Team:GeorgiaTech/Contact

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<input type="hidden" name="acctid" id="acctid" value="rnnod0docj83bji3" />
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<td colspan="2"><span class="c1"><input type="text" name="URL" size="17" value="http://"> :Your Website<br>
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<input type="hidden" name="formid" id="formid" value="819611" />
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<input type="text" name="user" size="17"> :Your Name<br>
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<input type="text" name="email" size="17"> :Your E-mail</span></td>
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<strong>Name:</strong>
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<option selected>Please Select One</option>
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</td>
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<option>GA Tech Institution</option>
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<option>Company</option>
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<input type="text" name="name" id="name" size="40" value="" />
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<option>Professor</option>
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<strong>Email Address:</strong>
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<td colspan="2"><span class="c2"><input type="checkbox" name="liked it" value="sendme" checked> I found this website useful<br>
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</td>
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<input type="checkbox" name="disliked it" value="sendme"> I did not find this website useful<br></span>  
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<td valign="top">
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<textarea cols="20" rows="10">
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<input type="text" name="email" id="email" size="40" value="" />
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Please type your comments or questions here.
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<div class="c3"><input name="redirect" type="hidden" value="https://2010.igem.org/Team:GeorgiaTech"> <input name="NEXT_URL" type="hidden" value="https://2010.igem.org/Team:GeorgiaTech"> <input type="submit" value="Send"> <input type="reset" value="Clear"></div>
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<strong>Your Website:</strong>
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<strong>Did you find this website helpful?</strong>
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<input type="checkbox" name="field-d627c09924aa95b[]" id="field-d627c09924aa95b_0" value="Yes" /> Yes<br/>
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Latest revision as of 02:40, 28 October 2010