<div class="om-columns">
<div class="om-column om-one-half">

  <div class="om-columns">
  <div class="om-column om-one-half">
    <p>[text* first-name placeholder "First Name *"]</p>
  </div>
  <div class="om-column om-one-half">
    <p>[text* last-name placeholder "Last Name *"]</p>
  </div>
  </div>

  <p>[text* job-title placeholder "Job Title *"]</p>

  <p>[text* company-name placeholder "Company Name *"]</p>

  <p class="note">Information above will appear on conference badge</p>

  <div class="om-columns">
  <div class="om-column om-one-half">
    <p>[email* email placeholder "Email Address *"]</p>
  </div>
  <div class="om-column om-one-half">
    <p>[text* phone placeholder "Phone Number *"]</p>
  </div>
  </div>

</div>
<div class="om-column om-one-half">

  <p>[text* address placeholder "Address *"]</p>

  <div class="om-columns">
  <div class="om-column om-one-half">
    <p>[text* city placeholder "City *"]</p>
  </div>
  <div class="om-column om-one-half">
    <p>[text* postal-code placeholder "Postal Code *"]</p>
  </div>
  </div>

  <p>[text* country placeholder "Country *"]</p>

  <p>[textarea commments x3 placeholder "Comments"]</p>

</div>
</div>

<p>[submit "Submit"]</p>