
<?php
include 'header.php';
?>
    <!--/.header-->

    <div class="heading">
        <div class="container">
        
    </div>

    <div class="container-fluid">
       <hr>
       <div class="row">
        <div class="col-md-12" style="background-color:#241e20;    width: 100%;
    height: 168px;padding-top: 51px;margin-top: -18px;">
    <h1 align="center" style="color:white">YOUNG LEARNERS BOOKING FORM</h1>
        <!--/ .row-->
    </div>
    </div>
    </div>
    <!--/ .container-->



    <div class="block">
        <div class="container">
           
	<div class="clearfix"></div>
	<br><br>
	<div class="row">
	<div class="col-md-4">
	
	</div>
	<div class="col-md-4">
	<h1 style="color:black">STEP 1: COURSE INFORMATION</h1><form action="email1.php" method="post">
	<label>First Name:</label>
	<input type="text" class="form-control" name="fname">
	<label>Last Name:</label>
	<input type="text" class="form-control" name="lname">
	<label>Date Of Birth:</label>
	<input type="text" class="form-control" name="dob">
	
	<label>Gender/Sex:</label>
	<select class="form-control" name="gender">
	<option>Male</option>
	<option>Female</option>
	
	</select>
	<label>Nationality:</label>
	<input type="text" class="form-control" name="na">
	<label>Phone number: (include country code)</label>
	<input type="text" class="form-control" name="ph">
	<label>Email:</label>
	<input type="text" class="form-control"  name="email">
	
	<br>
	<input type="submit" value="book now">
<input type="submit" value="Back"></form>
	</div>
	</div>
	
	
<br><br>
	
	<br><br><br><br>
	<div class="row">
    
        <!--/ .container-->
        <div class="bg"></div><!--/ .bg-->
    </div>
    <!--/ .block-->

    <div class="container"></div>

   <hr>
<p align="center">Copyright © 2016 Horizon | All Rights Reserved<p>

    
    <!--/ .block-->


</div>
</div>



<div class="modal fade workshop-detail" id="modal-workshop">
    <div class="modal-dialog">
        <div class="modal-content">
            <div class="modal-header">
                <button type="button" class="close" data-dismiss="modal" aria-label="Close"><span aria-hidden="true">&times;</span></button>
                <h2 class="modal-title">Life Success is Never Ending Battle</h2>
                <h3 class="date">02.03.2015</h3>
                <h4 class="place">University of London City</h4>
                <figure class="time"><i class="icon_clock"></i>11:00</figure>
            </div>
            <div class="modal-body">
                <div class="image"><img src="assets/img/workshop-detail.jpg" alt=""></div>
               
               
                <div class="clearfix">
                    <a href="#" class="btn btn-default pull-right">Get the tickets</a>
                </div>
            </div><!-- /.modal-body -->
        </div><!-- /.modal-content -->
    </div><!-- /.modal-dialog -->
</div><!-- /.modal -->

<script type="text/javascript" src="assets/js/jquery-2.1.4.min.js"></script>
<script type="text/javascript" src="assets/js/jquery-migrate-1.2.1.min.js"></script>
<script type="text/javascript" src="assets/bootstrap/js/bootstrap.min.js"></script>
<script type="text/javascript" src="assets/js/bootstrap-select.min.js"></script>
<script type="text/javascript" src="assets/js/zabuto_calendar.min.js"></script>
<script type="text/javascript" src="assets/js/jquery.validate.min.js"></script>
<script type="text/javascript" src="assets/js/custom.js"></script>

<!--[if lte IE 9]>
    <script src="assets/js/ie.js"></script>
<![endif]-->

</body>