<div id="popin-inscription" class="popin-li">
<div class="exit"></div>
<div class="popin-content">
<div class="popin-content-largeur">
<div class="row">
<div class="col-lg-12">
<div class="logo"></div>
<h3>Subscribe</h3>
<p class="infos">First time access as a parent?<br />Top-up your child's balance and subscribe to track your transactions & his orders.</p>
</div>
</div>
<div class="row">
<div class="col-lg-12">
<div class="input-material">
<input type="text" id="popin-inscription-id_number" required />
<label for="popin-inscription-id_number" class="required">Student's Id Number</label>
</div>
</div>
<div class="col-lg-12">
<div class="input-material">
<input type="text" id="popin-inscription-birthday" class="date" required />
<label for="popin-inscription-birthday" class="required">Student's birthday</label>
</div>
</div>
<div class="col-lg-12">
<div class="input-material">
<input type="text" id="popin-inscription-email" required />
<label for="popin-inscription-email" class="required">E-mail</label>
</div>
</div>
<div class="col-lg-12">
<div class="input-material">
<input type="text" id="popin-inscription-confirm_email" required />
<label for="popin-inscription-email" class="required">Confirm your e-mail</label>
</div>
</div>
<div class="col-lg-12">
<div class="custom-select">
<select id="popin-inscription-amount-change">
<option value="100">100,00 MAD</option>
<option value="500" selected>500,00 MAD</option>
<option value="1000">1.000,00 MAD</option>
<option value="2000">2.000,00 MAD</option>
<option value="0">Other amount</option>
</select>
</div>
<div class="input-material">
<input type="text" id="popin-inscription-amount" value="500" required />
<label for="popin-inscription-amount" class="required">Amount</label>
</div>
</div>
</div>
<div class="row">
<div class="col-lg-12" style="text-align:right">
<img src="/img/payzone.png" alt="moyen de paiement" style="width:80%;height:auto">
</div>
</div>
<div class="row">
<div class="col-lg-12">
<p>You will receive an email with your password at the end of the payment process</p>
<div class="popin-btn" id="popin-inscription-validate">Proceed</div>
<div class="logo-ras"></div>
</div>
</div>
</div>
</div>
</div>