<p>Your Name (required)<br />
    [text* your-name] </p>

<p>Your Email (required)<br />
    [email* your-email] </p>

<p>Your Phone Number (required)<br />
   [tel* PhoneNumber] </p>

<p>Select Courses (required)<br />
<p>Qur'an<br />
  [checkbox checkbox-558 label_first "Qira’ah " "Talaqqi Beginner" "Talaqqi Intermediate" "Talaqqi Advanced""Tajweed""Talaqqi & Tafseer (English or Bahasa Malaysia)"]
 </p>
<p>Arabic<br />
[checkbox* checkbox-207 "Arabic"]
<p>Islamic Studies<br />
[checkbox* checkbox-471 "Islam 101" "Islamic Studies for Kids" "Saturday Da’wah Class"]<p>Anything else you would like to add?<br />
    [textarea your-message] </p>

<p>[submit "Submit"]</p>