<div class="form_item">
<div class="form_element cf_textbox">{USERNAME}</div>
</div>
<div class="form_item">
<div class="form_element cf_textbox"><label class="cf_label" style="width: 100px;">Name</label> {text_0}</div>
</div>
<div class="form_item">
<div class="form_element cf_textbox"><label class="cf_label" style="width: 100px;">Address</label> {text_1}</div>
</div>
<div class="form_item">
<div class="form_element cf_textbox"><label class="cf_label" style="width: 100px;">City</label> {text_9}</div>
</div>
<div class="form_item">
<div class="form_element cf_textbox"><label class="cf_label" style="width: 100px;">Postal Code</label> {text_5}</div>
</div>
<div class="form_item">
<div class="form_element cf_textbox"><label class="cf_label" style="width: 100px;">Phone</label> {text_6}</div>
</div>
<div class="form_item">
<div class="form_element cf_textbox"><label class="cf_label" style="width: 100px;">Email</label> {text_4}</div>
</div>
<div class="form_item">
<div class="form_element cf_radiobutton"><label class="cf_label" style="width: 150px;">Referral Type</label>
<div class="float_left">{radio}              <br /> <br /></div>
</div>
</div>
<div class="form_item">
<div class="form_element cf_radiobutton"><label class="cf_label" style="width: 150px;">Replied</label>
<div class="float_left">{radio0}              <br /> <br /></div>
</div>
</div>
<div class="form_item">
<div class="form_element cf_radiobutton"><label class="cf_label" style="width: 150px;">Contacted By</label>
<div class="float_left">{radio1}              <br /> <br /></div>
</div>
</div>
<div class="form_item">
<div class="form_element cf_radiobutton"><label class="cf_label" style="width: 150px;">Book Time</label>
<div class="float_left">{radio2}              <br /> <br /></div>
</div>
</div>
<div class="form_item">
<div class="form_element cf_radiobutton"><label class="cf_label" style="width: 150px;">Showed Up</label>
<div class="float_left">{radio3}              <br /> <br /> <br /></div>
</div>
</div>
<div class="form_item">
<div class="form_element cf_radiobutton"><label class="cf_label" style="width: 150px;">Status</label>
<div class="float_left">{sradio}              <br /> <br /> <label class="radio_label" for="radio22">Active</label> <br /> <label class="radio_label" for="radio23">Potential</label> <br /> <label class="radio_label" for="radio24">Showd up</label> <br /> <label class="radio_label" for="radio25">Pending</label> <br /></div>
</div>
</div>
<div class="form_item">
<div class="form_element cf_datetimepicker"><label class="cf_label" style="width: 150px;">Date Scheduled</label> {datescheduled}</div>
</div>
<div class="form_item">
<div class="form_element cf_textbox"><label class="cf_label" style="width: 150px;">Trainer</label> {trainer}</div>
</div>
<div class="form_item">
<div class="form_element cf_textbox"><label class="cf_label" style="width: 150px;">Desk Staff</label> {deskstaff}</div>
</div>
<div class="form_item">
<div class="form_element cf_radiobutton"><label class="cf_label" style="width: 150px;">Signed Up</label>
<div class="float_left">{radio4}              <br /> <br /> {}<br /><br /></div>
</div>
</div>
<div class="form_item">
<div class="form_element cf_textarea"><label class="cf_label" style="width: 150px;">Notes</label> {notes}</div>
</div>
<div class="form_item">
<div class="form_element cf_textarea"><label class="cf_label" style="width: 100px;">Comments</label> {text_8}</div>
</div>
<div class="form_item">
<div class="form_element cf_textbox"><label class="cf_label" style="width: 150px;">Booked Time</label> {bookedtime}</div>
</div>
<div class="form_item">
<div class="form_element cf_textbox"><label class="cf_label" style="width: 150px;">Contacted When</label> {contactedwhen}</div>
</div>
<div class="form_item">
<div class="form_element cf_datetimepicker"><label class="cf_label" style="width: 150px;">Booked Date </label> {bookeddate}</div>
</div>
<p> </p>
<div class="form_item">
<div class="form_element cf_button">{cf_id}</div>
</div>