Titanium Europe Meetup Form

gistfile1.html

<form action="http://pollypolish.createsend.com/t/j/s/jjyhut/" method="post" id="subForm">
<div>
<p><label for="name" style="width: 150px; clear: both;">Name:</label><br /><input type="text" name="cm-name" id="name" style="border: 1px solid #959183; padding: 4px; width: 300px; margin-bottom: 10px;" /></p>

<p><label for="jjyhut-jjyhut" style="width: 150px; clear: both;">Email:</label><br /><input type="text" name="cm-jjyhut-jjyhut" id="jjyhut-jjyhut" style="border: 1px solid #959183; padding: 4px; width: 300px; margin-bottom: 10px;" /></p>

<p><label for="Titanium Proficiency">Titanium Proficiency:</label><br /><select name="cm-fo-pbdk">
<option value="259080">Beginner</option>
<option value="259081">Intermediate</option>
<option value="259082">Expert</option>
<option value="259083">Titan</option>
</select></p>

<p><label for="Twitter Handle (inc @)" style="width: 150px; clear: both;">Twitter Handle (inc @):</label><br /><input type="text" name="cm-f-plig" id="TwitterHandle(inc@)" style="border: 1px solid #959183; padding: 4px; width: 300px; margin-bottom: 10px;" /></p>

<p><label for="City" style="width: 150px; clear: both;">City:</label><br /><input type="text" name="cm-f-pliw" id="City" style="border: 1px solid #959183; padding: 4px; width: 300px; margin-bottom: 10px;" /></p>

<p><label for="Country" style="width: 150px; clear: both;">Country:</label><br /><input type="text" name="cm-f-pliyd" id="Country" style="border: 1px solid #959183; padding: 4px; width: 300px; margin-bottom: 10px;" /></p>

<p><label for="Max Travel Distance" style="width: 150px; clear: both;">Max Travel Distance:</label><br /><input type="text" name="cm-f-pliyh" id="MaxTravelDistance" style="border: 1px solid #959183; padding: 4px; width: 300px; margin-bottom: 10px;" /></p>

<p><label for="Max Travel Spend" style="width: 150px; clear: both;">Max Travel Spend:</label><br /><input type="text" name="cm-f-pliyk" id="MaxTravelSpend" style="border: 1px solid #959183; padding: 4px; width: 300px; margin-bottom: 10px;" /></p>

<p><input type="submit" value="Subscribe" style="clear: both; margin-top: 10px; border: 1px solid #959183; background-color: #E1DED4; padding: 6px 10px; font-size: 14px; text-transform: uppercase;" /></p>
</div>
</form>