<form action="" method="post">
 <label for="full_name">Full Name:</label>
 <input type="text" name="full_name" id="full_name" required />
 <label for="username">Username:</label>
 <input type="text" name="username" id="username" required />
 <label for="email">Email:</label>
 <input type="email" name="email" id="email" required />
 <label for="password">Password:</label>
 <input type="password" name="password" id="password" required />
 <input type="hidden" id="appointment_register_nonce" name="appointment_register_nonce" value="635d799963" /><input type="hidden" name="_wp_http_referer" value="/register/amp/" /> <input type="submit" name="appointment_register" value="Register" />
 </form>