d49411c13b1dcd0ee1d45b69e3d33858
<form action=? method=post>
<div align="center">
<table border="0"
   cellpadding="3" cellspacing="0" width="59%">
<tr>
<td colspan="2">
<h2 align="center">&nbsp;</h2>
<h2 align="center"><font color="blue" face="Arial">Contact Form</font></h2>
<p align="center">&nbsp;</p>
<td width="51%" align="right">
<p align="left"><font face="Arial">Email</font><font face="Times New
Roman">:</font><font face="Arial"> </font></td>
<td width="49%" align="left"><input type="text" name="email" size="20"></td>
</tr>

<tr>
<td width="51%" align="right">
<p align="left"><font face="Arial">First Name: </font></td>
<td width="49%" align="left"><input type="text" name="firstname"
size="20"></td>
</tr>
<tr>
<td width="51%" align="right">
<p align="left"><font face="Arial">Last Name: </font></td>
<td width="49%" align="left"><input type="text" name="lastname"
size="20"></td>
</tr>
<tr>
<td width="51%" align="right">
<p align="left"><font face="Arial">I know you in real life</font></td>
<td width="49%" align="left"><input type="checkbox" name="reallife"
size="20"></td>
</tr>
</table>
<p><input type="submit" value="contact me"
   name="B1"></p>

</center></div>
</form>
</td>
<td>&nbsp;</td>
</tr>
</table>