<?xml version="1.0" encoding="UTF-8"?>

<form url="pic_email_list2.php"
 window="_self"
 method="POST"
 fontname="MS Sans Serif"
 width="568"
 height="457"
 bkcolor="0xFFFFFF"
 transparent="f"
 fontcolor="0x000000"
 outlinecolor="0x000000"
 themecolor="0xFFFF99"
 fontcolor2="#000000"
 bkcolor2="#FFFFFF"
 includeresults="false"
 emailuser="true"
 bcc="webmaster;peaksislandcouncil=info"
 cc="lrichard;pwd=org"
 reqmessage="One or More Fields are Required"
 transition="0"
 autoresponseincluderesults="t"
 autoresponseaddtotop="t"
 usephp="true"
 disableclicktoactiveprompt="true"
 extensions="*.txt;*.gif;*.jpg;*.jpeg;*.zip;*.doc;*.png;*.pdf;*.rtf"
>

<hidden
 name="thankyoupage"
 value="http://www.peaksislandcouncil.info"
></hidden>

<hidden
 name="subject"
 value="PIC Email List"
></hidden>

<image
 image="email-1.jpg"
 x="452"
 y="20"
></image>

<textinput
 name="Date"
 x="184"
 y="64"
 w="64"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
  fontname="Tahoma"
  fontcolor="0x000000"
  restrict="date"
>
</textinput>

<textinput
 name="First Name"
 x="184"
 y="104"
 w="242"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
  fontname="Tahoma"
  fontcolor="0x000000"
>
</textinput>

<textinput
 name="Last Name"
 x="184"
 y="152"
 w="242"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
  fontname="Tahoma"
  fontcolor="0x000000"
>
</textinput>

<textinput
 name="E-mail Address"
 x="184"
 y="196"
 w="243"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
  fontname="Tahoma"
  fontcolor="0x000000"
 emailbox="true"
  restrict="email"
>
</textinput>

<checkbox
 name="Add"
 x="184"
 y="248"
 w="290"
 h="23"
 label="Add my Email Address to the PIC List"
 labelPos="right"
 value="checked"
  fontsize="16"
  fontname="Arial"
  fontcolor="0x000080"
></checkbox>

<checkbox
 name="Remove"
 x="184"
 y="280"
 w="339"
 h="23"
 label="Remove my Email Address from the PIC List"
 labelPos="right"
 value="checked"
  fontsize="16"
  fontname="Arial"
  fontcolor="0x000080"
></checkbox>

<submitbutton
 name="Submit Button"
 x="112"
 y="360"
 w="185"
 h="32"
 label="Submit"
 fontname="Georgia"
 fontcolor="0xFF0000"
 fontbold="bold"
  fontsize="18"
></submitbutton>

<label
 name="My Text 3"
 x="23"
 y="200"
 w="47"
 h="16"
 text="Email"
 fontbold="bold"
  fontname="Georgia"
  fontcolor="0x0000FF"
  fontsize="13"
></label>

<label
 name="My Text 4"
 x="25"
 y="68"
 w="136"
 h="16"
 text="Date (MM/DD/YY)"
 fontbold="bold"
  fontname="Georgia"
  fontcolor="0x0000FF"
  fontsize="13"
></label>

<label
 name="My Text 5"
 x="144"
 y="12"
 w="238"
 h="38"
 text="PIC Email List"
 fontbold="bold"
  fontname="Georgia"
  fontcolor="0xFF0000"
  fontsize="32"
></label>

<label
 name="My Text 6"
 x="24"
 y="108"
 w="83"
 h="16"
 text="First Name"
 fontbold="bold"
  fontname="Georgia"
  fontcolor="0x0000FF"
  fontsize="13"
></label>

<captcha
 name="My Captcha 1"
 x="404"
 y="332"
 w="133"
 h="100"
 text="Verification code"
 fnt="Tahoma"
 fntclr="0x000000"
 fntsize="11"
 bkbdrcolor="0x000000"
 bkfillclr="0xFFFFFF"
 bkdobdr="t"
 bkbdrsolid="t"
 bkdobk="t"
 bkfillalpha="100"
 message="Incorrect code!"
></captcha>

<label
 name="My Text 1"
 x="23"
 y="250"
 w="137"
 h="16"
 text="Please Choose One"
 fontbold="bold"
  fontname="Georgia"
  fontcolor="0x0000FF"
  fontsize="13"
></label>

<label
 name="My Text 2"
 x="24"
 y="154"
 w="80"
 h="16"
 text="Last Name"
 fontbold="bold"
  fontname="Georgia"
  fontcolor="0x0000FF"
  fontsize="13"
></label>

</form>