xt"
																	/>
																</div>
																<div class="form-group">
																	<label>Email</label>
																	<input
																		class="form-control form-control-lg"
																		type="email"
																	/>
																</div>
																<div class="form-group">
																	<label>Date of birth</label>
																	<input
																		class="form-control form-control-lg date-picker"
																		type="text"
																	/>
					