<div class="list-group">
<form name="eligibility" method="POST" action="apply.php?token=<?php echo md5(2);?>&cp=new_account">
					<!-- notification -->
					<?php echo $new_error;
					$phoneno="";
					$email="";
					$level="";
					?>

  <div class="form-group">
    <label for="regno">Matric Number</label>
    <input value="<?php echo $_SESSION['reg_no']; ?>" name="regno" type="text" class="form-control" id="regno" readonly>
  </div>

  <div class="form-group">
    <label for="phoneno">Phone Number</label>
    <input value="<?php echo $phoneno;?>" name="phoneno" type="text" class="form-control" id="phoneno">
  </div>
   <div class="form-group">
    <label for="email">Email</label>
    <input value="<?php echo $email;?>" name="email" type="email" class="form-control" id="email">
  </div>
	
  <input name="btncreateAccount" type="submit" class="btn btn-default" value="Create Account"/>

   </form>
</div>
