<form class="surf_form" method="post" action="http://www.iceland.co.uk/trip-to-verona-competition/" id="surf_form">
    <p><strong>Question:</strong> According to the ad because it’s frozen…we can bring delicious soft Gelato from Verona to the grans in which coastal town? (<a href="https://youtu.be/n-Q057wTVQk" rel="prettyPhoto[gallery1]" title="Iceland - The Power of Frozen">Watch the ad</a>)</p>
    <input name="radio_5d1ade47-307d-4db5-86da-ca760062673b" id="skegness" type="radio" value="Skegness" class="question-radio"><label for="skegness" class="rdio">A) Skegness</label>
    <input name="radio_5d1ade47-307d-4db5-86da-ca760062673b" id="cromer" type="radio" value="Cromer" class="question-radio"><label for="cromer" class="rdio">B) Cromer</label>
    <input name="radio_5d1ade47-307d-4db5-86da-ca760062673b" id="brighton" type="radio" value="Brighton" class="question-radio"><label for="brighton" class="rdio">C) Brighton</label>
    <input name="text_89ce515c-c634-4d57-b02f-951019c32ee6" id="first_name" type="text" placeholder="First Name">
    <input name="text_afb68441-83ed-46b9-b910-f4be912515af" id="last_Name" type="text" placeholder="Last Name" class="last">
    <input name="email_7505d153-80b6-427e-ab70-ed6546d2d956" id="email_address" type="text" placeholder="E-Mail Address">
    <input name="text_46a33579-5477-4a9a-adbb-783d2c60d1af" id="phone_number" type="text" placeholder="Contact Phone Number" class="last">
    <input id="terms" type="checkbox" value="terms">
    <label for="terms">I accept the <a href="/competition/trip-to-verona/terms">terms and conditions</a></label>
    <input id="submit" type="submit" value="Submit Your Entry" disabled="disabled">
    <input type="hidden" value="true" name="SxForm_Posted_CustomForm">
</form>