<div class="jumbotron" align="center">
<h1>PLAYER INFO</h1>
</div>
<label class="col-md-3 control-label" style="color: white;">Name:*</label>
<div class="col-sm-2"><input type="firstname" class="form-control" id="firstname" name="firstname" placeholder="First Name" maxlength="30" value="<%=firstname%>"></div>
<div class="col-sm-2"><input type="middlename" class="form-control" id="middlename" name="middlename" placeholder="Middle Name" maxlength="1" value="<%=middlename%>"></div>
<div class="col-sm-2"><input type="lastname" class="form-control" id="lastname" name="lastname" placeholder="Last Name" maxlength="30" value="<%=lastname%>"></div>
</div>
<div class="form-group">
<label class="col-md-3 control-label" for="address1" style="color: white;">Address 1:</label>
<div class="col-md-6">
<input type="text" class="form-control" id="address1" name="address1" placeholder="Address 1" maxlength="50" value="<%=address1%>">
</div>
</div>
<div class="form-group">
<label class="col-md-3 control-label" for="address2" style="color: white;">Address 2:</label>
<div class="col-md-6">
<input type="text" class="form-control" id="address2" name="address2" placeholder="Address 2" maxlength="50" value="<%=address2%>">
</div>
</div>
<div class="form-group">
<label class="col-md-3 control-label" style="color: white;">City, State, Zip:*</label>
<div class="col-sm-2"><input type="text" class="form-control" id="city" name="city" placeholder="City" maxlength="30" value="<%=city%>"></div>
<div class="col-sm-2"><select class="form-control" id="state" name="state">
<option value="AL">AL</option>
<option value="AK">AK</option>
<option value="AZ">AZ</option>
<option value="AR">AR</option>
<option value="CA">CA</option>
<option value="CO">CO</option>
<option value="CT">CT</option>
<option value="DE">DE</option>
<option value="DC">DC</option>
<option value="FL">FL</option>
<option value="GA">GA</option>
<option value="HI">HI</option>
<option value="ID">ID</option>
<option value="IL">IL</option>
<option value="IN">IN</option>
<option value="IA">IA</option>
<option value="KS">KS</option>
<option value="KY">KY</option>
<option value="LA">LA</option>
<option value="ME">ME</option>
<option value="MD">MD</option>
<option value="MA">MA</option>
<option value="MI">MI</option>
<option value="MN">MN</option>
<option value="MS">MS</option>
<option value="MO">MO</option>
<option value="MT">MT</option>
<option value="NE">NE</option>
<option value="NV">NV</option>
<option value="NH">NH</option>
<option value="NJ">NJ</option>
<option value="NM">NM</option>
<option value="NY">NY</option>
<option value="NC">NC</option>
<option value="ND">ND</option>
<option value="OH">OH</option>
<option value="OK">OK</option>
<option value="OR">OR</option>
<option value="PA">PA</option>
<option value="RI">RI</option>
<option value="SC">SC</option>
<option value="SD">SD</option>
<option value="TN">TN</option>
<option value="TX">TX</option>
<option value="UT">UT</option>
<option value="VT">VT</option>
<option value="VA">VA</option>
<option value="WA">WA</option>
<option value="WV">WV</option>
<option value="WI">WI</option>
<option value="WY">WY</option>
<option value="AS">AS</option>
<option value="GU">GU</option>
<option value="MP">MP</option>
<option value="PR">PR</option>
<option value="UM">UM</option>
<option value="VI">VI</option>
<option value="AA">AA</option>
<option value="AP">AP</option>
<option value="AE">AE</option>
</select>
</div>
<div class="col-sm-2"><input type="text" class="form-control" id="zip" name="zip" placeholder="Zip" maxlength="10" value="<%=zip%>"></div>
</div>
<div class="form-group">
<label class="col-md-3 control-label" for="mobile" style="color: white;">Mobile Phone:*</label>
<div class="col-md-2">
<input type="text" class="form-control" id="mobile" name="mobile" placeholder="Mobile Phone" maxlength="12" value="<%=mobile%>" autocomplete="off">
</div>
<label class="col-md-2 control-label" for="home" style="color: white;">Home Phone:</label>
<div class="col-md-2">
<input type="text" class="form-control" id="home" name="home" placeholder="Home Phone" maxlength="12" value="<%=home%>" autocomplete="off">
</div>
</div>
<div class="form-group">
<label class="col-md-3 control-label" for="password" style="color: white;">Password:*</label>
<div class="col-md-6">
<input type="password" class="form-control" id="password" name="password" maxlength="8" placeholder="Password" autocomplete="off">
</div>
</div>
<div class="form-group">
<label class="col-md-3 control-label"></label>
<div class="col-md-2" style="color: #ffffff;"><span id="8char" class="glyphicon glyphicon-remove" style="color:#FF0004;"></span> 8 Characters Long<br>
<span id="ucase" class="glyphicon glyphicon-remove" style="color:#FF0004;"></span> One Uppercase Letter</div>
<div class="col-md-2" style="color: #ffffff;"><span id="lcase" class="glyphicon glyphicon-remove" style="color:#FF0004;"></span> One Lowercase Letter<br>
<span id="num" class="glyphicon glyphicon-remove" style="color:#FF0004;"></span> One Number</div>
</div>
<div class="form-group">
<label class="col-md-3 control-label" for="confirmpassword" style="color: white;">Confirm Password:*</label>
<div class="col-md-6">
<input type="password" class="form-control" id="confirmpassword" name="confirmpassword" maxlength="8" placeholder="Confirm Password" autocomplete="off">
</div>
</div>
<div class="form-group">
<label class="col-md-3 control-label"></label>
<div class="col-md-2" style="color: #ffffff;"><span id="pwmatch" class="glyphicon glyphicon-remove" style="color:#FF0004;"></span> Passwords Match</div>
</div>
<div class="form-group">
<label class="col-md-3 control-label" style="color: white;">Your Interests:</label>
<div class="col-md-2 checkbox" style="padding-left:34px;">
<input class="form-control styled check" type="checkbox" name="chkDining" id="chkDining">
<label for="chkDining" style="color: white;">
Dining
</label><br>
<input class="form-control styled check" type="checkbox" name="chkEntertainment" id="chkEntertainment">
<label for="chkEntertainment" style="color: white;">
Entertainment
</label>
</div>
<div class="col-md-2 checkbox" style="padding-left:34px;">
<input class="form-control styled check" type="checkbox" name="chkTableGames" id="chkTableGames">
<label for="chkTableGames" style="color: white;">
Table Games
</label><br>
<input class="form-control styled check" type="checkbox" name="chkSlotPlay" id="chkSlotPlay">
<label for="chkSlotPlay" style="color: white;">
Slot Play
</label>
</div>
<div class="col-md-2 checkbox" style="padding-left:34px;">
<input class="form-control styled check" type="checkbox" name="chkOnlineGaming" id="chkOnlineGaming">
<label for="chkOnlineGaming" style="color: white;">
Online Gaming
</label><br>
<input class="form-control styled check" type="checkbox" name="chkAll" id="chkAll">
<label for="chkAll" style="color: white;">
All
</label>
</div>
</div>