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- <html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" lang="en">
- <head>
- <title>Contact us</title>
- <meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
- <link rel="stylesheet" type="text/css" href="style.css">
- <script src='https://www.google.com/recaptcha/api.js'></script>
- </head>
- <body>
- <div class="landing-page"><div class="form-appointment"><div class="wpcf7" id="wpcf7-f560-p590-o1">
- <form action="send-mail.php" method="post" class="wpcf7-form">
- <label for="field_name">Username:*</label>
- <input maxlength="50" type="text" id="field_name" name="sender_name" pattern="^[a-zA-Z]+[a-zA-Z0-9]{2,12}$" title="Your username must begin with a letter and be a minimum of 3 characters and a maximum of 13" required>
- <br /><br />
- <label for="field_email">Your e-mail:*</label>
- <input maxlength="50" type="text" id="field_email" name="sender_email" required>
- <br /><br />
- <label for="field_password">Password:*</label>
- <input maxlength="50" type="text" id="field_password" name="sender_password" pattern="^(?=.*[A-Za-z])(?=.*\d)[A-Za-z\d]{8,}$" title="Your pasword must contain: minimum eight characters and at least one letter and one number:" required>
- <br /><br />
- <label for="field_password_confirm">Confirm Password:*</label>
- <input maxlength="50" type="text" id="field_password_confirm" name="sender_password_confirm" required>
- <br /><br />
- <div style="text-align: center; padding-top: 2em; border-top: 1px solid rgb(153, 202, 129); margin-top: 1em;"><input type="submit" name="send_message" value="Send" class="wpcf7-form-control wpcf7-submit"></div>
- </form>
- </body>
- </html>
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