<center><form action="https://apps.neuronworks.com.my/neuronmail/subscribe" method="POST" accept-charset="utf-8"><!-- [et_pb_line_break_holder] --> <label for="name">Nama Panggilan</label><br/><!-- [et_pb_line_break_holder] --> <input type="text" name="name" id="name"/><!-- [et_pb_line_break_holder] --> <br/><!-- [et_pb_line_break_holder] --> <label for="email">Email anda</label><br/><!-- [et_pb_line_break_holder] --> <input type="email" name="email" id="email"/><!-- [et_pb_line_break_holder] --><br/><!-- [et_pb_line_break_holder] --><label for="HP">Nombor HP</label><br/><!-- [et_pb_line_break_holder] --><input type="text" name="HP" id="HP"/><br/><div style="display:none;"><!-- [et_pb_line_break_holder] --> <label for="hp">HP</label><br/><!-- [et_pb_line_break_holder] --> <input type="text" name="hp" id="hp"/><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> <input type="hidden" name="list" value="p6orShVrB408BHDsKMrQdw"/><!-- [et_pb_line_break_holder] --> <input type="hidden" name="subform" value="yes"/><!-- [et_pb_line_break_holder] --> <input type="submit" name="submit" id="submit"/><!-- [et_pb_line_break_holder] --></center></form>