"]::-webkit-inner-spin-button {
margin: 2px 22px 0 0;
}
input[type=radio], input.other {
display: none;
}
label.radio {
position: relative;
display: inline-block;
margin: 5px 20px 10px 0;
cursor: pointer;
}
.question span {
margin-left: 30px;
}
label.radio:before {
content: "";
position: absolute;
top: 2px;
left: 0;
width: 15px;
height: 15px;
border-radius: 50%;
border: 2px solid #ccc;
}
#radio_5:checked ~ input.other {
display: block;
}
input[type=radio]:checked + label.radio:before {
border: 2px solid #a82877;
background: #a82877;
}
label.radio:after {
content: "";
position: absolute;
top: 7px;
left: 5px;
width: 7px;
height: 4px;
border: 3px solid #fff;
border-top: none;
border-right: none;
transform: rotate(-45deg);
opacity: 0;
}
input[type=radio]:checked + label:after {
opacity: 1;
}
.btn-block {
margin-top: 10px;
text-align: center;
}
button {
width: 150px;
padding: 10px;
border: none;
border-radius: 5px;
background: #a82877;
font-size: 16px;
color: #fff;
cursor: pointer;
}
button:hover {
background: #bf1e81;
}
@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>Entertainment Booking Form</h1>
</div>
<div class="item">
<p>Date of Event</p>
<input type="date" name="bdate" />
<i class="fas fa-calendar-alt"></i>
</div>
<div class="item">
<p>Time of Event</p>
<input type="time" name="name" />
<i class="fas fa-clock"></i>
</div>
<div class="item">
<p>Select Artist</p>
<select>
<option value=""></option>
<option value="1">*Please select*</option>
<option value="2">Artist 1</option>
<option value="3">Artist 2</option>
<option value="4">Artist 3</option>
<option value="5">Artist 4</option>
</select>
</div>
<div class="item">
<p>Description of Event</p>
<textarea rows="3" ></textarea>
</div>
<div class="item">
<p>Promoter's Name</p>
<input type="text" name="name"/>
</div>
<div class="item">
<p>Venue Name</p>
<input type="text" name="name"/>
</div>
<div class="item">
<p>Venue Address</p>
<input type="text" name="name" placeholder="Street address" />
<input type="text" name="name" placeholder="Street address line 2" />
<div class="city-item">
<input type="text" name="name" placeholder="City" />
<input type="text" name="name" placeholder="Region" />
<input type="text" name="name" placeholder="Postal / Zip code" />
<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>Venue Capacity</p>
<input type="text" name="name"/>
</div>
<div class="item">
<p>Expected Attendance</p>
<input type="text" name="name"/>
</div>
<div class="item">
<p>Type of Performance</p>
<select>
<option value=""></option>
<option value="1">*Please select*</option>
<option value="2">Solo Performance</option>
<option value="3">Full Band</option>
</select>
</div>
<div class="item">
<p>Set Time (in minutes)</p>
<input type="text" name="name"/>
</div>
<div class="item">
<p>Contact Person</p>
<div class="name-item">
<input type="text" name="name" placeholder="First" />
<input type="text" name="name" placeholder="Last" />
</div>
</div>
<div class="item">
<p>Contact Email</p>
<input type="text" name="name"/>
</div>
<div class="item">
<p>Contact Number</p>
<input type="text" name="name"/>
</div>
<div class="question">
<p>Will this event be recorded?</p>
<div class="question-answer">
<div>
<input type="radio" value="none" id="radio_1" name="recorded" />
<label for="radio_1" class="radio"><span>Yes</span></label>
</div>
<div>
<input type="radio" value="none" id="radio_2" name="recorded" />
<label for="radio_2" class="radio"><span>No</span></label>
</div>
</div>
</div>
<div class="btn-block">
<button type="submit" href="/">SEND</button>
</div>
</form>
</div>
</body>
</html>