Fan Club Mailing List

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=160 BGCOLOR="#FFFFFF" TEXT="#080000" bgproperties="fixed" background="00600a40egerdp.png"> <div> <A HREF="id2.htm" TARGET="_top" TITLE="WELCOME!"><B>Home Page</B></A></div> <div> <B><IMG SRC="20528460.png" border=0 width="40" height="70" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> </div> </td> </tr><tr> <td valign="top" width=170 BGCOLOR="#000099" TEXT="#F7F7FF"> <div> <IMG SRC="21f8db00.jpg" border=0 width="141" height="176" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> - <A HREF="id2.htm" TARGET="_top" TITLE="WELCOME!">BACK</A> -</div> <div> Welcome to the Official Fan Club of Tim Padilla</div> <div> Sign up today!!!</div> </td> <td valign="top" height=320 width="100%" BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <B>Fan Club Mailing List</B></div> <div>  <form action="http://csbmail.globalscape.com/cgi-bin/csbmail/csbmail.pl" method="POST" enctype="application/x-www-form-urlencoded"><input type="hidden" name="tlx_SortOrder" value="FirstName,LastName,Email,Address1,City,State,Zip,Phone,MailingList"><input type="hidden" name="tlx_FormIndex" value="2"><input type="hidden" name="tlx_OKMessage" value="Thank you for your request. www.TimPadilla.com"><input type="hidden" name="tlx_SendMode" value="1"><input type="hidden" name="tlx_Subject" value="A request form was submitted"><input type="hidden" name="tlx_EmailTo" value="TimPadillaMusic@att.net"> <table cellpadding="0" cellspacing="1" border="0" align="center"> <tr> <td align="left">First Name: <br> <input type="text" name="FirstName" size="30" maxlength="100"> </td> </tr> <tr> <td align="left">Last Name: <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">Address Line 1: <br> <input type="text" name="Address1" size="30" maxlength="100"> </td> </tr> <tr> <td align="left">City: <br> <input type="text" name="City" size="30" maxlength="100"> </td> </tr> <tr> <td align="left">State: <br> <input type="text" name="State" size="30" maxlength="100"> </td> </tr> <tr> <td align="left">Zip: <br> <input type="text" name="Zip" size="10" maxlength="10"> </td> </tr> <tr> <td align="left">Phone Number: <br> <input type="text" name="Phone" size="14" maxlength="14"> </td> </tr> <tr> <td> <input type="checkbox" name="MailingList" value="yes"> Add me to your mailing list</td> </tr> <tr> <td align="right"><input type="reset"> <input type="submit" value="Send" name="tlx_send"></td> </tr> </table> </form>  </div> <bR> <div>  <HTML> <HEAD> <TITLE>Fan Club Mailing List</TITLE> </HEAD> <script></script> </SCRIPT> <BODY BGCOLOR="#FFFFFF" OnLoad="tmx1a=window.setTimeout('scroll_status(100)',50);">  </div> </td> </tr></table></body>