<div class="col50"><label> Title
   [select Title "Mr" "Mrs" "Ms" "Prof" "Dr" "Other"]  </label></div>

<div class="col50"><label> First name
    [text* your-name autocomplete:name] </label></div>

<div class="col50"><label> Last name
    [text* last-name autocomplete:name] </label></div>

<div class="col50"><label> Your email
    [email* your-email autocomplete:email] </label></div>

<div class="col50"><label> Phone Number
    [text phone-number] </label></div>

<div class="col50"><label> I'm saying YES to Jesus <strong>*</strong>
    [radio saying-yes-to-jesus use_label_element "For the first time" "Recommitting my life"] </label></div>

<div class="col50"><label> I would like <strong>*</strong>
    [radio i-would-like use_label_element "Someone to pray with me" "To talk to someone" "To know what's next"] </label></div>

<div class="col50"><label> How did you hear about us <strong>*</strong>
    [radio how-did-you-hear-about-us "Friend/Family/Colleague" "Social Media" "Google or Website" "Others"] </label></div>

<label> Your message (optional)
    [textarea your-message] </label>

[submit "Submit"]