document.write('<script type=\"text/javascript\" src=\"https://assets.bravenet.com/bn/js/emailfwd/bn_email_forms.min.js\"></script><link rel=\"stylesheet\" href=\"https://pub39.bravenet.com/emailfwd/v2/bnet-form.css.php?usernum=3271421378&formid=4171&formpadding=0\"><form method=\"post\" class=\"bnet-form\" enctype=\"multipart/form-data\" action=\"#bn-ajax-post:3271421378:39:4171\"><div class=\"bn-form-header\"><div class=\"bn-form-legend\"><div>Subscription Request Form (Grades 9-10)</div></div> </div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">First Name: <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-1\" placeholder=\"your first name\" validator=\"\" required=\"required\" value=\"\"></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">Last Name: <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-149804007488883\" placeholder=\"your last name\" validator=\"\" required=\"required\" value=\"\"></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">Email ID: <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-2\" placeholder=\"you must enter a valid email address\" validator=\"email\" required=\"required\" 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-149804019220835\" 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-1498040198592108\" placeholder=\"\" validator=\"\" value=\"\"></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">Phone: </span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-149804019771110\" placeholder=\"optional\" 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-149804036144013[]\"><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\">Select your Package(s): <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-149804093075218[]\" value=\"TA01: Comprehension/Reading - INR 1,000.00\" required=\"required\"> <span class=\"bn-inner-label\">TA01: Comprehension/Reading - INR 1,000.00</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-149804093075218[]\" value=\"TB01: Writing Skills / Compositions - INR 2,000.00\" required=\"required\"> <span class=\"bn-inner-label\">TB01: Writing Skills / Compositions - INR 2,000.00</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-149804093075218[]\" value=\"TC01: Grammar - INR 3,000.00\" required=\"required\"> <span class=\"bn-inner-label\">TC01: Grammar - INR 3,000.00</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-149804093075218[]\" value=\"TD01: Entre Jeunes 1 &amp; 2 + Culture &amp; Civilisation - INR 3,000.00\" required=\"required\"> <span class=\"bn-inner-label\">TD01: Entre Jeunes 1 &amp; 2 + Culture &amp; Civilisation - INR 3,000.00</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-149804093075218[]\" value=\"TE01 : Extra Worksheets - INR 2,500.00\" required=\"required\"> <span class=\"bn-inner-label\">TE01 : Extra Worksheets - INR 2,500.00</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-149804094315311[]\" 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-149804094315311[]\" value=\"Credit Card (2.5% convenience fee)\" required=\"required\"> <span class=\"bn-inner-label\">Credit Card (2.5% convenience fee)</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-149804094315311[]\" value=\"Bank Cheque (this option is available only to subscribers in India)\" required=\"required\"> <span class=\"bn-inner-label\">Bank Cheque (this option is available only to subscribers in India)</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-149804094315311[]\" value=\"UPI (GPay / Paytm / etc.)\" required=\"required\"> <span class=\"bn-inner-label\">UPI (GPay / Paytm / etc.)</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 9-10\"><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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