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<form>
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      <div class="col-sm-2"><label class="control-label"><svg class="icomoon icomoon-user">
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          </svg>Login</label></div>
      <div class="col-sm-4 col-md-3"><label class="sr-only" for="loginUsername">E-mail address</label><input name="loginUsername" id="loginUsername" type="text" class="form-control" placeholder="E-mail address" autocomplete="on"></div>
      <div class="col-sm-4 col-md-3"><label class="sr-only" for="loginPassword">Password</label><input name="loginPassword" type="password" id="loginPassword" class="form-control" placeholder="Password"></div>
      <div class="col-sm-2"><input type="submit" class="loginBtn btn btn-default" value="Login"></div>
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          <li><a href="https://my.raps.org/account/login.aspx?forgot=yes&amp;RedirectUrl=https%3a%2f%2fwww.raps.org%2f?reload=timezone" id="Header_ForgotPassword">Forgot Password?</a></li>
          <li><a href="https://my.raps.org/account/login.aspx?signup=yes&amp;RedirectUrl=https%3a%2f%2fwww.raps.org%2f" id="Header_CreateAccount">Create an Account</a></li>
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</form>

<form class="form-horizontal">
  <div class="form-group">
    <div class="col-sm-offset-2 col-sm-8"><label class="control-label" for="txtAddEmail">Email</label><input type="email" id="txtAddEmail" class="form-control" value="shyam.banuprakash@bioclinica.com"></div>
  </div>
  <div class="form-group">
    <div class="col-sm-offset-2 col-sm-8"><label class="control-label" for="txtAddFirst">First Name</label><input type="text" id="txtAddFirst" class="form-control" value=""></div>
  </div>
  <div class="form-group">
    <div class="col-sm-offset-2 col-sm-8"><label class="control-label" for="txtAddLast">Last Name</label><input type="text" id="txtAddLast" class="form-control" value=""></div>
  </div>
  <div class="form-group">
    <div class="col-sm-offset-2 col-sm-8"><button id="btnAdd" type="submit" class="btn btn-success" disabled="">Update Preferences</button></div>
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</form>

POST https://webto.salesforce.com/servlet/servlet.WebToLead?encoding=UTF-8

<form action="https://webto.salesforce.com/servlet/servlet.WebToLead?encoding=UTF-8" method="POST"><input name="oid" type="hidden" value="00Do0000000aIJN"> <input name="retURL" type="hidden" value="https://www.raps.org/events?sponsorship=calendar">
  <div class="form-row row">
    <div class="col-md-6 offset-md-3 form-group"><label for="exhibitorVenue">RAPS Venue: &nbsp;</label> <select class="form-control" id="exhibitorVenue" name="lead_source" required="" style="display: inline-block; width: 60%;">
        <option value="Convergence">Convergence</option>
        <option value="EuroConvergence">Euro Convergence</option>
        <option value="OtherRAPSEvents">Other RAPS Events</option>
      </select></div>
    <div class="form-group col-md-6"><label for="exhibitorFirst">First Name</label> <input class="form-control" id="exhibitorFirst" maxlength="40" name="first_name" required="" type="text"></div>
    <div class="form-group col-md-6"><label for="exhibitorLast">Last Name</label> <input class="form-control" id="exhibitorLast" maxlength="80" name="last_name" required="" type="text"></div>
    <div class="form-group col-md-6"><label for="exhibitorEmail">Email</label> <input class="form-control" id="exhibitorEmail" maxlength="80" name="email" required="" type="email"></div>
    <div class="form-group col-md-6"><label for="exhibitorTitle">Title</label> <input class="form-control" id="exhibitorTitle" maxlength="40" name="title" required="" type="text"></div>
    <div class="form-group col-md-6"><label for="exhibitorCompany">Company</label> <input class="form-control" id="exhibitorCompany" maxlength="40" name="company" required="" type="text"></div>
    <div class="form-group col-md-6"><label for="industry">Industry</label> <select class="form-control" id="industry" name="industry">
        <option value="">--None--</option>
        <option value="Medical Devices">Medical Devices</option>
        <option value="Pharmaceuticals">Pharmaceuticals</option>
        <option value="Biopharmaceuticals">Biopharmaceuticals</option>
        <option value="Biotechnology">Biotechnology</option>
        <option value="Food &amp; Beverage">Food &amp; Beverage</option>
        <option value="Nutrition">Nutrition</option>
        <option value="Consulting">Consulting</option>
        <option value="Government">Government</option>
        <option value="Education">Education</option>
        <option value="Other">Other</option>
      </select></div>
  </div>
  <div class="form-group">
    <div class="form-check"><input class="form-check-input" id="exhibitorConsent" type="checkbox"> <label class="form-check-label" for="exhibitorConsent"> I consent to receive e-mail communications from RAPS relating to RAPS Events. I understand that
        I may unsubscribe at any time by clicking the "Unsubscribe" link at the bottom of all e-mails or by <a href="mailto:raps@raps.org">e-mailing RAPS.</a> </label></div>
  </div>
  <div class="float-right"><button class="btn btn-outline-primary mr-4" data-dismiss="modal" type="button">Close</button> &nbsp; &nbsp;<button class="btn btn-primary" disabled="" id="exhibitorSubmit" type="submit">Submit</button></div>
</form>

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