Shezad Syed
<script type="text/javascript">
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<div class="mc-field-group" style="margin: 1.3em 5%;"><label for="mce-MMERGE3" style="display: block;margin: .3em 0;line-height: 1em;font-weight: bold;">Title:<strong class="note-required">*</strong></p>
<p></label><select name="MMERGE3" class="required" id="mce-MMERGE3" style="margin-right: 1.5em;padding: .2em .3em;width:60px; height:20px; border:1px solid #C5BE98; background-color:#FFFFCC; position: relative;z-index: 999;"><br />
<option value="Mr">Mr</option><br />
<option value="Mrs">Mrs</option><br />
<option value="Miss">Miss</option><br />
<option value="Ms">Ms</option><br />
<option value="Dr">Dr</option></p>
</select>
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<div class="mc-field-group" style="margin: 1.3em 5%;">
<label for="mce-FNAME" style="display: block;margin: .3em 0;line-height: 1em;font-weight: bold;">First Name:<strong class="note-required">*</strong></label>
<input type="text" value="" name="FNAME" class="required" id="mce-FNAME" style="margin-right: 1.5em;padding: .2em .3em;width: 60%; height:15px; border:1px solid #C5BE98; background-color:#FFFFCC; position: relative;z-index: 999;">
</div>
<div class="mc-field-group" style="margin: 1.3em 5%;">
<label for="mce-LNAME" style="display: block;margin: .3em 0;line-height: 1em;font-weight: bold;">Last Name:<strong class="note-required">*</strong></label>
<input type="text" value="" name="LNAME" class="required" id="mce-LNAME" style="margin-right: 1.5em;padding: .2em .3em;width: 60%; height:15px; border:1px solid #C5BE98; background-color:#FFFFCC; position: relative;z-index: 999;">
</div>
<div class="mc-field-group" style="margin: 1.3em 5%;">
<label for="mce-EMAIL" style="display: block;margin: .3em 0;line-height: 1em;font-weight: bold;">Email Address:<strong class="note-required">*</strong></label>
<input type="text" value="" name="EMAIL" class="required email" id="mce-EMAIL" style="margin-right: 1.5em;padding: .2em .3em;width: 60%; height:15px; border:1px solid #C5BE98; background-color:#FFFFCC; position: relative;z-index: 999;">
<p></div><script type="text/javascript">document.getElementById('mce-EMAIL').value = unescape(getQueryVariable('email').replace(/\+/g, " "));</script>
<div class="mc-field-group" style="margin: 1.3em 5%;"><br />
<label for="mce-MMERGE5" style="display: block;margin: .3em 0;line-height: 1em;font-weight: bold;">Where did you hear about us?:</label><br />
<select name="MMERGE5" class="" id="mce-MMERGE5" style="margin-right: 1.5em;padding: .2em .3em;width: 61%; height:23px; border:1px solid #C5BE98; background-color:#FFFFCC; position: relative;z-index: 999;"><br />
<option value="Search engine">Search engine</option><br />
<option value="Another Website">Another Website</option><br />
<option value="Magazine/Newspaper">Magazine/Newspaper</option><br />
<option value="Recommendation">Recommendation</option></p>
</select>
</div>
<div id="mce-responses" style="position: relative;top: 1em;padding: 1em .5em 0em 2em;overflow: hidden;">
<div class="response" id="mce-error-response" style="display: none;margin: 1em 0;padding: .5em 1em 1em 1em;font-weight: bold;position: relative;top: -1.5em;z-index: 1;width: 60%;background: #FFFFFF;color: #FF0000;"></div>
<div class="response" id="mce-success-response" style="display: none;margin: 1em 0;padding: .5em 1em 1em 1em;font-weight: bold;position: relative;top: -1.5em;z-index: 1;width: 60%;background: #;color: #529214;"></div>
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<div><input type="submit" value="Subscribe" name="subscribe" id="mc-embedded-subscribe" class="btn" style="width: auto;margin: .2em 3em;display: block;"><br /><br /></div>
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2009-06-01T20:42:07+01:00
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2009-06-01T20:42:07+01:00
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2009-07-07T10:44:58+01:00
<script type="text/javascript">
function getQueryVariable(variable) {
var query = window.location.search.substring(1);
var vars = query.split("&");
for (var i=0;i<vars.length;i++) {
var pair = vars[i].split("=");
if (pair[0] == variable) {
return pair[1];
}
}
}</script><div style="width:770px; margin-top:0px;" align="center" >
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<script type="text/javascript" src="http://apiedi.us1.list-manage.com/js/jquery.validate.js"></script>
<script type="text/javascript" src="http://apiedi.us1.list-manage.com/js/jquery.form.js"></script>
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<div id="mc_embed_signup" style="width: 570px; margin-top:0px;" align="left">
<form action="http://apiedi.us1.list-manage.com/subscribe/post?u=62eecb46a3276211d61d01d86&id=6c7c635e22" method="post" id="mc-embedded-subscribe-form" name="mc-embedded-subscribe-form" class="validate" target="_blank" style="font: normal 100% Arial;font-size: 11px;"><fieldset style="-moz-border-radius: 4px;border-radius: 4px;-webkit-border-radius: 4px;border: 1px dotted #C5BE98;margin:.5em 0; padding-top: 1.5em;background-color: #FFFFFF;color: #4C4C4C;"><div class="indicate-required" style="text-align: right;font-style:normal;overflow: hidden;color: #4C4C4C;margin: 0 15% 0 0;">* indicates required field</div>
<div class="mc-field-group" style="margin: 1.3em 5%;"><label for="mce-MMERGE3" style="display: block;margin: .3em 0;line-height: 1em;font-weight: bold;">Title:<strong class="note-required">*</strong>
</label><select name="MMERGE3" class="required" id="mce-MMERGE3" style="margin-right: 1.5em;padding: .2em .3em;width:60px; height:20px; border:1px solid #C5BE98; background-color:#FFFFCC; position: relative;z-index: 999;">
<option value="Mr">Mr</option>
<option value="Mrs">Mrs</option>
<option value="Miss">Miss</option>
<option value="Ms">Ms</option>
<option value="Dr">Dr</option>
</select>
</div>
<div class="mc-field-group" style="margin: 1.3em 5%;">
<label for="mce-FNAME" style="display: block;margin: .3em 0;line-height: 1em;font-weight: bold;">First Name:<strong class="note-required">*</strong>
</label>
<input type="text" value="" name="FNAME" class="required" id="mce-FNAME" style="margin-right: 1.5em;padding: .2em .3em;width: 60%; height:15px; border:1px solid #C5BE98; background-color:#FFFFCC; position: relative;z-index: 999;">
</div>
<div class="mc-field-group" style="margin: 1.3em 5%;">
<label for="mce-LNAME" style="display: block;margin: .3em 0;line-height: 1em;font-weight: bold;">Last Name:<strong class="note-required">*</strong>
</label>
<input type="text" value="" name="LNAME" class="required" id="mce-LNAME" style="margin-right: 1.5em;padding: .2em .3em;width: 60%; height:15px; border:1px solid #C5BE98; background-color:#FFFFCC; position: relative;z-index: 999;">
</div>
<div class="mc-field-group" style="margin: 1.3em 5%;">
<label for="mce-EMAIL" style="display: block;margin: .3em 0;line-height: 1em;font-weight: bold;">Email Address:<strong class="note-required">*</strong>
</label>
<input type="text" value="" name="EMAIL" class="required email" id="mce-EMAIL" style="margin-right: 1.5em;padding: .2em .3em;width: 60%; height:15px; border:1px solid #C5BE98; background-color:#FFFFCC; position: relative;z-index: 999;">
</div><script type="text/javascript">document.getElementById('mce-EMAIL').value = unescape(getQueryVariable('email').replace(/\+/g, " "));</script>
<div class="mc-field-group" style="margin: 1.3em 5%;">
<label for="mce-MMERGE5" style="display: block;margin: .3em 0;line-height: 1em;font-weight: bold;">Where did you hear about us?:</label>
<select name="MMERGE5" class="" id="mce-MMERGE5" style="margin-right: 1.5em;padding: .2em .3em;width: 61%; height:23px; border:1px solid #C5BE98; background-color:#FFFFCC; position: relative;z-index: 999;">
<option value="Search engine">Search engine</option>
<option value="Another Website">Another Website</option>
<option value="Magazine/Newspaper">Magazine/Newspaper</option>
<option value="Recommendation">Recommendation</option>
</select>
</div>
<div id="mce-responses" style="position: relative;top: 1em;padding: 1em .5em 0em 2em;overflow: hidden;">
<div class="response" id="mce-error-response" style="display: none;margin: 1em 0;padding: .5em 1em 1em 1em;font-weight: bold;position: relative;top: -1.5em;z-index: 1;width: 60%;background: #FFFFFF;color: #FF0000;"></div>
<div class="response" id="mce-success-response" style="display: none;margin: 1em 0;padding: .5em 1em 1em 1em;font-weight: bold;position: relative;top: -1.5em;z-index: 1;width: 60%;background: #;color: #529214;"></div>
</div>
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