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<span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-174307668003380[]\" value=\"Email\" required=\"required\"> <span class=\"bn-inner-label\">Email</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-174307668003380[]\" value=\"WhatsApp\" required=\"required\"> <span class=\"bn-inner-label\">WhatsApp</span></label></span></span></div></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">Email ID: </span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-2\" placeholder=\"you must enter a valid email address\" validator=\"email\" value=\"\"></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">Phone/Whatsapp : </span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-149768020961479\" placeholder=\"optional\" validator=\"\" value=\"\"></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">City: </span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-149767998145351\" placeholder=\"\" validator=\"\" value=\"\"></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">Country: </span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-149768002753311\" placeholder=\"\" validator=\"\" value=\"\"></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><div class=\"bn-row\"><span class=\"bn-label\">I am a </span> <span class=\"bn-input\"><span class=\"bn-select\"><select name=\"Field-149768016964672[]\"><option value=\"Student\" selected=\"selected\">Student</option><option value=\"Parent\">Parent</option><option value=\"Teacher\">Teacher</option></select></span></span></div></div><div class=\"fields-wrapper ui-sortable-handle\"><div class=\"bn-row rowcb\"><span class=\"bn-label\">Tick the packages you want to subscribe to : <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-149772990609579[]\" value=\"P1001 : Grade 10 Intensive\" required=\"required\"> <span class=\"bn-inner-label\">P1001 : Grade 10 Intensive</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-149772990609579[]\" value=\"P10E : Extra Practice Worksheets\" required=\"required\"> <span class=\"bn-inner-label\">P10E : Extra Practice Worksheets</span></label></span></span></div></div><div class=\"fields-wrapper ui-sortable-handle\"><div class=\"bn-row rowcb\"><span class=\"bn-label\">I\'ll pay by <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-149773010002382[]\" value=\"Bank Transfer / Netbanking\" required=\"required\"> <span class=\"bn-inner-label\">Bank Transfer / Netbanking</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-149773010002382[]\" value=\"UPI (GPay/Paytm/etc.)\" required=\"required\"> <span class=\"bn-inner-label\">UPI (GPay/Paytm/etc.)</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-149773010002382[]\" value=\"Bank Cheque (only for subscribers in India)\" required=\"required\"> <span class=\"bn-inner-label\">Bank Cheque (only for subscribers in India)</span></label></span></span></div></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">Additional queries (if any): </span> <span class=\"bn-input\"><textarea name=\"Field-3\" placeholder=\"jot down any queries/concerns that you may have\" validator=\"\"></textarea></span></label></div>  <input type=\"hidden\" name=\"carboncopy\" value=\"\"> <input type=\"hidden\" name=\"thankyou\" value=\"\"> <input type=\"hidden\" name=\"thankyoutext\" value=\"Thank you for your form submission. \"> <input type=\"hidden\" name=\"subject\" value=\"Subscription Request P10\"><div class=\"bn-form-submit\"><button type=\"submit\" class=\"formbtn\">Submit Form</button></div> <style type=\"text/css\">.bnet-form ::-webkit-input-placeholder {');
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