<div class="cmsmasters_row_margin cmsmasters_1212">
<div class="cmsmasters_column one_half">
<p>Your Name (required)<br />
    [text* your-name] </p>

<p>Your Available Services (required)<br />
[select menu-372 "Select" "Business English" "EAS – English for Academic Studies" "Everyday English Program" "French & Cooking Course in France" "Intensive English Program" "Kids Only Classes: Ages 3-5, 5-8 and 8-10" "Parents & Tots Classes: Ages 1-3" "Part-Time Daytime Program" "Part-Time Evening Program" "Private Lessons" "Semi-Intensive Language Program" "Summer Camps" "Weekend English"] </p>
</div>
<div class="cmsmasters_column one_half">
<p>Your Phone Number (required)<br />
    [tel* YourPhoneNumber] </p>

<p>Staffs <br />
[select menu-450 "Select" "Richard Hill" "Danny Awesome" "Kimberly Richiez" "Dylan Taylor" "Amy Clarke"]</p>
</div>
</div>
<div class="cmsmasters_row_margin cmsmasters_131313">
<div class="cmsmasters_column one_third">
<p>Select Date<br />
    [date date-0] </p>
</div>
<div class="cmsmasters_column one_third">
<p>Start (required)<br />
[select menu-857 "9.00 am" "10.00 am" "11.00 am" "12.00 am" "1.00 pm" "2.00 pm" "3.00 pm" "4.00 pm" "5.00 pm" "6.00 pm"] </p>
</div>
<div class="cmsmasters_column one_third">
<p>End (required)<br />
[select menu-857 "10.00 am" "11.00 am" "12.00 am" "1.00 pm" "2.00 pm" "3.00 pm" "4.00 pm" "5.00 pm" "6.00 pm" "7.00 pm"] </p>
</div>
</div>
<p>[submit "Sign up"]</p>