54 lines
2.4 KiB
HTML
54 lines
2.4 KiB
HTML
---
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title: Contact Me
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description: Contact form to get ahold of me.
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imageUrl: /img/venice-mailbox.jpg
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imageTitle: Snitch box in Venice
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imageDescription: This mailbox was used for reporting public health offenses in Venice. It survived the wrath of Napoleon because it didn't look enough like a lion.
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blurImageUrl: /img/venice-mailbox_blur.jpg
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motto: Contact Me
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---
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<form class="form-horizontal pageclip-form"
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action="https://usebasin.com/f/787df7bfd22e"
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method="post">
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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 type="text" class="form-control" id="name" name="name" placeholder="Jay Lush" required>
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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 type="email" class="form-control" id="email" name="email" placeholder="jlush@iastate.edu" required>
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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 type="tel" class="form-control" id="phone" name="phone" placeholder="(515) 294-2160">
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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 type="text" class="form-control" id="subject" name="subject" placeholder="Beef genetics" required>
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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 rows="5" class="form-control font-sans" id="message" name="body" required style="min-height: 72pt;"></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"><span>Submit</span></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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