<div id="formwrapper">
<fieldset>
<legend>Contact Details</legend>
<div class="form_item">
  <div class="form_element cf_dropdown">
    <label class="cf_label" style="width: 150px;">Title</label>
    <select class="cf_inputbox validate-selection" id="select_4" size="1" title=""  name="Title">
    <option value="">Choose Option</option>
      <option value="Mr">Mr</option>
<option value="Mrs">Mrs</option>
<option value="Ms">Ms</option>

    </select>
    
  </div>
  <div class="cfclear">&nbsp;</div>
</div>

<div class="form_item">
  <div class="form_element cf_textbox">
    <label class="cf_label" style="width: 150px;">Surname</label>
    <input class="cf_inputbox required validate-alpha" maxlength="150" size="30" title="Required; letters only" id="text_2" name="Surname" type="text" />
  
  </div>
  <div class="cfclear">&nbsp;</div>
</div>

<div class="form_item">
  <div class="form_element cf_textbox">
    <label class="cf_label" style="width: 150px;">Firstname</label>
    <input class="cf_inputbox required validate-alpha" maxlength="150" size="30" title="Required; letters only" id="text_3" name="Firstname" type="text" />
  
  </div>
  <div class="cfclear">&nbsp;</div>
</div>

<div class="form_item">
  <div class="form_element cf_textbox">
    <label class="cf_label" style="width: 150px;">E-mail</label>
    <input class="cf_inputbox required validate-email" maxlength="150" size="30" title="Valid e-mail required" id="text_10" name="Email" type="text" />
  
  </div>
  <div class="cfclear">&nbsp;</div>
</div>

<div class="form_item">
  <div class="form_element cf_textbox">
    <label class="cf_label" style="width: 150px;">Phone</label>
    <input class="cf_inputbox required validate-digits" maxlength="150" size="30" title="Can't have spaces" id="text_6" name="Phone" type="text" />
  
  </div>
  <div class="cfclear">&nbsp;</div>
</div>

<div class="form_item">
  <div class="form_element cf_textbox">
    <label class="cf_label" style="width: 150px;">Mobile</label>
    <input class="cf_inputbox validate-digits" maxlength="150" size="30" title="Can't have spaces" id="text_7" name="Mobile" type="text" />
  
  </div>
  <div class="cfclear">&nbsp;</div>
</div>
</fieldset>
<fieldset>
<legend>Student Details</legend>
<div class="form_item">
  <div class="form_element cf_textbox">
    <label class="cf_label" style="width: 150px;">Student Surname</label>
    <input class="cf_inputbox required validate-alpha" maxlength="150" size="30" title="Required; letters only" id="text_8" name="StudentSurname" type="text" />
  
  </div>
  <div class="cfclear">&nbsp;</div>
</div>
<div class="form_item">
  <div class="form_element cf_textbox">
    <label class="cf_label" style="width: 150px;">Student Firstname</label>
    <input class="cf_inputbox required validate-alpha" maxlength="150" size="30" title="Required; letters only" id="text_8" name="StudentFirstname" type="text" />
  
  </div>
  <div class="cfclear">&nbsp;</div>
</div>

<div class="form_item">
  <div class="form_element cf_dropdown">
    <label class="cf_label" style="width: 150px;">Course</label>
    <select class="cf_inputbox validate-selection" id="select_9" size="1" title=""  name="Code">
    <option value="">Choose Option</option>
      <option value="IntHN151210">IntHN151210</option>

    </select>
    
  </div>
  <div class="cfclear">&nbsp;</div>
</div>
</fieldset>
<fieldset>
<legend>Verification</legend>
<div class="form_item">
  <div class="form_element cf_dropdown">
    <label class="cf_label" style="width: 150px;">Do you want to receive e-mails about future courses?</label>
    <select class="cf_inputbox validate-selection" id="select_4" size="1" title=""  name="Updates">
    <option value="">Choose Option</option>
      <option value="No">No</option>
<option value="Yes">Yes</option>

    </select>
    
  </div>
  <div class="cfclear">&nbsp;</div>
</div>

<div class="form_item">
  <div class="form_element cf_captcha">
    <label class="cf_label" style="width: 150px;">Enter Code</label>
    <span>{imageverification}</span>    
    </div>
  <div class="cfclear">&nbsp;</div>
</div>
</fieldset>
<div class="form_item">
  <div class="form_element cf_button">
    <input value="Submit" name="button_12" type="submit" class="button"/>
  </div>
  <div class="cfclear">&nbsp;</div>
</div>
</div>