Clients can not input information after the first three lines of my form, how do I correct this?

Location of form is here: http://southernmscycletraining.com/Form.html

Hi, I see the script line of code might be causing the conflict:

I would recommend you to remove all the embedded code of your form, and get the iFrame code of your form, copy as it is, and paste in your web page. Let us know what happens.

That did not resolve my issue. Anymore suggestions?
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Hello taylor8126,

Please let us know which browser you are having this issue. Upon checking yoru web page, I was unable to replicate the problem. I see the complete form and was able to input in all the fields. Please check the screenshot below:

I did check your form in Chrome / Mozilla and IE but it works as expected. Have you solved your problem already?

We will wait for your response.

Thank you!

I'm using google chrome. Clients have complained that they can not enter information as well. I can enter the information when I'm on your site but can not when I go to my site.
Sent from my iPhone
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You are still using the Javascript Method. Please consider using our iFrame Method: Getting the Form iFrame Code, this time, remove the script tags;

See image on what to remove:

Thanks