<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h1" label="Interested in Joining Regus?&amp;nbsp;"/>&#13;
		<field type="paragraph" subtype="p" label="Simply Fill in the information below and someone will reach out to you to give you more information on a location near you.&amp;nbsp;"/>&#13;
		<field type="date" label="Date Field" name="date-1717869712619" className="form-control"/>&#13;
		<field type="text" required="true" label="First name" name="first-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Last name" name="last-name" subtype="text" className="form-control"/>&#13;
		<field required="true"  type="text" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" label="City" name="address-city" subtype="text" className="form-control"/>&#13;
		<field type="text" label="State" name="address-state" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Zip" name="address-zip" subtype="text" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>