[md-form class="wmform"]

[md-text label="Name"]

[/md-text]

[md-text label="Email"]

[/md-text]

[md-text label="Phone Number"]

[/md-text]

[md-checkbox label="Preferred Method of Communication"]
EmailCallText
[/md-checkbox]

[md-text label="Website"]

[/md-text]

[md-checkbox* label="Register as"]
AlliancePartnerCommunity ChampionGirls AmbassadorNot Sure
[/md-checkbox]

[md-text label="Comment"]

[/md-text]

[md-submit]

[/md-submit]

[/md-form]