Scheda di registrazione

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0><script> (function(i,s,o,g,r,a,m){i['GoogleAnalyticsObject']=r;i[r]=i[r]||function(){ (i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o), m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m) })(window,document,'script','//www.google-analytics.com/analytics.js','ga'); ga('create', 'UA-47423994-1', 'fortunecity.ws'); ga('send', 'pageview'); </script> <center> <br> <div> <script language="javascript" type="text/javascript" src="http://ad.broadcaststation.net/ads/show_ad.php?width=728&height=90"></script> </div> </center> <table cellpadding=0 cellspacing=0 border=0 height="100%"><tr> <td valign="top" width=140 BGCOLOR="#000000" TEXT="#F7F7FF" bgproperties="fixed" background="04e7e7e3.jpg"> <div> <A HREF="index.htm" TARGET="_top" TITLE="SoloTango"><U><IMG SRC="046781f0.gif" border=0 width="120" height="31" ALT="Ritorna alla pagina iniziale" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></U></A></div> <bR> <div> <I>Inserisci i tuoi dati.</I></div> <bR> <div> <I>Verrai informato sulle nostre iniziative.</I></div> </td> <td valign="top" BGCOLOR="#000000" TEXT="#F7F7FF"> <div> Scheda di registrazione</div> <div>  <form action="http://formmail.trellix.com/servlets/TlxMailer" method="POST" enctype="application/x-www-form-urlencoded"><input type="hidden" name="tlx_SortOrder" value="FirstName,LastName,Email,Phone,Comments"><input type="hidden" name="tlx_FormIndex" value="2"><input type="hidden" name="tlx_OKMessage" value="Grazie per averci inviato le vostre informazioni."><input type="hidden" name="tlx_SendMode" value="1"><input type="hidden" name="tlx_Subject" value="DaSoloTangoForm"><input type="hidden" name="tlx_EmailTo" value="solotango@libero.it"> <table cellpadding="0" cellspacing="1" border="0" align="center"> <tr> <td align="left">Nome:<br> <input type="text" name="FirstName" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Cognome:<br> <input type="text" name="LastName" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Email:<br> <input type="text" name="Email" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Telefono:<br> <input type="text" name="Phone" size="14" maxlength="14"></td> </tr> <tr> <td align="left">Commenti:<br> <textarea name="Comments" rows="5" cols="30"></textarea></td> </tr> <tr> <td align="right"><input type="reset"> <input type="submit" value="Send" name="tlx_send"></td> </tr> </table> </form>  </div> </td> </tr></table></body>