<div class="register-form">   
      <div class="form-group">
       [text* firstname id:fname class:form-control placeholder "First Name"]
      </div>
    
      <div class="form-group">
       [text lastname id:lname class:form-control placeholder "Last Name"]
      </div>
    
  <div class="form-group">
   [hidden Email class:form-control placeholder "Email"]
  </div>
  <div class="form-group">
    [text* city id:city class:form-control placeholder "City"]
  </div>
  <div class="form-group">
    [text* state id:state class:form-control placeholder "State"]
  </div>
  <div class="form-group">
    [tel Phone id:phone class:form-control placeholder "Phone"]
  </div>
  <p>We do not share or sell any registration information</p>
  [submit id:register class:register-btn "Register"]
</div>