
<form name="bmw_signup" id="bmw_signup" method="post" action="">
<div class="container register">
  <div class="row">
    <div class="col-md-3 register-left">
      <img src="https://image.ibb.co/n7oTvU/logo_white.png" alt=""/>
      <h3>Welcome</h3>
      <p>You are 30 seconds away from earning your own money!</p>
    </div>
    <div class="col-md-9 register-right">
      <div class="tab-content" id="myTabContent">
          <div class="tab-pane show active" id="home" role="tabpanel" aria-labelledby="home-tab">
          <h3 class="register-heading">Registration Form</h3>
          <div class="row register-form">
              <div class="col-md-6">
                  <div class="form-group">
                    <input type="text" class="form-control" name="username" placeholder="User Name *" id="letscms_username" maxlength="20" size="37" value="" onBlur="checkUserNameAvailability('https://shop.h2detox.com/wp-admin/admin-ajax.php',this.value);" >
                    <!-- <div id="check_user"></div> -->
                    <span style="font-size:12px; font-style:italic; color:#666666">User name must be 5 character, at least one number and alphabet. </span><br>
                    <span class="error_weight" id="err_username"></span>
                  </div>

                      <div class="form-group">
                      <input class="form-control" type="text" name="firstname" placeholder="First Name *"id="letscms_firstname" value="" maxlength="20" size="37" onBlur="return checkname(this.value, 'firstname');" >
                      <div id="check_firstname"></div><span class="error_weight" id="err_firstname"></span>
                  </div>
                  <div class="form-group">
                      <input class="form-control" type="text" name="lastname" placeholder="Last Name *" id="letscms_lastname" value="" maxlength="20" size="37" onBlur="return checkname(this.value, 'lastname');">
                      <div id="check_lastname"></div><span class="error_weight" id="err_lastname"></span>
                  </div>

                  <div class="form-group">
                      <input class="form-control" type="password" name="password" placeholder="Password *" id="letscms_password" maxlength="20" size="37" />
                      <span style="font-size:12px; font-style:italic; color:#666666">Password length at least 6 character</span></br><span class="error_weight" id="err_password"></span>
                  </div>
                  <div class="form-group">
                      <input class="form-control" type="password" name="confirm_password" placeholder="Confim Password *" id="letscms_confirm_password" maxlength="20" size="37" ><span class="error_weight" id='message'></span>
                  </div>

                  <div class="form-group">
                      <input class="form-control" type="text" name="email" placeholder="Email Id *" id="letscms_email" value=""  size="37" onBlur="checkEmailAvailability('https://shop.h2detox.com/wp-admin/admin-ajax.php',this.value);">
                      <div id="check_email" class="error_weight"></div>
                  </div>
                  <div class="form-group">
                      <input class="form-control dob" type="date" name="dob" placeholder="DOB *" value="" maxlength="20" size="22" >
                  </div><span class="error_weight" id="err_dob"></span>
              </div>
              
              <div class="col-md-6">
                  <div class="form-group">
                      <input class="form-control" type="text" name="address1" placeholder="Address *" id="letscms_address1" value=""  size="37" ><span class="error_weight" id="err_address"></span>
                  </div>
                  <div class="form-group">
                      <input class="form-control" type="text" name="city" placeholder="City" id="letscms_city" value="" maxlength="30" size="37" ><span class="error_weight" id="err_city"></span>
                  </div>
                  <div class="form-group">
                      <input class="form-control" type="text" name="state" placeholder="State" id="letscms_state" value="" maxlength="30" size="37" ><span class="error_weight" id="err_state"></span>
                  </div>
                  <div class="form-group">
                      <input class="form-control" type="text" name="postalcode" placeholder="Postal Code" id="letscms_postalcode" value="" maxlength="20" size="37" onBlur="return allowspace(this.value,'postalcode');"><span class="error_weight" id="err_postalcode"></span>
                  </div>
                  <div class="form-group">
                                          <input type="text" class="form-control" name="sponsor" id="sponsor" placeholder="Sponsor Name*" value="" maxlength="20" size="37" onBlur="checkReferrerAvailability('https://shop.h2detox.com/wp-admin/admin-ajax.php',this.value);" />
                       <span class="error_weight" style="font-size:12px; font-style:italic; color:#666666">Sponsor name</span>
                      <div id="check_referrer"></div><span class="error_weight" id="err_sponsor"></span>
                  </div>
                  <div class="form-group">
                                          Left Leg <input id="left" type="radio" name="leg" value="0"   required/>Right Leg<input id="right" type="radio" name="leg" value="1"  />
                  </div>
                  <div class="form-group">
                      
                  </div>
                    <button class="btn btn-primary" name="submit" id="bmw_register" type="submit">Register </button>
                  </div>
                  </div>
                </div>
                
            </div>
        </div>
    </div>
</div>
</form>
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