-xs-12">
                      </div>
                    </div>
                    <div class="form-group">
                      <label class="control-label col-md-3 col-sm-3 col-xs-12" for="last-name">Last Name <span class="required">*</span>
                      </label>
                      <div class="col-md-6 col-sm-6 col-xs-12">
                        <input type="text" id="last-name" name="last-name" required="required" class="form-control col-md-7 col-xs-12">
                      </div>
     