<TABLE><TR>
<TD ALIGN=RIGHT>

Your Name:</TD><TD><INPUT TYPE=TEXT NAME="subject" SIZE=25 MAXLENGTH=50></td><tr><TD ALIGN=RIGHT>

Phone Number:</TD><TD><INPUT TYPE=TEXT NAME="name" SIZE=25 MAXLENGTH=50</TD></TR><TR>
<TD ALIGN=RIGHT>

E-Mail Address:</TD><TD><INPUT TYPE=TEXT NAME="email" SIZE=25 MAXLENGTH=50></TD></TR><TR>
</TD></TR><TR>
<TD COLSPAN=2 ALIGN=CENTER>

Message:

<TEXTAREA COLS=50 ROWS=10 NAME="body" WRAP=VIRTUAL>Address:
Apartment:
City:
Postal Code:
Notes:</TEXTAREA></TD></TR><TR>
<TD COLSPAN=2 ALIGN=CENTER>

If you'd like to have the option of deleting your post later,
please provide a password (CASE SENSITIVE!):</TD></TR><TR>
<TD ALIGN=RIGHT>

Password:</TD><TD><INPUT TYPE=PASSWORD NAME="password" SIZE=25></TD></TR><TR>
<TH COLSPAN=2>

<INPUT TYPE=SUBMIT NAME="Post" VALUE="Post Message"></TH></TR></TABLE>