<html>
<head>
  <title><%if site_title%><%site_title%><%else%>Gossamer Gossamer List<%endif%> - Subscribe</title>
  <%include include_style.txt%>
</head>
<%set set_focus = 'myform.usr_username'%>
<body <%if set_focus%>onload="document.<%set_focus%>.focus()"<%endif%>>
<form name="myform" action="signup.cgi" method="post">
<table width="520" border="0" cellspacing="0" cellpadding="0" align="center" height=90%>
  <tr>
    <td valign=middle>
      <table width="100%" border="0" cellspacing="0" cellpadding="0" align="center" bgcolor="#FFFFFF">
        <tr>
          <td><img src="<%image_url%>/pics/1pixel.gif" width="1" height="3"></td>
        </tr>
        <tr bgcolor="#C5E1A3">
          <td>
            <table width="100%" border="0" cellspacing="1" cellpadding="1" bgcolor="#C5E1A3">
              <tr class="bold_white">
                <td bgcolor="#336600" colspan="2">
                  <table width="100%" border="0" cellspacing="0" cellpadding="0">
                    <tr class=bold_white height=20>
                      <td width=1><img src="<%image_url%>/icons/user.gif" hspace=2></td>
                      <td width=100% class=bold_white><b> Subscribe to a Mailing List</td>
                    </tr>
                  </table>
                </td>
              </tr>
              <tr bgcolor="#FFFFFF">
                <td class="body" colspan="2"><br/>
                  <p align=center class=body><%if msg%><pre class="body"><%msg%></pre><%endif%></p>
                  <table border="0" cellspacing="2" cellpadding="2" align="center" width=550>
                    <tr class=body>
                      <td width="32%" align="right">Name:</td>
                      <td><input class="object" type="text" name="name" size="20" value="<%if name%><%name%><%endif%>" /><font color=green>*</font></td>
                    </tr>
                    <tr class=body>
                      <td class=body><div align="right">Email Address:</div></td>
                      <td><input class="object" type="text" name="email" size="<%if is_ie or is_mozilla%>35<%else%>25<%endif%>" value="<%if email%><%email%><%endif%>" /><font color=green>*</font></td>
                    </tr>
                    <tr class=body>
                      <td width="32%" align="right">Company Name:</td>
                      <td><input class="object" type="text" name="company" size="40" value="<%if company%><%company%><%endif%>" /></td>
                    </tr>
                    <tr class=body>
                      <td width="32%" align="right">Website Address:</td>
                      <td><input class="object" type="text" name="website" size="40" value="<%if website%><%website%><%endif%>" /></td>
                    </tr>
                    <tr class=body>
                      <td width="32%" align="right">Shipping Address:</td>
                      <td><textarea name="shipping_address" rows="3" cols="30"><%if shipping_address%><%shipping_address%><%endif%></textarea></td>
                    </tr>

                    <tr class=body>
                      <td width="32%" align="right">Race Director Name:</td>
                      <td><input class="object" type="text" name="race_director_name" size="40" value="<%if race_director_name%><%race_director_name%><%endif%>" /></td>
                    </tr>
                    <tr class=body>
                      <td width="32%" align="right">Race Director Phone:</td>
                      <td><input class="object" type="text" name="race_director_phone" size="40" value="<%if race_director_phone%><%race_director_phone%><%endif%>" /></td>
                    </tr>
                    <tr class=body>
                      <td width="32%" align="right">Race Director Email:</td>
                      <td><input class="object" type="text" name="race_director_email" size="40" value="<%if race_director_email%><%race_director_email%><%endif%>" /></td>
                    </tr>

                    <tr class=body>
                      <td width="32%" align="right">Sponsorship coordinator Name:</td>
                      <td><input class="object" type="text" name="sponsorship_name" size="40" value="<%if sponsorship_name%><%sponsorship_name%><%endif%>" /></td>
                    </tr>
                    <tr class=body>
                      <td width="32%" align="right">Sponsorship coordinator Phone:</td>
                      <td><input class="object" type="text" name="sponsorship_phone" size="40" value="<%if sponsorship_phone%><%sponsorship_phone%><%endif%>" /></td>
                    </tr>
                    <tr class=body>
                      <td width="32%" align="right">Sponsorship coordinator Email:</td>
                      <td><input class="object" type="text" name="sponsorship_email" size="40" value="<%if sponsorship_email%><%sponsorship_email%><%endif%>" /></td>
                    </tr>

                    <tr class=body>
                      <td width="32%" align="right">Press Relation Manager Name:</td>
                      <td><input class="object" type="text" name="pr_manager_name" size="40" value="<%if pr_manager_name%><%pr_manager_name%><%endif%>" /></td>
                    </tr>
                    <tr class=body>
                      <td width="32%" align="right">Press Relation Manager Phone:</td>
                      <td><input class="object" type="text" name="pr_manager_phone" size="40" value="<%if pr_manager_phone%><%pr_manager_phone%><%endif%>" /></td>
                    </tr>
                    <tr class=body>
                      <td width="32%" align="right">Press Relation Manager Email:</td>
                      <td><input class="object" type="text" name="pr_manager_email" size="40" value="<%if pr_manager_email%><%pr_manager_email%><%endif%>" /></td>
                    </tr>

                    <tr class=body>
                      <td width="32%" align="right">Pro Athlete Liaison Name:</td>
                      <td><input class="object" type="text" name="pro_athlete_liaison_name" size="40" value="<%if pro_athlete_liaison_name%><%pro_athlete_liaison_name%><%endif%>" /></td>
                    </tr>
                    <tr class=body>
                      <td width="32%" align="right">Pro Athlete Liaison Phone:</td>
                      <td><input class="object" type="text" name="pro_athlete_liaison_phone" size="40" value="<%if pro_athlete_liaison_phone%><%pro_athlete_liaison_phone%><%endif%>" /></td>
                    </tr>
                    <tr class=body>
                      <td width="32%" align="right">Pro Athlete Liaison Email:</td>
                      <td><input class="object" type="text" name="pro_athlete_liaison_email" size="40" value="<%if pro_athlete_liaison_email%><%pro_athlete_liaison_email%><%endif%>" /></td>
                    </tr>

                    <tr class=body>
                      <td width="32%" align="right">Goods &amp; Services Buyer Name:</td>
                      <td><input class="object" type="text" name="goods_buyer_name" size="40" value="<%if goods_buyer_name%><%goods_buyer_name%><%endif%>" /></td>
                    </tr>
                    <tr class=body>
                      <td width="32%" align="right">Goods &amp; Services Buyer Phone:</td>
                      <td><input class="object" type="text" name="goods_buyer_phone" size="40" value="<%if goods_buyer_phone%><%goods_buyer_phone%><%endif%>" /></td>
                    </tr>
                    <tr class=body>
                      <td width="32%" align="right">Goods &amp; Services Buyer Email:</td>
                      <td><input class="object" type="text" name="goods_buyer_email" size="40" value="<%if goods_buyer_email%><%goods_buyer_email%><%endif%>" /></td>
                    </tr>
                    <tr>
                      <td class="body" align="right" colspan="2"><BR/><font color=green>(*): Required</font></td>
                    </tr>
                  </table>
                </td>
              </tr>
              <tr bgcolor="#C5E1A3">
                <td class="body">&nbsp;<a href="glist.cgi?do=user_login"><b>Sign In</b></a></td>
                <td height="30" align="right" valign="middle">
                  <input type="submit" name="subscribe" value="Subscribe" class="button" />
                </td>
              </tr>
            </table>
          </td>
        </tr>
      </table>
    </td>
  </tr>
</table>
<input type="hidden" name="list_id" value="21" />
<input type=hidden name="do" value="user_subscribe" />
<%hidden_objects%>
</form>
</body>
</html>
