landing page

I need a landing page to capture a name and a phone number of people that are interested in a special offer regarding martial art self defense. The landing page should consist of 250 words plus a headline of two rows. I will provide the points to be inserted in the form of the landing page (not points for the headline) and you can add to it and create the landing page. No need for html, database or design, just the above description. Your job is to do it in a way that attract people to enter their name and phone number.

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