Form question
Is there anyway to create a form like the one here without having to go through a program like the site i'm using?
- A way to edit the form so that, when the member clicks 'sumbit' it either sends a plain text file with the info to my email, or stores it somewhere on my server?
I know nothing on how forms work. =) Thank you~
- A way to edit the form so that, when the member clicks 'sumbit' it either sends a plain text file with the info to my email, or stores it somewhere on my server?
I know nothing on how forms work. =) Thank you~
<form name="form" action="mailto:gazettestreetteam@gmail.c
enctype="text/plain">
<input name="subject" value="Member Registration"
type="hidden"> <input name="required"
value="lastname,name,email,dob,city,sta
type="hidden"><input name="redirect"
value="http://www.gazettestreet.net/danke" type="hidden">
<table border="0" cellpadding="5" cellspacing="5">
<tbody>
<tr>
<td valign="top"></td>
<td
style="margin: 0pt; padding: 5px; font-family: verdana; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal; color: rgb(255, 255, 255); text-align: left;"
valign="top" width=""> <b>First Name:</b>
</td>
<td valign="top"></td>
<td
style="margin: 0pt; padding: 5px; font-family: verdana; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal; color: rgb(255, 255, 255); text-align: left;"
valign="top" width=""> <input name="name"
size="40" value="" type="text"> </td>
</tr>
<tr>
<td valign="top"></td>
<td
style="margin: 0pt; padding: 5px; font-family: verdana; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal; color: rgb(255, 255, 255); text-align: left;"
valign="top" width=""> <b>Last Name:</b>
</td>
<td valign="top"></td>
<td
style="margin: 0pt; padding: 5px; font-family: verdana; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal; color: rgb(255, 255, 255); text-align: left;"
valign="top" width=""> <input name="lastname"
size="40" value="" type="text"> </td>
</tr>
<tr>
<td valign="top"></td>
<td
style="margin: 0pt; padding: 5px; font-family: verdana; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal; color: rgb(255, 255, 255); text-align: left;"
valign="top" width=""> <b>Nickname:</b> </td>
<td valign="top"></td>
<td
style="margin: 0pt; padding: 5px; font-family: verdana; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal; color: rgb(255, 255, 255); text-align: left;"
valign="top" width=""> <input name="nickname"
size="40" value="" type="text"> </td>
</tr>
<tr>
<td valign="top"></td>
<td
style="margin: 0pt; padding: 5px; font-family: verdana; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal; color: rgb(255, 255, 255); text-align: left;"
valign="top" width=""> <b>Email Address:</b>
</td>
<td valign="top"></td>
<td
style="margin: 0pt; padding: 5px; font-family: verdana; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal; color: rgb(255, 255, 255); text-align: left;"
valign="top" width=""> <input name="email"
size="40" value="" type="text"> </td>
</tr>
<tr>
<td valign="top"></td>
<td
style="margin: 0pt; padding: 5px; font-family: verdana; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal; color: rgb(255, 255, 255); text-align: left;"
valign="top" width=""> <b>Date of Birth
(mm/dd/yyyy): </b> </td>
<td valign="top"></td>
<td
style="margin: 0pt; padding: 5px; font-family: verdana; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal; color: rgb(255, 255, 255); text-align: left;"
valign="top" width=""> <input name="dob"
size="40" value="" type="text"> </td>
</tr>
<tr>
<td valign="top"></td>
<td
style="margin: 0pt; padding: 5px; font-family: verdana; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal; color: rgb(255, 255, 255); text-align: left;"
valign="top" width=""> <b>Mailing Address (NOT
EMAIL)</b> </td>
<td valign="top"></td>
<td
style="margin: 0pt; padding: 5px; font-family: verdana; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal; color: rgb(255, 255, 255); text-align: left;"
valign="top" width=""> <input name="address"
size="40" value="" type="text"> </td>
</tr>
<tr>
<td valign="top"></td>
<td
style="margin: 0pt; padding: 5px; font-family: verdana; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal; color: rgb(255, 255, 255); text-align: left;"
valign="top" width=""> <b>Zip Code</b> </td>
<td valign="top"></td>
<td
style="margin: 0pt; padding: 5px; font-family: verdana; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal; color: rgb(255, 255, 255); text-align: left;"
valign="top" width=""> <input name="zip"
size="40" value="" type="text"> </td>
</tr>
<tr>
<td valign="top"></td>
<td
style="margin: 0pt; padding: 5px; font-family: verdana; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal; color: rgb(255, 255, 255); text-align: left;"
valign="top" width=""> <b>City</b> </td>
<td valign="top"></td>
<td
style="margin: 0pt; padding: 5px; font-family: verdana; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal; color: rgb(255, 255, 255); text-align: left;"
valign="top" width=""> <input name="city"
size="40" value="" type="text"> </td>
</tr>
<tr>
<td valign="top"></td>
<td
style="margin: 0pt; padding: 5px; font-family: verdana; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal; color: rgb(255, 255, 255); text-align: left;"
valign="top" width=""> <b>State</b> </td>
<td valign="top"></td>
<td
style="margin: 0pt; padding: 5px; font-family: verdana; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal; color: rgb(255, 255, 255); text-align: left;"
valign="top" width=""> <input name="state"
size="40" value="" type="text"> </td>
</tr>
<tr>
<td valign="top"></td>
<td
style="margin: 0pt; padding: 5px; font-family: verdana; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal; color: rgb(255, 255, 255); text-align: left;"
valign="top" width=""> <b>Country</b> </td>
<td valign="top"></td>
<td
style="margin: 0pt; padding: 5px; font-family: verdana; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal; color: rgb(255, 255, 255); text-align: left;"
valign="top" width="">
<select name="country">
<option value="[AF] Afghanistan">[AF] Afghanistan</option>
<option value="[AL]Albania">[AL]Albania</option>
<option value="[DZ]Algeria">[DZ]Algeria</option>
<option value="[AS]American Samoa">[AS]American
Samoa</option>
<option value="[AD]Andorra">[AD]Andorra</option>
<option value="[AO]Angola">[AO]Angola</option>
<option value="[AI]Anguilla">[AI]Anguilla</optio
<option value="[AQ]Antarctica">[AQ]Antarctica</o
<option value="[AG]Antigua and Barbuda">[AG]Antigua
and Barbuda</option>
<option value="[AR]Argentina">[AR]Argentina</opt
<option value="[AM]Armenia">[AM]Armenia</option>
<option value="[AW]Aruba">[AW]Aruba</option>
<option value="[AU]Australia">[AU]Australia</opt
<option value="[AT]Austria">[AT]Austria</option>
<option value="[AZ]Azerbaijan">[AZ]Azerbaijan</o
<option value="[BS]Bahamas">[BS]Bahamas</option>
<option value="[BH]Bahrain">[BH]Bahrain</option>
<option value="[BD]Bangladesh">[BD]Bangladesh</o
<option value="[BB]Barbados">[BB]Barbados</optio
<option value="[BY]Belarus">[BY]Belarus</option>
<option value="[BE]Belgium">[BE]Belgium</option>
<option value="[BZ]Belize">[BZ]Belize</option>
<option value="[BJ]Benin">[BJ]Benin</option>
<option value="[BM]Bermuda">[BM]Bermuda</option>
<option value="[BT]Bhutan">[BT]Bhutan</option>
<option value="[BO]Bolivia">[BO]Bolivia</option>
<option value="[BA]Bosnia and Herzegowina">[BA]Bosnia
and Herzegowina</option>
<option value="[BW]Botswana">[BW]Botswana</optio
<option value="[BV]Bouvet Island">[BV]Bouvet Island</option>
<option value="[BR]Brazil">[BR]Brazil</option>
<option value="[IO]British Indian Ocean Territory">[IO]British
Indian Ocean Territory</option>
<option value="[BN]Brunei Darussalam">[BN]Brunei
Darussalam</option>
<option value="[BG]Bulgaria">[BG]Bulgaria</optio
<option value="[BF]Burkina Faso">[BF]Burkina Faso</option>
<option value="[BI]Burundi">[BI]Burundi</option>
<option value="[KH]Cambodia">[KH]Cambodia</optio
<option value="[CM]Cameroon">[CM]Cameroon</optio
<option value="[CA]Canada">[CA]Canada</option>
<option value="[CV]Cape Verde">[CV]Cape Verde</option>
<option value="[KY]Cayman Islands">[KY]Cayman
Islands</option>
<option value="[CF]Central African Republic">[CF]Central
African Republic</option>
<option value="[TD]Chad">[TD]Chad</option>
<option value="[CL]Chile">[CL]Chile</option>
<option value="[CN]China">[CN]China</option>
<option value="[CX]Christmas Island">[CX]Christmas
Island</option>
<option value="[CC]Cocoa (Keeling) Islands">[CC]Cocoa
(Keeling) Islands</option>
<option value="[CO]Colombia">[CO]Colombia</optio
<option value="[KM]Comoros">[KM]Comoros</option>
<option value="[CG]Congo">[CG]Congo</option>
<option value="[CK]Cook Islands">[CK]Cook Islands</option>
<option value="[CR]Costa Rica">[CR]Costa Rica</option>
<option value="[CI]Cote Divoire">[CI]Cote Divoire</option>
<option value="[CT]Croatia (Hrvatska)">[CT]Croatia
(Hrvatska)</option>
<option value="[CU]Cuba">[CU]Cuba</option>
<option value="[CY]Cyprus">[CY]Cyprus</option>
<option value="[CZ]Czech Republic">[CZ]Czech
Republic</option>
<option value="[DK]Denmark">[DK]Denmark</option>
<option value="[DJ]Djibouti">[DJ]Djibouti</optio
<option value="[DM]Dominica">[DM]Dominica</optio
<option value="[DO]Dominican Republic">[DO]Dominican
Republic</option>
<option value="[TP]East Timor">[TP]East Timor</option>
<option value="[EC]Ecuador">[EC]Ecuador</option>
<option value="[EG]Egypt">[EG]Egypt</option>
<option value="[SV]El Salvador">[SV]El Salvador</option>
<option value="[GQ]Equatorial Guinea">[GQ]Equatorial
Guinea</option>
<option value="[ER]Eritrea">[ER]Eritrea</option>
<option value="[EE]Estonia">[EE]Estonia</option>
<option value="[ET]Ethiopia">[ET]Ethiopia</optio
<option value="[FK]Falkland Islands (Malvinas)">[FK]Falkland
Islands (Malvinas)</option>
<option value="[FO]Faroe Islands">[FO]Faroe Islands</option>
<option value="[FJ]Fiji">[FJ]Fiji</option>
<option value="[FI]Finland">[FI]Finland</option>
<option value="[FR]France">[FR]France</option>
<option value="[FX]France, Metropolitan">[FX]France,
Metropolitan</option>
<option value="[GF]French Guiana">[GF]French Guiana</option>
<option value="[PF]French Polynesia">[PF]French
Polynesia</option>
<option value="[TF]French Southern Territories">[TF]French
Southern Territories</option>
<option value="[GA]Gabon">[GA]Gabon</option>
<option value="[GM]Gambia">[GM]Gambia</option>
<option value="[GE]Georgia">[GE]Georgia</option>
<option value="[DE]Germany">[DE]Germany</option>
<option value="[GH]Ghana">[GH]Ghana</option>
<option value="[GI]Gibraltar">[GI]Gibraltar</opt
<option value="[GR]Greece">[GR]Greece</option>
<option value="[GL]Greenland">[GL]Greenland</opt
<option value="[GD]Grenada">[GD]Grenada</option>
<option value="[GP]Guadeloupe">[GP]Guadeloupe</o
<option value="[GU]Guam">[GU]Guam</option>
<option value="[GT]Guatemala">[GT]Guatemala</opt
<option value="[GN]Guinea">[GN]Guinea</option>
<option value="[GW]Guinea-Bissau">[GW]Guinea-Bis
<option value="[GY]Guyana">[GY]Guyana</option>
<option value="[HT]Haiti">[HT]Haiti</option>
<option value="[HM]Heard and Mc Donald Islands">[HM]Heard
and Mc Donald Islands</option>
<option value="[HN]Honduras">[HN]Honduras</optio
<option value="[HK]Hong Kong">[HK]Hong Kong</option>
<option value="[HU]Hungary">[HU]Hungary</option>
<option value="[IS]Iceland">[IS]Iceland</option>
<option value="[IN]India">[IN]India</option>
<option value="[ID]Indonesia">[ID]Indonesia</opt
<option value="[IR]Iran (Islamic Republic of)">[IR]Iran
(Islamic Republic of)</option>
<option value="[IQ]Iraq">[IQ]Iraq</option>
<option value="[IE]Ireland">[IE]Ireland</option>
<option value="[IL]Israel">[IL]Israel</option>
<option value="[IT]Italy">[IT]Italy</option>
<option value="[JM]Jamaica">[JM]Jamaica</option>
<option value="[JP]Japan">[JP]Japan</option>
<option value="[JO]Jordan">[JO]Jordan</option>
<option value="[KZ]Kazakhstan">[KZ]Kazakhstan</o
<option value="[KE]Kenya">[KE]Kenya</option>
<option value="[KI]Kiribati">[KI]Kiribati</optio
<option value="[KP]Korea, Democratic Peoples Republic of">[KP]Korea,
Democratic Peoples Republic of</option>
<option value="[KR]Korea, Republic of">[KR]Korea,
Republic of</option>
<option value="[KW]Kuwait">[KW]Kuwait</option>
<option value="[KG]Kyrgyzstan">[KG]Kyrgyzstan</o
<option value="[LA]Lao Peoples Democratic Republic">[LA]Lao
Peoples Democratic Republic</option>
<option value="[LV]Latvia">[LV]Latvia</option>
<option value="[LB]Lebanon">[LB]Lebanon</option>
<option value="[LS]Lesotho">[LS]Lesotho</option>
<option value="[LR]Liberia">[LR]Liberia</option>
<option value="[LY]Libyan Arab Jamahiriya">[LY]Libyan
Arab Jamahiriya</option>
<option value="[LI]Liechtenstein">[LI]Liechtenst
<option value="[LT]Lithuania">[LT]Lithuania</opt
<option value="[LU]Luxembourg">[LU]Luxembourg</o
<option value="[MO]Macau">[MO]Macau</option>
<option
value="[MK]Macedonia, The Former Yugoslav Republic of">[MK]Macedonia,
The Former Yugoslav Republic of</option>
<option value="[MG]Madagascar">[MG]Madagascar</o
<option value="[MW]Malawi">[MW]Malawi</option>
<option value="[MY]Malaysia">[MY]Malaysia</optio
<option value="[MV]Maldives">[MV]Maldives</optio
<option value="[ML]Mali">[ML]Mali</option>
<option value="[MT]Malta">[MT]Malta</option>
<option value="[MH]Marshall Islands">[MH]Marshall
Islands</option>
<option value="[MQ]Martinique">[MQ]Martinique</o
<option value="[MR]Mauritania">[MR]Mauritania</o
<option value="[MU]Mauritius">[MU]Mauritius</opt
<option value="[YT]Mayotte">[YT]Mayotte</option>
<option value="[MX]Mexico">[MX]Mexico</option>
<option value="[FM]Micronesia, Federated States of">[FM]Micronesia,
Federated States of</option>
<option value="[MD]Moldova, Republic of">[MD]Moldova,
Republic of</option>
<option value="[MC]Monaco">[MC]Monaco</option>
<option value="[MN]Mongolia">[MN]Mongolia</optio
<option value="[MS]Montserrat">[MS]Montserrat</o
<option value="[MA]Morocco">[MA]Morocco</option>
<option value="[MZ]Mozambique">[MZ]Mozambique</o
<option value="[MM]Myanmar">[MM]Myanmar</option>
<option value="[NA]Namibia">[NA]Namibia</option>
<option value="[NR]Nauru">[NR]Nauru</option>
<option value="[NP]Nepal">[NP]Nepal</option>
<option value="[NL]Netherlands">[NL]Netherlands<
<option value="[AN]Netherlands Antilles">[AN]Netherlands
Antilles</option>
<option value="[NC]New Caledonia">[NC]New Caledonia</option>
<option value="[NZ]New Zealand">[NZ]New Zealand</option>
<option value="[NI]Nicaragua">[NI]Nicaragua</opt
<option value="[NE]Niger">[NE]Niger</option>
<option value="[NG]Nigeria">[NG]Nigeria</option>
<option value="[NU]Niue">[NU]Niue</option>
<option value="[NF]Norfolk Island">[NF]Norfolk
Island</option>
<option value="[MP]Northern Mariana Islands">[MP]Northern
Mariana Islands</option>
<option value="[NO]Norway">[NO]Norway</option>
<option value="[OM]Oman">[OM]Oman</option>
<option value="[PK]Pakistan">[PK]Pakistan</optio
<option value="[PW]Palau">[PW]Palau</option>
<option value="[PA]Panama">[PA]Panama</option>
<option value="[PG]Papua New Guinea">[PG]Papua New
Guinea</option>
<option value="[PY]Paraguay">[PY]Paraguay</optio
<option value="[PE]Peru">[PE]Peru</option>
<option value="[PH]Philippines">[PH]Philippines<
<option value="[PN]Pitcairn">[PN]Pitcairn</optio
<option value="[PL]Poland">[PL]Poland</option>
<option value="[PT]Portugal">[PT]Portugal</optio
<option value="[PR]PuertoRico">[PR]PuertoRico</o
<option value="[QA]Qatar">[QA]Qatar</option>
<option value="[RE]Reunion">[RE]Reunion</option>
<option value="[RO]Romania">[RO]Romania</option>
<option value="[RU]Russian Federation">[RU]Russian
Federation</option>
<option value="[RW]Rwanda">[RW]Rwanda</option>
<option value="[KN]Saint Kitts and Nevis">[KN]Saint
Kitts and Nevis</option>
<option value="[LC]Saint Lucia">[LC]Saint Lucia</option>
<option value="[VC]Saint Vincent and the Grenadines">[VC]Saint
Vincent and the Grenadines</option>
<option value="[WS]Samoa">[WS]Samoa</option>
<option value="[SM]SanMarino">[SM]SanMarino</opt
<option value="[ST]Sao Tome and Principe">[ST]Sao
Tome and Principe</option>
<option value="[SA]Saudi Arabia">[SA]Saudi Arabia</option>
<option value="[SN]Senegal">[SN]Senegal</option>
<option value="[SC]Seychelles">[SC]Seychelles</o
<option value="[SL]Sierra Leone">[SL]Sierra Leone</option>
<option value="[SG]Singapore">[SG]Singapore</opt
<option value="[SK]Slovakia (Slovak Republic)">[SK]Slovakia
(Slovak Republic)</option>
<option value="[SI]Slovenia">[SI]Slovenia</optio
<option value="[Sb]Solomon Islands">[Sb]Solomon
Islands</option>
<option value="[SO]Somalia">[SO]Somalia</option>
<option value="[ZA]South Africa">[ZA]South Africa</option>
<option
value="[GS]SouthGeorgia and the South Sandwich Islands">[GS]SouthGeorgia
and the South Sandwich Islands</option>
<option value="[ES]Spain">[ES]Spain</option>
<option value="[LK]Sri Lanka">[LK]Sri Lanka</option>
<option value="[SH]St. Helena">[SH]St. Helena</option>
<option value="[PM]St. Pierre andMiquelon">[PM]St.
Pierre andMiquelon</option>
<option value="[SD]Sudan">[SD]Sudan</option>
<option value="[SR]Suriname">[SR]Suriname</optio
<option value="[SJ]Svalbard and Jan Mayen Islands">[SJ]Svalbard
and Jan Mayen Islands</option>
<option value="[SZ]Swaziland">[SZ]Swaziland</opt
<option value="[SE]Sweden">[SE]Sweden</option>
<option value="[CH]Switzerland">[CH]Switzerland<
<option value="[SY]Syrian ArabRepublic">[SY]Syrian
ArabRepublic</option>
<option value="[TW]Taiwan">[TW]Taiwan</option>
<option value="[TJ]Tajikistan">[TJ]Tajikistan</o
<option value="[TZ]Tanzania, United Republic of">[TZ]Tanzania,
United Republic of</option>
<option value="[TH]Thailand">[TH]Thailand</optio
<option value="[TG]Togo">[TG]Togo</option>
<option value="[TK]Tokelau">[TK]Tokelau</option>
<option value="[TO]Tonga">[TO]Tonga</option>
<option value="[TT]Trinidad and Tobago">[TT]Trinidad
and Tobago</option>
<option value="[TN]Tunisia">[TN]Tunisia</option>
<option value="[TR]Turkey">[TR]Turkey</option>
<option value="[TM]Turkmenistan">[TM]Turkmenista
<option value="[TC]Turks and Caicos Islands">[TC]Turks
and Caicos Islands</option>
<option value="[TV]Tuvalu">[TV]Tuvalu</option>
<option value="[UG]Uganda">[UG]Uganda</option>
<option value="[UA]Ukraine">[UA]Ukraine</option>
<option value="[AE]United ArabEmirates">[AE]United
ArabEmirates</option>
<option value="[UK]United Kingdom">[UK]United
Kingdom</option>
<option value="[US]United States">[US]United States</option>
<option value="[UM]United States Minor Outlying Islands">[UM]United
States Minor Outlying Islands</option>
<option value="[UY]Uruguay">[UY]Uruguay</option>
<option value="[UZ]Uzbekistan">[UZ]Uzbekistan</o
<option value="[VU]Vanuatu">[VU]Vanuatu</option>
<option value="[VA]Vatican City State(Holy See)">[VA]Vatican
City State(Holy See)</option>
<option value="[VE]Venezuela">[VE]Venezuela</opt
<option value="[VN]Viet Nam">[VN]Viet Nam</option>
<option value="[VG]Virgin Islands (British)">[VG]Virgin
Islands (British)</option>
<option value="[VI]Virgin Islands (U.S.)">[VI]Virgin
Islands (U.S.)</option>
<option value="[WF]Wallis and Futuna Islands">[WF]Wallis
and Futuna Islands</option>
<option value="[EH]Western Sahara">[EH]Western
Sahara</option>
<option value="[YE]Yeman">[YE]Yeman</option>
<option value="[YU]Yugoslavia">[YU]Yugoslavia</o
<option value="[ZR]Zaire">[ZR]Zaire</option>
<option value="[ZM]Zambia">[ZM]Zambia</option>
<option value="[ZW]Zimbabwe">[ZW]Zimbabwe</optio
</select>
</td>
</tr>
<tr>
<td valign="top"></td>
<td
style="margin: 0pt; padding: 5px; font-family: verdana; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal; color: rgb(255, 255, 255); text-align: left;"
valign="top" width=""> <b>Website Name</b><br>
(webmasters only; no myspaces; blogs; etc.)
</td>
<td valign="top"></td>
<td
style="margin: 0pt; padding: 5px; font-family: verdana; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal; color: rgb(255, 255, 255); text-align: left;"
valign="top" width=""> <input name="webname"
size="40" value="" type="text"> </td>
</tr>
<tr>
<td valign="top"></td>
<td
style="margin: 0pt; padding: 5px; font-family: verdana; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal; color: rgb(255, 255, 255); text-align: left;"
valign="top" width=""> <b>Website URL</b><br>
(moderators of LJ communities, Community URL OK)
</td>
<td valign="top"></td>
<td
style="margin: 0pt; padding: 5px; font-family: verdana; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal; color: rgb(255, 255, 255); text-align: left;"
valign="top" width=""> <input name="weburl"
size="40" value="" type="text"> </td>
</tr>
<tr>
<td valign="top"></td>
<td
style="margin: 0pt; padding: 5px; font-family: verdana; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal; color: rgb(255, 255, 255); text-align: left;"
valign="top" width=""> <b>Would you like to be
a coordinator?<br>
(No minors)</b> </td>
<td valign="top"></td>
<td
style="margin: 0pt; padding: 5px; font-family: verdana; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal; color: rgb(255, 255, 255); text-align: left;"
valign="top" width=""> <input name="coordinator"
value="Yes" type="radio">Yes<br>
<input name="coordinator" value="No"
type="radio"> No<br>
<input name="coordinator" value="Maybe/Undecided"
type="radio"> Maybe/Undecided<br>
<input name="field-6063e6327098f80"
value="Yes, but i am not old enough yet." type="radio">Yes,
but i am not old enough yet.<br>
</td>
</tr>
<tr>
<td valign="top"></td>
<td
style="margin: 0pt; padding: 5px; font-family: verdana; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal; color: rgb(255, 255, 255); text-align: left;"
valign="top" width=""> <b>Do you speak
& understand Japanese fluently?</b> </td>
<td valign="top"></td>
<td
style="margin: 0pt; padding: 5px; font-family: verdana; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal; color: rgb(255, 255, 255); text-align: left;"
valign="top" width=""> <input name="japanese"
value="Yes" type="radio">Yes<br>
<input name="japanese" value="No" type="radio">
No<br>
<input name="japanese" value="I am currently learning"
type="radio"> I am
currently learning<br>
</td>
</tr>
<tr>
<td valign="top"></td>
<td
style="margin: 0pt; padding: 5px; font-family: verdana; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal; color: rgb(255, 255, 255); text-align: left;"
valign="top" width=""> <b>Select a few of your
interests </b> </td>
<td valign="top"></td>
<td
style="margin: 0pt; padding: 5px; font-family: verdana; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal; color: rgb(255, 255, 255); text-align: left;"
valign="top" width=""> <input name="interests[]"
value="Japanese Culture & Language" type="checkbox">Japanese
Culture & Language<br>
<input name="interests[]" value="Japanese St Fashion"
type="checkbox"> Japanese
St Fashion<br>
<input name="interests[]" value="Web design"
type="checkbox"> Web design<br>
<input name="interests[]" value="HTML/CSS"
type="checkbox"> HTML/CSS<br>
<input name="interests[]" value="Javascript"
type="checkbox"> Javascript<br>
<input name="interests[]"
value="Graphic Design/Digital Art" type="checkbox">Graphic
Design/Digital Art<br>
<input name="interests[]" value="Filming/Editing Film"
type="checkbox">Filming/Editing
Film<br>
<input name="interests[]" value="Photography"
type="checkbox"> Photography<br>
<input name="interests[]" value="Cosplay"
type="checkbox"> Cosplay<br>
<input name="interests[]" value="Fashion design"
type="checkbox"> Fashion design<br>
<input name="interests[]" value="Make Up/Hair"
type="checkbox"> Make Up/Hair<br>
<input name="interests[]" value="Sports"
type="checkbox"> Sports<br>
<input name="interests[]" value="Writting/Reading"
type="checkbox">Writting/Reading<br>
<input name="interests[]"
value="Singing/Playing an Instrument" type="checkbox">Singing/Playing
an Instrument<br>
</td>
</tr>
<tr>
<td valign="top"></td>
<td
style="margin: 0pt; padding: 5px; font-family: verdana; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal; color: rgb(255, 255, 255); text-align: left;"
valign="top" width=""> <b>Favorite Member</b>
</td>
<td valign="top"></td>
<td
style="margin: 0pt; padding: 5px; font-family: verdana; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal; color: rgb(255, 255, 255); text-align: left;"
valign="top" width=""> <input name="member"
value="Aoi" type="radio">Aoi<br>
<input name="member" value="Kai" type="radio">
Kai<br>
<input name="member" value="Reita" type="radio">
Reita<br>
<input name="member" value="Ruki" type="radio">
Ruki<br>
<input name="member" value="Uruha" type="radio">
Uruha<br>
</td>
</tr>
<tr>
<td valign="top"></td>
<td
style="margin: 0pt; padding: 5px; font-family: verdana; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal; color: rgb(255, 255, 255); text-align: left;"
valign="top" width=""> <b>Comments/Suggestions</b>
</td>
<td valign="top"></td>
<td
style="margin: 0pt; padding: 5px; font-family: verdana; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal; color: rgb(255, 255, 255); text-align: left;"
valign="top" width=""> <textarea name="comments"
rows="4" cols="24"></textarea>
</td>
</tr>
<tr>
<td colspan="2" align="center"> <input
name="Submit" value="Submit" type="submit"> </td>
</tr>
</tbody>
</table>
</form>
