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form.html
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form.html
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<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Strict//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-strict.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<meta content="text/html; charset=utf-8" http-equiv="Content-Type" />
<title>Wood Island Petition</title>
<style type="text/css">.frmtext {margin-left:3px; padding:0px; padding-bottom:2px;font-size:14px;font-weight:normal;color:#c0c0c0;}
.frmtext label {display:block; line-height:normal; font-size:13px; color:#555; line-height:27px;font-weight:normal;}
.frmtext .frm-select { margin:0px; padding:0px; background:#FFFFFF; border:1px solid #707070; width:272px; padding:2px; line-height:21px; }
.frmtext .frm-txt { color:#666;margin:0px; padding:0px; background:#f2f2f2; border:1px solid #333; width:180px; padding-left:4px; padding-top:1px;padding-bottom:1px;line-height:21px; height:21px;-moz-border-radius: 4px;-webkit-border-radius: 4px;-khtml-border-radius:4px;border-radius: 4px; }
</style>
<meta content="noindex" name="robots" />
</head>
<body bgcolor="#777777">
<div style="border:0px solid #333;padding:5px;background:url(http://i.imgur.com/34V3o5m.png) no-repeat;">
<div style="color:#ffffff;margin-bottom:10px;margin-left:3px;font-size:19px;font-family:garamond;">Express Your Support for Wood Island Restoration</div>
<form action="https://getsimpleform.com/messages?form_api_token=ce7620d20381fe35384a2dd2b71089e8" id="form1" method="post" name="form1"><input name="go" type="hidden" value="true" />
<table>
<tbody>
<tr>
<td>
<div class="frmtext">First Name:</div>
</td>
<td>
<div class="frmtext"><input class="frm-txt" name="first_name" type="text" value="" /></div>
</td>
</tr>
<tr>
<td>
<div class="frmtext">Last Name:</div>
</td>
<td>
<div class="frmtext"><input class="frm-txt" name="last_name" type="text" value="" /></div>
</td>
</tr>
<tr>
<td>
<div class="frmtext">Email:</div>
</td>
<td>
<div class="frmtext"><input class="frm-txt" name="email" type="text" value="" /></div>
</td>
</tr>
<tr>
<td>
<div class="frmtext">Address:</div>
</td>
<td>
<div class="frmtext"><input class="frm-txt" name="address" type="text" value="" /></div>
</td>
</tr>
<tr>
<td>
<div class="frmtext">City:</div>
</td>
<td>
<div class="frmtext"><input class="frm-txt" name="city" type="text" value="" /></div>
</td>
</tr>
<tr>
<td>
<div class="frmtext">State:</div>
</td>
<td>
<div class="frmtext"><select class="frm-txt" name="state" style="padding:2px;height:25px;width:186px;"><option notset="" value="">-- select --</option><option value="AL">Alabama</option><option value="AK">Alaska</option><option value="AZ">Arizona</option><option value="AR">Arkansas</option><option value="CA">California</option><option value="CO">Colorado</option><option value="CT">Connecticut</option><option value="DE">Delaware</option><option value="DC">District of Columbia</option><option value="FL">Florida</option><option value="GA">Georgia</option><option value="HI">Hawaii</option><option value="ID">Idaho</option><option value="IL">Illinois</option><option value="IN">Indiana</option><option value="IA">Iowa</option><option value="KS">Kansas</option><option value="KY">Kentucky</option><option value="LA">Louisiana</option><option value="ME">Maine</option><option value="MD">Maryland</option><option value="MA">Massachusetts</option><option value="MI">Michigan</option><option value="MN">Minnesota</option><option value="MS">Mississippi</option><option value="MO">Missouri</option><option value="MT">Montana</option><option value="NE">Nebraska</option><option value="NV">Nevada</option><option value="NH">New Hampshire</option><option value="NJ">New Jersey</option><option value="NM">New Mexico</option><option value="NY">New York</option><option value="NC">North Carolina</option><option value="ND">North Dakota</option><option value="OH">Ohio</option><option value="OK">Oklahoma</option><option value="OR">Oregon</option><option value="PA">Pennsylvania</option><option value="RI">Rhode Island</option><option value="SC">South Carolina</option><option value="SD">South Dakota</option><option value="TN">Tennessee</option><option value="TX">Texas</option><option value="UT">Utah</option><option value="VT">Vermont</option><option value="VA">Virginia</option><option value="WA">Washington</option><option value="WV">West Virginia</option><option value="WI">Wisconsin</option><option value="WY">Wyoming</option> </select></div>
</td>
</tr>
<tr>
<td>
<div class="frmtext">Zip:</div>
</td>
<td>
<div class="frmtext"><input class="frm-txt" name="zip" type="text" value="" /></div>
</td>
</tr>
<tr>
<td></td>
<td>
<div class="frmtext"><textarea class="frm-txt" name="declaration" style="height:40px;padding:1px;line-height:17px;width:290px;resize: none;">I support the WILSSA plan to restore the Wood Island Life Saving Station.</textarea></div>
</td>
</tr>
<tr>
<td></td>
<td>
<div class="frmtext"><input name="volunteer" type="checkbox" value="Yes Volunteer" /> I am willing to volunteer</div>
</td>
</tr>
<tr>
<td></td>
<td><input name="submit" src="http://i.imgur.com/qhsXlef.png" type="image" width="230" /></td>
</tr>
</tbody>
</table>
</form>
</div>
</body>
</html>