<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* tel-839]</p>

Select Courses (required)

<p>Qur'an</p>
[checkbox* checkbox-18 label_last "Qira’ah" "Talaqqi Beginner" "Talaqqi Intermediate" "Talaqqi Advanced " "Tajweed " "Talaqqi & Tafseer (English or Bahasa Malaysia)"]

<p>Arabic</p>
[checkbox* checkbox-592 label_last "Arabic"]

<p>Islamic Studies</p>
[checkbox checkbox-91 label_last "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>