<form class="list">

        <ul>

          <li class="item-content item-input">

            <div class="item-inner">

              <div class="item-title item-label">First Name</div>

              <div class="item-input-wrap">

                <input id="reg_firstname" type="text" placeholder="First Name">

              </div>

            </div>

          </li>

          <li class="item-content item-input">

            <div class="item-inner">

              <div class="item-title item-label">Last Name</div>

              <div class="item-input-wrap">

                <input id="reg_lastname" type="text" placeholder="Last Name">

              </div>

            </div>

          </li>

          <li class="item-content item-input">

            <div class="item-inner">

              <div class="item-title item-label">Email</div>

              <div class="item-input-wrap">

                <input id="reg_email" type="email" placeholder="Email">

              </div>

            </div>

          </li>

          <li class="item-content item-input">

            <div class="item-inner">

              <div class="item-title item-label">Password</div>

              <div class="item-input-wrap">

                <input id="reg_password" type="password" placeholder="Password">

              </div>

            </div>

          </li>

          <li class="item-content item-input">

            <div class="item-inner">

              <div class="item-title item-label">Confirm Password</div>

              <div class="item-input-wrap">

                <input id="reg_confirmpwd" type="password" placeholder="Confirm Password">

              </div>

            </div>

          </li>

          <li class="item-content item-input">

            <div class="item-inner">

              <div class="item-title item-label">Phone/WhatsApp</div>

              <div class="item-input-wrap">

                <input id="reg_phone" type="text" placeholder="Phone">

              </div>

            </div>

          </li>

          <li class="item-content item-input">

            <div class="item-inner">

              <div class="item-input-wrap">

                <label class="item-checkbox">

                  <input id="terms" value="1" type="checkbox" checked name="terms">

                  <i class="icon icon-checkbox"></i></label>

                  I agree to the <a href="/terms/" class="text-secondary">Terms &amp; Conditions</a>

                

              </div>

            </div>

          </li>           

        </ul>

      <div class="separator-medium"></div>

          <div class="container">

            <button id="signup_button" class="btn btn-primary btn-block fw-700">Sign Up</button>

          </div>

      </form>

      <div class="separator-medium"></div>

      <div class="container text-center">

        <a href="/password_forgot/" class="btn btn-sm btn-info">Forgot Password?</a>

      </div>