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  1 rizwank 1.1 <HTML>
  2             <HEAD>
  3             <META HTTP-EQUIV="Content-Type" CONTENT="text/html; charset=windows-1252">
  4             <META HTTP-EQUIV="Content-Language" CONTENT="en-us">
  5             <TITLE>Untitled Form Page</TITLE>
  6             </HEAD>
  7             <BODY>
  8             <H1>Dykstra Third Floor Address Sharing</H1>
  9             <HR>
 10             <P>
 11             To make address sharing easy once we leave Dykstra,&nbsp;</P>
 12             <FORM METHOD="POST" action="../../_derived/nortbots.htm" onSubmit="location.href='../../_derived/nortbots.htm';return false;" webbot-action="--WEBBOT-SELF--" WEBBOT-onSubmit>
 13             <!--webbot bot="SaveResults" startspan U-File="../../geekymedia.old/images/dykstraresult.htm"
 14             S-Format="HTML/DL" B-Label-Fields="TRUE" --><input TYPE="hidden" NAME="VTI-GROUP" VALUE="0"><!--webbot
 15             bot="SaveResults" endspan i-checksum="43374" --><P>
 16             Please provide the following contact information for when you are at home:</P>
 17             <BLOCKQUOTE>
 18             <TABLE>
 19             <TR>
 20             <TD ALIGN="right">
 21             <EM>First Name</EM></TD>
 22 rizwank 1.1 <TD>
 23             <INPUT TYPE=TEXT NAME="Contact_FirstName" SIZE=25>
 24             </TD>
 25             </TR>
 26             <TR>
 27             <TD ALIGN="right">
 28             <EM>Last Name</EM></TD>
 29             <TD>
 30             <INPUT TYPE=TEXT NAME="Contact_LastName" SIZE=25>
 31             </TD>
 32             </TR>
 33             <TR>
 34             <TD ALIGN="right">
 35             <EM>Street Address</EM></TD>
 36             <TD>
 37             <INPUT TYPE=TEXT NAME="Contact_StreetAddress" SIZE=35>
 38             </TD>
 39             </TR>
 40             <TR>
 41             <TD ALIGN="right">
 42             <EM>Address (cont.)</EM></TD>
 43 rizwank 1.1 <TD>
 44             <INPUT TYPE=TEXT NAME="Contact_Address2" SIZE=35>
 45             </TD>
 46             </TR>
 47             <TR>
 48             <TD ALIGN="right">
 49             <EM>City</EM></TD>
 50             <TD>
 51             <INPUT TYPE=TEXT NAME="Contact_City" SIZE=35>
 52             </TD>
 53             </TR>
 54             <TR>
 55             <TD ALIGN="right">
 56             <EM>State/Province</EM></TD>
 57             <TD>
 58             <INPUT TYPE=TEXT NAME="Contact_State" SIZE=35>
 59             </TD>
 60             </TR>
 61             <TR>
 62             <TD ALIGN="right">
 63             <EM>Zip/Postal Code</EM></TD>
 64 rizwank 1.1 <TD>
 65             <INPUT TYPE=TEXT NAME="Contact_ZipCode" SIZE=12 MAXLENGTH=12>
 66             </TD>
 67             </TR>
 68             <TR>
 69             <TD ALIGN="right">
 70             <EM>Country</EM></TD>
 71             <TD>
 72             <INPUT TYPE=TEXT NAME="Contact_Country" SIZE=25>
 73             </TD>
 74             </TR>
 75             <TR>
 76             <TD ALIGN="right">
 77             <EM>Home Phone</EM></TD>
 78             <TD>
 79             <INPUT TYPE=TEXT NAME="Contact_HomePhone" SIZE=25 MAXLENGTH=25>
 80             </TD>
 81             </TR>
 82             <TR>
 83             <TD ALIGN="right">
 84             <EM>FAX</EM></TD>
 85 rizwank 1.1 <TD>
 86             <INPUT TYPE=TEXT NAME="Contact_FAX" SIZE=25 MAXLENGTH=25>
 87             </TD>
 88             </TR>
 89             <TR>
 90             <TD ALIGN="right">
 91             <EM>E-mail</EM></TD>
 92             <TD>
 93             <INPUT TYPE=TEXT NAME="Contact_Email" SIZE=25>
 94             </TD>
 95             </TR>
 96             <TR>
 97             <TD ALIGN="right">
 98             <EM>URL</EM></TD>
 99             <TD>
100             <INPUT TYPE=TEXT NAME="Contact_URL" SIZE=25 MAXLENGTH=25>
101             </TD>
102             </TR>
103             </TABLE>
104             </BLOCKQUOTE>
105             <P>
106 rizwank 1.1 What room do you live in right now on third floor Dykstra ?</P>
107             <BLOCKQUOTE>
108             <P>
109             <INPUT TYPE=TEXT NAME="roomnumber" SIZE=5 MAXLENGTH=5>
110             <BR>
111             </P>
112             </BLOCKQUOTE>
113             <INPUT TYPE=SUBMIT VALUE="Submit Form">
114             <INPUT TYPE=RESET VALUE="Reset Form">
115             </FORM>
116             </BODY>
117             </HTML>
Rizwan Kassim