ripplemap/amc-form.html at master · Ripplemap/ripplemap · GitHub

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<!doctype html>
<!--[if lt IE 7]>      <html class="no-js lt-ie9 lt-ie8 lt-ie7"> <![endif]-->
<!--[if IE 7]>         <html class="no-js lt-ie9 lt-ie8"> <![endif]-->
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<head>
  <meta charset="utf-8">
  <meta http-equiv="X-UA-Compatible" content="IE=edge">
  <title></title>
  <meta name="description" content="">
  <meta name="viewport" content="width=device-width, initial-scale=1.0">
  <!-- Place favicon.ico and apple-touch-icon.png in the root directory -->
  <link rel="stylesheet" href="styles/467d9426.main.css">
  <script src="scripts/vendor/7d72bbd1.modernizr.js"></script>
</head>
<body>

  <div class="container">
    <div class="row">
      <div class="col-md-6 col-md-offset-3">
        <header>
          <div class="row">
            <div class="col-md-4">
              <a href="/"><img src="/images/3aa7a079.amc_logo.png" alt="Allied Media Conference Logo" class="img-responsive logo"></a>
            </div>
            <div class="col-md-8">
              <h1>Help map the ripple effect of the Allied Media Conference!</h1>
            </div>
          </div>
        </header>
        <p class="lead">We are creating a giant interactive map of the many impacts that ripple from the AMC. Please help us by filling out this form. As a thank you, we will enter your name in a raffle for a complimentary registration to AMC2016. The winners will be announced at the closing ceremony on Sunday.</p>
        <p class="med-lead">Have you connected with anyone through the AMC who...</p>
        <form action="http://ripplemap.io:8888" method="post" id="" name="" class="form-vertical">


          <!-- question -->
          <div class="question">
            <p>You collaborated with on a project or campaign?</p>
            <div class="form-group">
              <label for="" class="form-label">Who?</label>
              <input type="text" name="collaborated-who" class="form-control">
            </div>
            <div class="form-group">
              <label for="" class="form-label">What was it?</label>
              <textarea class="form-control" name="collaborated-what"></textarea>
            </div>
          </div>
          <!-- /question -->

          <!-- question -->
          <div class="question">
            <p>Introduced you to a new tool or idea?</p>
            <div class="form-group">
              <label for="" class="form-label">Who?</label>
              <input type="text" name="introduced-who" class="form-control">
            </div>
            <div class="form-group">
              <label for="" class="form-label">What was it?</label>
              <textarea class="form-control" name="introduced-what"></textarea>
            </div>
          </div>
          <!-- /question -->

          <!-- question -->
          <div class="question">
            <p>Connected you with a contract or job opportunity?</p>
            <div class="form-group">
              <label for="" class="form-label">Who?</label>
              <input type="text" name="job-who" class="form-control">
            </div>
            <div class="form-group">
              <label for="" class="form-label">What was it?</label>
              <textarea class="form-control" name="job-what"></textarea>
            </div>
          </div>
          <!-- /question -->

          <!-- question -->
          <div class="question">
            <p>You co-founded a new organization/collective with?</p>
            <div class="form-group">
              <label for="" class="form-label">Who?</label>
              <input type="text" name="cofounded-who" class="form-control">
            </div>
            <div class="form-group">
              <label for="" class="form-label">What was it?</label>
              <textarea class="form-control" name="cofounded-what"></textarea>
            </div>
          </div>
          <!-- /question -->

          <!-- question -->
          <div class="question">
            <p>Connected you to a new community?</p>
            <div class="form-group">
              <label for="" class="form-label">Who?</label>
              <input type="text" name="community-who" class="form-control">
            </div>
            <div class="form-group">
              <label for="" class="form-label">What was it?</label>
              <textarea class="form-control" name="community-what"></textarea>
            </div>
          </div>
          <!-- /question -->

          <!-- question -->
          <div class="question">
            <p>Changed your life in any other way?</p>
            <div class="form-group">
              <label for="" class="form-label">Who?</label>
              <input type="text" name="life-who" class="form-control">
            </div>
            <div class="form-group">
              <label for="" class="form-label">What was it?</label>
              <textarea class="form-control" name="life-what"></textarea>
            </div>
          </div>
          <!-- /question -->
          <div class="question">

          <div class="form-group">
            <p> What is your name? </p>
            <input type="text" name="name" class="form-control">
          </div>
          </div>

          <div class="question">
            <p>How can we contact you to learn more?</p>
            <div class="row">
              <div class="col-md-6">
                <label for="" class="form-label">Email</label>

                <input type="text" name="email" class="form-control">
              </div>
              <div class="col-md-6">

                <label for="" class="form-label">Phone</label>
                <input type="text" name="phone" class="form-control">

              </div>


            </div>
          </div>
          <div class="question">
              <p>How would you prefer to be contacted? </p>

            <div class="form-group">


              <div class="checkbox">
                <label>
                  <input type="checkbox" name="email-ok"> Email
                </label>
              </div>
              <div class="checkbox">
                <label>
                  <input type="checkbox" name="phone-ok"> Phone
                </label>
              </div>
            </div>
          </div>
          <p class="pull-right">Thank you! ♥♥♥</p>

          <button type="submit" class="btn btn-primary btn-lg">Submit</button>
        </form>


      </div>
    </div>
  </div>
  <footer>
    <p>&copy; 2015 AMC</p>
  </footer>
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</body>
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