110 lines
2.9 KiB
HTML
110 lines
2.9 KiB
HTML
---
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title: Contact Me
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cardImage: venice-mailbox
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cardImageDescription:
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This mailbox was used for reporting public health offenses in Venice. It
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survived the wrath of Napoleon because it didn't look enough like a lion.
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motto: Contact Me
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description: Contact form to get ahold of me
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date: 2023-07-01
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menu:
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main:
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name: Contact
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params:
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icon: file-signature
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weight: 1
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fa-thumbnail: file-signature
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validation: true
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---
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<form
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class="form-horizontal"
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action="https://usebasin.com/f/787df7bfd22e"
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method="post"
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>
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<fieldset>
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<legend>Contact Me</legend>
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<input type="hidden" name="_gotcha" />
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<div class="form-group">
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<label for="name" class="col-lg-2 control-label">Name</label>
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<div class="col-lg-10">
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<input
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type="text"
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class="form-control"
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id="name"
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name="name"
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placeholder="Jay Lush"
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required
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/>
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</div>
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</div>
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<div class="form-group">
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<label for="email" class="col-lg-2 control-label">Email</label>
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<div class="col-lg-10">
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<input
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type="email"
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class="form-control"
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id="email"
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name="email"
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placeholder="jlush@iastate.edu"
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required
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/>
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</div>
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</div>
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<div class="form-group">
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<label for="phone" class="col-lg-2 control-label">Phone number</label>
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<div class="col-lg-10">
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<input
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type="tel"
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class="form-control"
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id="phone"
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name="phone"
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placeholder="(515) 294-2160"
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/>
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</div>
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</div>
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<div class="form-group">
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<label for="category" class="col-lg-2 control-label">Category</label>
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<div class="col-lg-10">
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<select class="form-select" id="category">
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<option>I'm hiring for artificial insemination</option>
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<option>Something else</option>
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</select>
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</div>
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</div>
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<div class="form-group">
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<label for="subject" class="col-lg-2 control-label">Subject</label>
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<div class="col-lg-10">
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<input
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type="text"
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class="form-control"
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id="subject"
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name="subject"
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placeholder="Beef genetics"
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required
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/>
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</div>
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</div>
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<div class="form-group">
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<label for="message" class="col-lg-2 control-label">Message</label>
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<div class="col-lg-10">
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<textarea
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rows="5"
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class="form-control font-sans"
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id="message"
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name="body"
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required
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style="min-height: 72pt;"
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></textarea>
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</div>
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</div>
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<div class="form-group">
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<div class="col-lg-10 col-lg-offset-2">
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<button type="reset" class="btn btn-default">Cancel</button>
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<button type="submit" class="btn btn-primary pageclip-form__submit">
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<span>Submit</span>
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</button>
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</div>
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</div>
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</fieldset>
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</form>
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