<input
				type="text"
				class="mf-input mf-conditional-input"
				id="mf-input-text-184663a1"
				name="name"
				placeholder="${ parent.decodeEntities(`What Is Your Name?`) } "
									onInput=${parent.handleChange}
					onBlur=${parent.handleChange}
					aria-invalid=${validation.errors['name'] ? 'true' : 'false'}
					ref=${el =>{
												parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":true,"expression":"null"}, el)
					}}
								/>
							<${validation.ErrorMessage}
					errors=${validation.errors}
					name="name"
					as=${html``}
					/>
			<input 
				type="email" 
				defaultValue="" 
				class="mf-input mf-conditional-input" 
				id="mf-input-email-47e25ccc" 
				name="email-address" 
				placeholder="${ parent.decodeEntities(`Email Address`) } " 
				onBlur=${parent.handleChange} onFocus=${parent.handleChange} aria-invalid=${validation.errors['email-address'] ? 'true' : 'false' } 
				ref=${el=> parent.activateValidation({"message":"This field is required.","emailMessage":"Please enter a valid Email address","minLength":1,"maxLength":"","type":"none","required":true,"expression":"null"}, el)}
							/>
						<${validation.ErrorMessage} 
				errors=${validation.errors} 
				name="email-address" 
				as=${html``}
			/>
			<input
				type="tel"
				class="mf-input "
				id="mf-input-telephone-5f16496" 
				name="mf-telephone"
				placeholder="${ parent.decodeEntities(`Phone Number`) } "
									onInput=${parent.handleChange}
					aria-invalid=${validation.errors['mf-telephone'] ? 'true' : 'false'}
					ref=${el => parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el)}
								/>
							<${validation.ErrorMessage}
					errors=${validation.errors}
					name="mf-telephone"
					as=${html``}
					/>
            <${props.Select}
                className=${"mf-input mf-input-select  " + ( validation.errors['mf-select'] ? 'mf-invalid' : '' )}
                classNamePrefix="mf_select"
                name="mf-select"
                placeholder="${ parent.decodeEntities(`State`) } "
                isSearchable=${false}
                options=${[{"label":"Bangladesh","value":"Bangladesh","isDisabled":false},{"label":"Nepal","value":"Nepal","isDisabled":false},{"label":"Pakistan","value":"Pakistan","isDisabled":false},{"label":"India","value":"India","isDisabled":false}]}
                value=${parent.getValue("mf-select") ? [{"label":"Bangladesh","value":"Bangladesh","isDisabled":false},{"label":"Nepal","value":"Nepal","isDisabled":false},{"label":"Pakistan","value":"Pakistan","isDisabled":false},{"label":"India","value":"India","isDisabled":false}].filter(item => item.value === parent.getValue("mf-select"))[0] : []}
                onChange=${(e)=> parent.handleSelect(e, "mf-select")}
                ref=${() => {
				                    register({ name: "mf-select" }, parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false}));
                    if ( parent.getValue("mf-select") === '' && false ) {
				    parent.setValue( 'mf-select', '', true );
                        parent.handleChange({
                            target: {
                                name: 'mf-select',
                                value: ''
                            }
                        });
                    }
                }}
                />
            				<${validation.ErrorMessage}
					errors=${validation.errors}
					name="mf-select"
					as=${html``}
					/>
			<textarea id="mf-input-text-area-7e5c045e"
				name="mf-comment" 
				placeholder="${ parent.decodeEntities(`A brief description about your consultation`) } "
				cols="30" rows="10"
									onInput=${ parent.handleChange }
					aria-invalid=${validation.errors['mf-comment'] ? 'true' : 'false'}
					ref=${ el => parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":true,"expression":"null"}, el)}
								></textarea>
							<${validation.ErrorMessage}
					errors=${validation.errors}
					name="mf-comment"
					as=${html``}
					/>
			 parent.handleCheckbox(el, 'onLoad')}
									class="mf-checkbox multi-option-input-type"
					id="mf-input-checkbox-721377a">
						<label>
														<input type="checkbox"
								class="mf-input mf-checkbox-input "
								name="mf-checkbox"
								value="yes"
								defaultChecked=""
																									onInput=${ el =>  parent.handleCheckbox(el.target, 'onClick') }
									aria-invalid=${validation.errors['mf-checkbox'] ? 'true' : 'false'}
									ref=${el => {
																				parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el)}
									}
																/>
								${ parent.decodeEntities(`By submitting your information you provide written consent to hostie and its family of brands contacting you.`) } 							
						</label>
							<${validation.ErrorMessage}
					errors=${validation.errors}
					name="mf-checkbox"
					as=${html``}
					/>
							<button type="submit" id="">
					${ parent.decodeEntities(`Submit Now`) } 
				</button>