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<html> <head> <title>insiteful testing form</title> </head> <body> <!-- insiteful code --> <script src="//a.insiteful.co/dist/compile.min.js"></script> <script defer>insiteful_activate('NjU3NzUxMjc3M2NhNA==');</script> <div align="center"> <form method="POST" id="testing-form" name="testing-form"> <div class="modal bmse-modal show" id="remindModal1" tabindex="-1" style="display: block;" aria-modal="true" role="dialog"> <div class="modal-dialog modal-dialog-centered"> <div class="modal-content purple-border"> <div class="modal-header p-0 border-0"> </div> <div class="modal-body p-0 "> <div class="feilds-details"> <div class="row mb-4"> <div class="col-md-6 form-group"> <label class="form-label" id="t_name">NAME</label> <input type="text" name="name" class="form-control" placeholder="type FULL NAME" required=""> </div> <div class="col-md-6 form-group"> <label class="form-label" id="t_email">EMAIL</label> <input type="text" name="email" class="form-control" placeholder="type EMAIL" required=""> </div> <div class="col-md-6 form-group"> <label class="form-label" id="t_city">CITY</label> <select name="city" class="form-select form-control" required=""> <option value="">Select</option> <option value="All-Keep Me Updated on Every Event">All-Keep Me Updated on Every Event</option> <option value="Austin">Austin</option> <option value="Chicago">Chicago</option> <option value="Cincinnati">Cincinnati</option> <option value="Colorado Springs">Colorado Springs</option> <option value="Columbus">Columbus</option> <option value="Denver">Denver</option> <option value="Honolulu">Honolulu</option> <option value="Houston">Houston</option> <option value="Loveland">Loveland</option> <option value="Miami">Miami</option> <option value="Milwaukee">Milwaukee</option> <option value="Minneapolis">Minneapolis</option> <option value="Pittsburg">Pittsburg</option> <option value="Portland">Portland</option> <option value="Raleigh">Raleigh</option> <option value="Sacramento">Sacramento</option> <option value="Tampa">Tampa</option> <option value="Virginia Beach">Virginia Beach</option> <option value="Virginia Beach">Virginia Beach</option> </select> </div> </div> <div class="row justify-content-end"> <div class="col-md-6 form-group"> <input type="submit" name="connect" class="btn btnsend" value="Stay In Touch"> </div> </div> </div> </div> </div> </div> </div> </form> </div> </body> </html>