<div class="contact-form"><div class="row"><div class="medium-6 small-12 columns"><label><input type="text" value="" placeholder="Your name here..."></label></div><div class="medium-6 small-12 columns"><label><input type="text" value="" placeholder="Your last name here..."></label></div></div><div class="row"><div class="medium-6 small-12 columns"><label><input type="text" value="" placeholder="Enter your Website ..."></label></div><div class="medium-6 small-12 columns"><label><input type="text" value="" placeholder="Reason contacting us ..."></label></div></div><div class="row"><div class="medium-6 small-12 columns"><label><select><option value="1">Chose Course</option><option value="2">Course One</option><option value="3">Course Two</option></select></label></div><div class="medium-6 small-12 columns"><label><select><option value="1">Chose Teacher</option><option value="2">Teacher One</option><option value="3">Teacher Two</option></select></label></div></div><div class="row"><div class="medium-12 small-12 columns"><label><textarea rows="4" placeholder="Your message ..."></textarea></label><input type="submit" class="button primary bordered-light" value="Send your message"></div></div></div>