<form action="http://pub13.bravenet.com/emailfwd/senddata.asp"
method="post">
    <input type="hidden" name="usernum" value="1105680530"><input
    type="hidden" name="thankyou"
    value="http://www.crosswinds.net/~centerpointstat/acsmthankyou.htm"><input
    type="hidden" name="carboncopy" value="joeco@deseretmail.com"><div
    align="center"><center><table border="1" cellpadding="10"
    background="spacebackground.gif" bgcolor="#00000C">
        <tr>
            <td>Your Name:<br>
            <input type="text" size="20" name="name"><br>
            <br>
            Contact E-mail:<br>
            <input type="text" size="20" name="email">(so we can
            get a hold of you)<br>
            <br>
            ICQ #:<br>
            <input type="text" size="20" name="icquin">(Otional:
            Want to get ICQ? Go to <a href="http://www.icq.com/"
            target="Content">http://www.icq.com/</a>)<br>
            <br>
            State/Province:<br>
            <input type="text" size="20" name="State/Province"><br>
            <br>
            Country:<br>
            <input type="text" size="20" name="country"><br>
            <br>
            Desired Full Fake Name:<br>
            <input type="text" size="20" name="fakename"><br>
            <br>
            Desired E-mail Handle:<br>
            <input type="text" size="20" name="ehandle"><br>
            <br>
            Your password will be generated and e-mailed to you.
            You will then have the option to change it.<br>
            Your e-mail will be in the format of <a
            href="mailto:user@centerpointstation.net">user@centerpointstation.net</a>.
            For pop e-mail, it will be <a
            href="mailto:user@centerpointstation.zzn.com">user@centerpointstation.zzn.com</a>.
            Both types will be reserved for you. If you want POP,
            you can have your centerpointstation.net forwarded to
            the ZZN account or any e-mail address of your choice.
            We will reserve you an account. Do not attempt to
            create one yourself. This is for visitors to contact
            you. Your personal e-mail address will remain
            private.<br>
            <br>
            What can you do for us?<br>
            <input type="checkbox" name="HTML" value="no">HTML<br>
            <input type="checkbox" name="Cards" value="yes">Cards
            (Prefered) or (At Least)<br>
            <input type="checkbox" name="Graphics" value="no">Graphics<br>
            <input type="checkbox" name="JAVA" value="no">Java<br>
            <input type="checkbox" name="CGI" value="no">CGI<br>
            <br>
            More? or Other? Type it in below.<br>
            <textarea name="more/other" rows="4" cols="18"
            wrap="virtual"></textarea><br>
            <br>
            What would you like to do for us?<br>
            <textarea name="do for us" rows="8" cols="25"
            wrap="virtual"></textarea><br>
            <br>
            Are you good at leadership? Try one of our leadership
            positions. Our policy is that you must contribute to
            our site frequently (once/twice a month).<br>
            <input type="radio" checked name="tryleadership"
            value="no">I'll give it a try! <input type="radio"
            name="notryleadership" value="no">No way!<br>
            <br>
            If yes, choose a position you would like to try. If
            no, click on Send Request now.<br>
            <br>
            <select name="tryposition" size="1">
                <option selected value="officer">none (Reg. Officer)</option>
                <option value="chooselater">Choose later</option>
                <option value="lt/moderator">Lieutenant (Forum Moderator) </option>
                <option value="cmdr/crdmon">Commander (Card Monitor) </option>
                <option value="Colonel/cmdrsame">Colonel (Same as Cmdr.)</option>
                <option value="gen">General (Lt. &amp; Cmdr.) </option>
                <option value="viceadmiral">Vice Admiral (under admiral)</option>
                <option value="adm/admin">Admiral (Administrator) </option>
                <option value="fleetadmiral">Fleet Admiral (Over Admiral)</option>
            </select><br>
            <br>
            EZBOARD Username: <input type="text" size="20"
            name="ezusrnm"> This is so we can make you a
            moderator in our card forum.<br>
            <br>
            If you don't have one, <a
            href="http://pub19.ezboard.com/BBSMessageBoard.showRegistrationChoice?boardName=centerpointstation45058&amp;language=EN"
            target="Content">Click here to make one.</a><br>
            <br>
            Web Site URL: <input type="text" size="20" name="url">(If
            applicable) <br>
            <br>
            <input type="submit" name="submit"
            value=" Send Request "> <input type="reset"
            name="reset" value=" Retype All "><hr>
            <p align="center"><a href="http://www.bravenet.com/"><img
            src="http://images.bravenet.com/brpics/formbutt.gif"
            border="0" width="100" height="35"></a> </p>
            </td>
        </tr>
    </table>
    </center></div>
</form>