<link rel="stylesheet" href="css/font-awesome.css"/>  
  
<div class="main">
	
	<div class="container">
	  <form>
		<div class="row">
		  <h4>Account Details</h4>
		  <div class="input-group input-group-icon">
			<input type="text" placeholder="Full Name"/>
			<div class="input-icon"><i class="fa fa-user"></i></div>
		  </div>
		  <div class="input-group input-group-icon">
			<input type="email" placeholder="Email Adress"/>
			<div class="input-icon"><i class="fa fa-envelope"></i></div>
		  </div>
		  <div class="input-group input-group-icon">
			<input type="password" placeholder="Password"/>
			<div class="input-icon"><i class="fa fa-key"></i></div>
		  </div>
		</div>
		<div class="row">
		  <div class="col-half">
			<h4>Date of Birth</h4>
			<div class="input-group">
			  <div class="col-third">
				<input type="text" placeholder="DD"/>
			  </div>
			  <div class="col-third">
				<input type="text" placeholder="MM"/>
			  </div>
			  <div class="col-third">
				<input type="text" placeholder="YYYY"/>
			  </div>
			</div>
		  </div>
		  <div class="col-half">
			<h4>Gender</h4>
			<div class="input-group">
			  <input type="radio" name="gender" value="male" id="gender-male"/>
			  <label for="gender-male">Male</label>
			  <input type="radio" name="gender" value="female" id="gender-female"/>
			  <label for="gender-female">Female</label>
			</div>
		  </div>
		</div>
		<div class="row">
		  <h4>Payment Details</h4>
		  <div class="input-group">
			<input type="radio" name="payment-method" value="card" id="payment-method-card" checked="true"/>
			<label for="payment-method-card"><span><i class="fa fa-cc-visa"></i>Credit Card</span></label>
			<input type="radio" name="payment-method" value="paypal" id="payment-method-paypal"/>
			<label for="payment-method-paypal"> <span><i class="fa fa-cc-paypal"></i>Paypal</span></label>
		  </div>
		  <div class="input-group input-group-icon">
			<input type="text" placeholder="Card Number"/>
			<div class="input-icon"><i class="fa fa-credit-card"></i></div>
		  </div>
		  <div class="col-half">
			<div class="input-group input-group-icon">
			  <input type="text" placeholder="Card CVC"/>
			  <div class="input-icon"><i class="fa fa-user"></i></div>
			</div>
		  </div>
		  <div class="col-half">
			<div class="input-group">
			  <select>
				<option value="">Select</option>
				<option value="01 Jan">01 Jan</option>
				<option value="01 Feb">01 Feb</option>
				<option value="01 Mar">01 Mar</option>
				<option value="01 Apr">01 Apr</option>
				<option value="01 May">01 May</option>
				<option value="01 Jun">01 Jun</option>
				<option value="01 Jul">01 Jul</option>
				<option value="01 Aug">01 Aug</option>
				<option value="01 Sep">01 Sep</option>
				<option value="01 Oct">01 Oct</option>
				<option value="01 Nov">01 Nov</option>
				<option value="01 Dec">01 Dec</option>
			  </select>
			  <select>
				<option value="">Select</option>
				<option>2010</option>
				<option>2011</option>
				<option>2012</option>
				<option>2013</option>
				<option>2014</option>
				<option>2015</option>
				<option>2016</option>
				<option>2017</option>
				<option>2018</option>
				<option>2019</option>
				<option>2020</option>
				<option>2021</option>
				<option>2022</option>
				<option>2023</option>
				<option>2024</option>
				<option>2025</option>
				<option>2026</option>
				<option>2027</option>
				<option>2028</option>
				<option>2029</option>
				<option>2030</option>
			  </select>
			</div>
		  </div>
		</div>
		<div class="row">
		  <h4>Terms and Conditions</h4>
		  <div class="input-group">
			<input type="checkbox" id="terms"/>
			<label for="terms">I accept the terms and conditions.</label>
		  </div>
		</div>
		<div class="row">
		  <input type="submit" class="submit_btn" name="submit" value="SUBMIT"/>
		</div>
	  </form>
	</div>
	
</div>

 /******************************         
 http://www.freetimelearning.com  
 http://www.freetimelearn.com          
 *******************************/
.main{ margin:10px auto 20px !important; width:600px;}
*,
*:before,
*:after {
  box-sizing: border-box;
}
body {
  padding: 16px;
  font-family: Arial, Helvetica, sans-serif;
  font-size: 15px;
  color: #b9b9b9;
  background-color: #F3F3F3;
}
h4 {
  color: #7ed321;
}
input,
input[type="radio"] + label,
input[type="checkbox"] + label:before,
select option,
select {
  width: 100%;
  padding: 1em;
  line-height: 1.4;
  background-color: #f9f9f9;
  border: 1px solid #e5e5e5;
  border-radius: 3px;
  -webkit-transition: 0.35s ease-in-out;
  -moz-transition: 0.35s ease-in-out;
  -o-transition: 0.35s ease-in-out;
  transition: 0.35s ease-in-out;
  transition: all 0.35s ease-in-out;
}
input:focus {
  outline: 0;
  border-color: #64ac15;
}
input:focus + .input-icon i {
  color: #7ed321;
}
input:focus + .input-icon:after {
  border-right-color: #7ed321;
}
input[type="radio"] {
  display: none;
}
input[type="radio"] + label,
select {
  display: inline-block;
  width: 50%;
  text-align: center;
  float: left;
  border-radius: 0;
}
input[type="radio"] + label:first-of-type {
  border-top-left-radius: 3px;
  border-bottom-left-radius: 3px;
}
input[type="radio"] + label:last-of-type {
  border-top-right-radius: 3px;
  border-bottom-right-radius: 3px;
}
input[type="radio"] + label i {
  padding-right: 0.4em;
}
input[type="radio"]:checked + label,
input:checked + label:before,
select:focus,
select:active {
  background-color: #7ed321;
  color: #fff;
  border-color: #64ac15;
}
input[type="checkbox"] {
  display: none;
}
input[type="checkbox"] + label {
  position: relative;
  display: block;
  padding-left: 1.6em;
}
input[type="checkbox"] + label:before {
  position: absolute;
  top: 0.2em;
  left: 0;
  display: block;
  width: 1em;
  height: 1em;
  padding: 0;
  content: "";
}
input[type="checkbox"] + label:after {
  position: absolute;
  top: 0.45em;
  left: 0.2em;
  font-size: 0.8em;
  color: #fff;
  opacity: 0;
  font-family: FontAwesome;
  content: "\f00c";
}
input:checked + label:after {
  opacity: 1;
}
select {
  height: 3.4em;
  line-height: 2;
}
select:first-of-type {
  border-top-left-radius: 3px;
  border-bottom-left-radius: 3px;
}
select:last-of-type {
  border-top-right-radius: 3px;
  border-bottom-right-radius: 3px;
}
select:focus,
select:active {
  outline: 0;
}
select option {
  background-color: #7ed321;
  color: #fff;
}
.input-group {
  margin-bottom: 1em;
  zoom: 1;
}
.input-group:before,
.input-group:after {
  content: "";
  display: table;
}
.input-group:after {
  clear: both;
}
.input-group-icon {
  position: relative;
}
.input-group-icon input {
  padding-left: 4.4em;
}
.input-group-icon .input-icon {
  position: absolute;
  top: 0;
  left: 0;
  width: 3.4em;
  height: 3.4em;
  line-height: 3.4em;
  text-align: center;
  pointer-events: none;
}
.input-group-icon .input-icon:after {
  position: absolute;
  top: 0.6em;
  bottom: 0.6em;
  left: 3.4em;
  display: block;
  border-right: 1px solid #e5e5e5;
  content: "";
  -webkit-transition: 0.35s ease-in-out;
  -moz-transition: 0.35s ease-in-out;
  -o-transition: 0.35s ease-in-out;
  transition: 0.35s ease-in-out;
  transition: all 0.35s ease-in-out;
}
.input-group-icon .input-icon i {
  -webkit-transition: 0.35s ease-in-out;
  -moz-transition: 0.35s ease-in-out;
  -o-transition: 0.35s ease-in-out;
  transition: 0.35s ease-in-out;
  transition: all 0.35s ease-in-out;
}
.container {
  max-width: 38em;
  padding: 1em 3em 2em 3em;
  margin: 0em auto;
  background-color: #fff;
  border-radius: 4.2px;
  box-shadow: 0px 3px 10px -2px rgba(0, 0, 0, 0.2);
}
.row {
  zoom: 1;
}
.row:before,
.row:after {
  content: "";
  display: table;
}
.row:after {
  clear: both;
}
.col-half {
  padding-right: 10px;
  float: left;
  width: 50%;
}
.col-half:last-of-type {
  padding-right: 0;
}
.col-third {
  padding-right: 10px;
  float: left;
  width: 33.33333333%;
}
.col-third:last-of-type {
  padding-right: 0;
}
@media only screen and (max-width: 540px) {
  .col-half {
    width: 100%;
    padding-right: 0;
  }
}
.submit_btn{ background:#7ed321; border-radius:3px; color:#FFF; cursor:pointer;} .submit_btn:hover{ background:#090;}