Shamay Holistic Solutions
Email address: <input type="email" id="mc4wp_email" name="EMAIL" placeholder="Your Email address" required="required" />
First Name: <input required="required" placeholder="Your first name " name="FNAME" type="text">
Last Name: <input placeholder="Your last name " name="LNAME" type="text">
<input type="submit" value="Sign up " />