<?xml version="1.0" encoding="UTF-8"?>

<form url="peterson1.php"
 window="_self"
 method="POST"
 fontname="MS Sans Serif"
 width="350"
 height="643"
 bkcolor="0xFFFFFF"
 transparent="f"
 fontcolor="0x000000"
 outlinecolor="0x000000"
 themecolor="0xFFFF99"
 fontcolor2="#000000"
 bkcolor2="#FFFFFF"
 includeresults="false"
 emailuser="false"
 verifymessage="The E-Mail address you entered does not match !"
 reqmessage="One or More Fields are Required"
 transition="0"
 autoresponseincluderesults="f"
 autoresponseaddtotop="f"
 usephp="true"
 disableclicktoactiveprompt="true"
 extensions="*.txt;*.gif;*.jpg;*.jpeg;*.zip;*.doc;*.png;*.pdf;*.rtf"
>

<hidden
 name="thankyoupage"
 value="http://petersonphc.com/promotionconfirm.htm"
></hidden>

<hidden
 name="subject"
 value="Crazy Nomination Form"
></hidden>

<textinput
 name="Full Name"
 x="12"
 y="64"
 w="175"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 editable="true"
>
</textinput>

<textinput
 name="Address"
 x="12"
 y="176"
 w="175"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 editable="true"
>
</textinput>

<textarea
 name="Nomination Information"
 x="12"
 y="453"
 w="314"
 h="91"
 initvalue=""
 wordwrap="true"
 editable="true"
 bkcolor="0xFFFFFF"
  fontsize="12"
  fontname="Arial"
  fontcolor="0x000000"
></textarea>

<submitbutton
 name="Submit Button"
 x="84"
 y="563"
 w="185"
 h="20"
 label="Send My Message"
 fontname="Georgia"
 fontcolor="0x000000"
  fontsize="12"
></submitbutton>

<textinput
 name="Zip Code"
 x="8"
 y="344"
 w="175"
 h="22"
 initvalue=""
 maxchars="25"
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 editable="true"
>
</textinput>

<textinput
 name="State"
 x="8"
 y="288"
 w="175"
 h="22"
 initvalue=""
 maxchars="25"
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 editable="true"
>
</textinput>

<textinput
 name="City"
 x="12"
 y="236"
 w="175"
 h="22"
 initvalue=""
 maxchars="25"
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 editable="true"
>
</textinput>

<combobox
 name="Donation Information"
 x="8"
 y="396"
 bkcolor="0xFFFFFF"
 fontcolor="0x000000"
 isemail="false"
 w="100"
 h="20">
  <item name="Select One"></item>
  <item name="Web Site"></item>
  <item name="Daily Camera"></item>
  <item name="Times-Call"></item>
  <item name="Radio"></item>
  <item name="Movie Ad"></item>
  <item name="Direct Mail"></item>
  <item name="Rythm on the River"></item>
  <item name="Friend"></item>
</combobox>

<textinput
 name="Online Address"
 x="12"
 y="120"
 w="175"
 h="22"
 initvalue=""
 maxchars="25"
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 editable="true"
>
</textinput>

<label
 name="My Text 1"
 x="14"
 y="425"
 w="137"
 h="16"
 text="Your Nomination:"
 fontbold="bold"
  fontname="Georgia"
  fontcolor="0x993300"
  fontsize="13"
></label>

<label
 name="My Text 2"
 x="12"
 y="152"
 w="67"
 h="16"
 text="Address:"
 fontbold="bold"
  fontname="Georgia"
  fontcolor="0x800000"
  fontsize="13"
></label>

<label
 name="My Text 3"
 x="12"
 y="98"
 w="157"
 h="16"
 text="Your E-Mail Address:"
 fontbold="bold"
  fontname="Georgia"
  fontcolor="0x800000"
  fontsize="13"
></label>

<label
 name="My Text 4"
 x="12"
 y="42"
 w="91"
 h="16"
 text="Your Name:"
 fontbold="bold"
  fontname="Georgia"
  fontcolor="0x800000"
  fontsize="13"
></label>

<label
 name="My Text 5"
 x="36"
 y="12"
 w="292"
 h="23"
 text="Nominate Your Local Charity"
 fontbold="bold"
  fontname="Georgia"
  fontcolor="0x633232"
  fontsize="19"
></label>

<label
 name="My Text 6"
 x="12"
 y="216"
 w="34"
 h="16"
 text="City"
 fontbold="bold"
  fontname="Georgia"
  fontcolor="0x633232"
  fontsize="13"
></label>

<label
 name="My Text 7"
 x="8"
 y="268"
 w="40"
 h="16"
 text="State"
 fontbold="bold"
  fontname="Georgia"
  fontcolor="0x633232"
  fontsize="13"
></label>

<label
 name="My Text 8"
 x="8"
 y="324"
 w="66"
 h="16"
 text="Zip Code"
 fontbold="bold"
  fontname="Georgia"
  fontcolor="0x633232"
  fontsize="13"
></label>

<label
 name="My Text 9"
 x="8"
 y="376"
 w="280"
 h="16"
 text="How did you hear about our donation?"
 fontbold="bold"
  fontname="Georgia"
  fontcolor="0x633232"
  fontsize="13"
></label>

</form>