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<div class="container center"> <!-- Header Section --> <p><span>CONTACT US</span><br>Nam porttitor blandit accumsan. Ut vel dictum sem, a pretium dui. In malesuada </p><br> <!-- Form Section --> <div class="form-box center"> <form method="post"> <div class="row1"> <div class="row1-1"><label for="fullname">FULL NAME</label><br><input type="text" name="fullname" id="fullname" minlength="6" pattern="[a-zA-Z]{6,}" required></div> <div class="row1-2"><label for="phone">PHONE</label><br><input type="text" name="phone" id="phone" minlength="11" pattern="09[0-9]{9}" required></div> <div class="row1-3"><label for="email">EMAIL</label><br><input type="email" name="email" id="email" required></div> </div><br> <div class="row2"> <div class="row2-1"><label for="gender">GENDER</label><br><select name="gender" id="gender" required> <option value="" disabled selected>Please Select</option> <option value="Male">Male</option> <option value="Female">Female</option> <option value="Other">Other</option> </select></div> <div class="row2-2"><label for="city">CITY</label><br><select name="ciry" id="city" required> <option value="" disabled selected>Please Select</option> <option value="Abrantes">Abrantes</option> <option value="Beja">Beja</option> <option value="Elvas">Elvas</option> <option value="Guarda">Guarda</option> <option value="Valbom">Valbom</option> </select></div> </div><br> <div class="row3"><label for="message">MESSAGE</label><br><textarea placeholder="Nam porttior blandit accumsan" name="message" id="message" cols="70" rows="10"></textarea><br> </div> <br> <div class="submit center"><input type="submit" name="submit"></div> </form> <hr> </div> </div>
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