<p>First Name (required)<br />
    [text* first-name] </p>

<p>Last Name (required)<br />
    [text* last-name] </p>

<p>School (required)<br />
    [text* school] </p>

<p>LoginID (required)<br />
    [text* loginID] </p>

<p>Password (required)<br />
    [text* password] </p>

<p>Your Email (required)<br />
    [email* your-email] </p>

<p>Phone (required)<br />
    [text* phone] </p>

<p>State<br />
    [text* state] </p>

<p>Comments<br />
   [textarea comments]</p>

<p>[checkbox elementary-courses "I am interested in Elementary School courses"]</p>

<p>[checkbox middle-courses "I am interested in Middle School courses"]</p>

<p>[submit "Send"]</p>