89 lines
3.1 KiB
HTML
89 lines
3.1 KiB
HTML
<div class="contact-form-container">
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<form class="e2c-contact-form" action="#" method="post">
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<div class="form-group">
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<label for="country">Country *</label>
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<select id="country" name="country" required>
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<option value="">Select your country</option>
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<option value="US">United States</option>
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<option value="CA">Canada</option>
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<option value="GB">United Kingdom</option>
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<option value="AU">Australia</option>
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<option value="DE">Germany</option>
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<option value="FR">France</option>
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<option value="IT">Italy</option>
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<option value="ES">Spain</option>
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<option value="NL">Netherlands</option>
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<option value="SE">Sweden</option>
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<option value="NO">Norway</option>
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<option value="DK">Denmark</option>
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<option value="JP">Japan</option>
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<option value="KR">South Korea</option>
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<option value="CN">China</option>
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<option value="IN">India</option>
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<option value="BR">Brazil</option>
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<option value="MX">Mexico</option>
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<option value="AR">Argentina</option>
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<option value="CL">Chile</option>
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<option value="ZA">South Africa</option>
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<option value="NZ">New Zealand</option>
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<option value="other">Other</option>
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</select>
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</div>
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<div class="form-group">
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<label for="email">Email *</label>
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<input type="email" id="email" name="email" required>
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</div>
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<div class="form-group">
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<label for="name">Name</label>
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<input type="text" id="name" name="name">
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</div>
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<div class="form-group">
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<label for="organization">Organization</label>
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<input type="text" id="organization" name="organization">
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</div>
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<div class="form-group">
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<label for="organization_url">Organization URL</label>
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<input type="url" id="organization_url" name="organization_url" placeholder="https://">
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</div>
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<div class="form-group">
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<label>Interests in E2C</label>
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<div class="checkbox-group">
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<label class="checkbox-label">
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<input type="checkbox" name="interests" value="get_support">
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Get support with my E2C
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</label>
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<label class="checkbox-label">
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<input type="checkbox" name="interests" value="share_experience">
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Share my E2C experience
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</label>
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<label class="checkbox-label">
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<input type="checkbox" name="interests" value="offer_support">
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Offer support to others
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</label>
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<label class="checkbox-label">
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<input type="checkbox" name="interests" value="other">
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Other
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</label>
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</div>
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</div>
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<div class="form-group">
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<label for="additional_info">Anything else you'd like to add?</label>
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<textarea id="additional_info" name="additional_info" rows="4"></textarea>
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</div>
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<div class="form-group">
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<label class="checkbox-label">
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<input type="checkbox" name="email_updates" value="yes">
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Opt in to email updates from E2C Collective
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</label>
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</div>
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<button type="submit" class="submit-btn">Submit</button>
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</form>
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</div> |