<?xml version="1.0" encoding="UTF-8"?>

<form url="contact_form_emr.php"
 window="_self"
 method="POST"
 fontname="MS Sans Serif"
 width="280"
 height="422"
 bkcolor="0x2A2A2A"
 transparent="f"
 fontcolor="0x000000"
 outlinecolor="0x2A2A2A"
 themecolor="0xFFFF99"
 fontcolor2="#000000"
 bkcolor2="#FFFFFF"
 includeresults="false"
 emailuser="true"
 verifymessage="The E-Main 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="contact2.htm"
></hidden>

<hidden
 name="subject"
 value="Membership information request from Web site"
></hidden>

<textinput
 name="Where did you hear about EMR"
 x="11"
 y="14"
 w="256"
 h="22"
 initvalue=""
 maxchars="100"
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 editable="true"
>
</textinput>

<textinput
 name="Name"
 x="9"
 y="58"
 w="261"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 required="true"
 editable="true"
>
</textinput>

<textinput
 name="EMain"
 x="9"
 y="102"
 w="261"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 required="true"
 editable="true"
>
</textinput>

<textinput
 name="Street"
 x="8"
 y="145"
 w="262"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 editable="true"
>
</textinput>

<textinput
 name="City"
 x="8"
 y="189"
 w="175"
 h="22"
 initvalue=""
 maxchars="25"
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 editable="true"
>
</textinput>

<textinput
 name="State"
 x="8"
 y="230"
 w="69"
 h="22"
 initvalue=""
 maxchars="25"
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 editable="true"
>
</textinput>

<textinput
 name="Zip code"
 x="89"
 y="232"
 w="126"
 h="22"
 initvalue=""
 maxchars="25"
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 editable="true"
>
</textinput>

<submitbutton
 name="Submit Button"
 x="8"
 y="370"
 w="90"
 h="29"
 label="Send it off!"
 fontname="Arial"
 fontcolor="0x000000"
 image="submitscircularroundmall.png"
  fontsize="12"
></submitbutton>

<label
 name="My Text 1"
 x="8"
 y="42"
 w="33"
 h="16"
 text="Name"
 fontbold="bold"
  fontname="Trebuchet MS"
  fontcolor="0xFFFFFF"
  fontsize="11"
></label>

<label
 name="My Text 2"
 x="7"
 y="86"
 w="83"
 h="16"
 text="E-Main address"
 fontbold="bold"
  fontname="Trebuchet MS"
  fontcolor="0xFFFFFF"
  fontsize="11"
></label>

<label
 name="My Text 6"
 x="7"
 y="129"
 w="82"
 h="16"
 text="Street address"
 fontbold="bold"
  fontname="Trebuchet MS"
  fontcolor="0xFFFFFF"
  fontsize="11"
></label>

<label
 name="My Text 5"
 x="7"
 y="173"
 w="25"
 h="16"
 text="City"
 fontbold="bold"
  fontname="Trebuchet MS"
  fontcolor="0xFFFFFF"
  fontsize="11"
></label>

<label
 name="My Text 7"
 x="7"
 y="214"
 w="31"
 h="16"
 text="State"
 fontbold="bold"
  fontname="Trebuchet MS"
  fontcolor="0xFFFFFF"
  fontsize="11"
></label>

<label
 name="My Text 8"
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 y="216"
 w="52"
 h="16"
 text="Zip code"
 fontbold="bold"
  fontname="Trebuchet MS"
  fontcolor="0xFFFFFF"
  fontsize="11"
></label>

<captcha
 name="My Captcha 1"
 x="8"
 y="258"
 w="133"
 h="100"
 text="Enter Key Here:"
 fnt="Arial"
 fntclr="0x000000"
 fntsize="11"
 bkbdrcolor="0x000000"
 bkfillclr="0xFFFFFF"
 bkdobdr="t"
 bkbdrsolid="t"
 bkdobk="t"
 bkfillalpha="100"
 message="Incorrect key!"
></captcha>

<label
 name="My Text 9"
 x="148"
 y="258"
 w="88"
 h="16"
 text="Please fill in the"
 fontbold="bold"
  fontname="Trebuchet MS"
  fontcolor="0xFFFFFF"
  fontsize="11"
></label>

<label
 name="My Text 10"
 x="148"
 y="279"
 w="109"
 h="16"
 text="characters you see"
 fontbold="bold"
  fontname="Trebuchet MS"
  fontcolor="0xFFFFFF"
  fontsize="11"
></label>

<label
 name="My Text 11"
 x="152"
 y="294"
 w="8"
 h="18"
 text=""
 fontbold="bold"
  fontname="Trebuchet MS"
  fontcolor="0x808080"
  fontsize="13"
></label>

<label
 name="My Text 12"
 x="148"
 y="301"
 w="94"
 h="16"
 text="on the left in the"
 fontbold="bold"
  fontname="Trebuchet MS"
  fontcolor="0xFFFFFF"
  fontsize="11"
></label>

<label
 name="My Text 13"
 x="148"
 y="322"
 w="92"
 h="16"
 text="box. Then press"
 fontbold="bold"
  fontname="Trebuchet MS"
  fontcolor="0xFFFFFF"
  fontsize="11"
></label>

<label
 name="My Text 14"
 x="148"
 y="344"
 w="82"
 h="16"
 text="submit button."
 fontbold="bold"
  fontname="Trebuchet MS"
  fontcolor="0xFFFFFF"
  fontsize="11"
></label>

<label
 name="My Text 3"
 x="9"
 y="-2"
 w="223"
 h="16"
 text="Where did you hear about Elk Mountain?"
 fontbold="bold"
  fontname="Trebuchet MS"
  fontcolor="0xFFFFFF"
  fontsize="11"
></label>

</form>