1 <?PHP
include_once('header.php'); ?
>
4 <div
class='col-sm-12'> please enter your name
and zip code
as it appears on your Maryland Voter Registration
</div
>
6 <div
class='col-sm-6'>first name
</div
>
8 <div
class='col-sm-6'>last name
</div
>
11 <div
class='col-sm-6'><input
> </div
>
13 <div
class='col-sm-6'><input
> </div
>
15 <div
class='col-sm-6'>house number
</div
>
17 <div
class='col-sm-6'>zip code
</div
>
20 <div
class='col-sm-6'><input
> </div
>
22 <div
class='col-sm-6'><input
> </div
>
24 <button type
="button" class="btn btn-success">Submit
</button
>
27 <?PHP
include_once('footer.php');