<div class="member_feedback">
    <div class="row">
        <div class="col-lg-6 col-md-6 col-sm-6 col-xs-12">
            <div class="input-group">
                [text* text-name placeholder akismet:author "First Name"]
            </div>
        </div>
        <div class="col-lg-6 col-md-6 col-sm-6 col-xs-12">
            <div class="input-group">
                [text* text-name2 placeholder akismet:author "Last Name"]
            </div>
        </div>
        <div class="col-lg-6 col-md-6 col-sm-6 col-xs-12">
            <div class="input-group">
                [email* email placeholder akismet:author_email "E-mail"]
            </div>
        </div>
        <div class="col-lg-6 col-md-6 col-sm-6 col-xs-12">
            <div class="input-group">
                [tel phone placeholder "Phone Number"]
            </div>
        </div>
        <div class="col-lg-6 col-md-6 col-sm-6 col-xs-12">
            <div class="input-group">
                [text* city placeholder "City"]
            </div>
        </div>
        <div class="col-lg-6 col-md-6 col-sm-6 col-xs-12">
            <div class="input-group">
                [select state first_as_label "Select State (USA only)" "Value 1" "Value 2"]
            </div>
        </div>
        <div class="col-lg-6 col-md-6 col-sm-6 col-xs-12">
            <div class="input-group">
                [select country first_as_label "Country" "Value 1" "Value 2"]
            </div>
        </div>
        <div class="col-lg-6 col-md-6 col-sm-6 col-xs-12">
            <div class="input-group">
                <button type="submit" class="button size-lg icon_left"><i class="fa fa-chevron-right"></i> Submit</button>
            </div>
        </div>
    </div>
</div>
1
Title
<wordpress@consulting.stylemixthemes.com/demo>
test@gmail.com
[text-name][text-name2][email][phone][city][state][country]













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