[Alfer]

<form method="get" id="searchform" class="searchform" action="/" role="search">
		  
                  <div id="selectLocation" class="selectLocation block">
                     <div class="form-inline">
                        <span class="title">Where</span>
                        <div class="input-group date">
                           <input type="search" class="placepicker form-control" id="s" name="#s" data-map-container-id="collapseOne" placeholder="Lombok">
						
                           <span class="input-group-addon">
                              <i class="glyphicon glyphicon-globe"></i>
                           </span>
                        </div>
                        <div id="collapseOne" class="collapse">
                           <div class="placepicker-map thumbnail"></div>
                        </div>
                     </div>
                  </div>
                  <div id="selectDate" class="selectDate block">
                     <div class="form-inline">
                        <span class="title">When</span>
                        <div class="input-group date">
                           <input type="text" class="form-control" placeholder="Select Date">
						   
                           <span class="input-group-addon">
                           <i class="glyphicon glyphicon-calendar"></i>
                           </span>
                        </div>
                     </div>
                  </div>
				  
                  <span class="search-button">
				  <input type="submit" id="searchsubmit" value="Submit" />
                  </span>
               </form>

вот такая форма