[gravityform id="10" title="false" description="false"]
<div class='gf_browser_unknown gform_wrapper free-workout-homepage_wrapper gform_legacy_markup_wrapper' id='gform_wrapper_10' ><form method='post' enctype='multipart/form-data' id='gform_10' class='free-workout-homepage gform_legacy_markup' action='/category/weight-loss/' >
<input type='hidden' class='gforms-pum' value='{"closepopup":false,"closedelay":0,"openpopup":false,"openpopup_id":0}' />
<div class='gform_body gform-body'><ul id='gform_fields_10' class='gform_fields top_label form_sublabel_below description_below'><li id="field_10_1" class="gfield gfield_contains_required field_sublabel_below field_description_below hidden_label gfield_visibility_visible" data-js-reload="field_10_1"><label class='gfield_label gfield_label_before_complex' >Name<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_complex ginput_container no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name' id='input_10_1'>
<span id='input_10_1_3_container' class='name_first' >
<input type='text' name='input_1.3' id='input_10_1_3' value='' aria-required='true' placeholder='First Name' />
<label for='input_10_1_3' >First</label>
</span>
<span id='input_10_1_6_container' class='name_last' >
<input type='text' name='input_1.6' id='input_10_1_6' value='' aria-required='true' placeholder='Last Name' />
<label for='input_10_1_6' >Last</label>
</span>
</div></li><li id="field_10_2" class="gfield gfield_contains_required field_sublabel_below field_description_below hidden_label gfield_visibility_visible" data-js-reload="field_10_2"><label class='gfield_label' for='input_10_2' >Email<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_email'>
<input name='input_2' id='input_10_2' type='text' value='' class='large' placeholder='Email Address' aria-required="true" aria-invalid="false" />
</div></li><li id="field_10_3" class="gfield field_sublabel_below field_description_below hidden_label gfield_visibility_visible" data-js-reload="field_10_3"><label class='gfield_label' for='input_10_3' >Phone</label><div class='ginput_container ginput_container_phone'><input name='input_3' id='input_10_3' type='text' value='' class='large' placeholder='Phone Number' aria-invalid="false" /></div></li><li id="field_10_4" class="gfield gform_validation_container field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_10_4"><label class='gfield_label' for='input_10_4' >Email</label><div class='ginput_container'><input name='input_4' id='input_10_4' type='text' value='' /></div><div class='gfield_description' id='gfield_description_10_4'>This field is for validation purposes and should be left unchanged.</div></li></ul></div>
<div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_10' class='gform_button button' value='Submit' onclick='if(window["gf_submitting_10"]){return false;} window["gf_submitting_10"]=true; ' onkeypress='if( event.keyCode == 13 ){ if(window["gf_submitting_10"]){return false;} window["gf_submitting_10"]=true; jQuery("#gform_10").trigger("submit",[true]); }' />
<input type='hidden' class='gform_hidden' name='is_submit_10' value='1' />
<input type='hidden' class='gform_hidden' name='gform_submit' value='10' />
<input type='hidden' class='gform_hidden' name='gform_unique_id' value='' />
<input type='hidden' class='gform_hidden' name='state_10' value='WyJbXSIsIjUwMTA5YWZhNzkzYzVjZGRjM2Q3Y2JhYTE3YjBiMDA5Il0=' />
<input type='hidden' class='gform_hidden' name='gform_target_page_number_10' id='gform_target_page_number_10' value='0' />
<input type='hidden' class='gform_hidden' name='gform_source_page_number_10' id='gform_source_page_number_10' value='1' />
<input type='hidden' name='gform_field_values' value='' />
</div>
<p style="display: none !important;"><label>Δ<textarea name="ak_hp_textarea" cols="45" rows="8" maxlength="100"></textarea></label><input type="hidden" id="ak_js_2" name="ak_js" value="142"/><script>document.getElementById( "ak_js_2" ).setAttribute( "value", ( new Date() ).getTime() );</script></p></form>
</div>
