Volvo For Life Awards 6 Media Materials<table width="700" border="1" cellpadding="5" cellspacing="0" bordercolor="#CCCCCC">
  <tr>
    <td valign="middle"><img src="../images/vfla_banner.gif" alt="VFLA " width="700" height="65" /><br />
        <hr width="90%" size="1" />
        <p>&nbsp;</p>
        <table width="80%" border="0" align="center" cellpadding="0" cellspacing="0" bordercolor="#CCCCCC">
          <tr>
            <td valign="top">Please fill in the form to enter the VFLA Retailer
            Public Relations Materials Site </td>
          </tr>
        </table>
        <p>&nbsp;</p>
        <form action="http://vfla6.haberspace.com/index.php" method="post" name="vfla_entry" id="vfla_entry">
          <table width="80%" border="1" align="center" cellpadding="0" cellspacing="0" bordercolor="#CCCCCC">
            <tr>
              <td><table width="80%" border="0" align="center" cellpadding="0" cellspacing="0">
                <tr>
                  <td width="21%">First Name:</td>
                  <td width="79%"><input name="fname" size="15" maxlength="15" /></td>
                </tr>
                <tr>
                  <td>Last Name:</td>
                  <td><input type="text" name="lname" size="15" maxlength="30" /></td>
                </tr>
                <tr>
                  <td>Email Address:</td>
                  <td><input type="text" name="email" size="20" maxlength="40" /></td>
                </tr>
                <tr>
                  <td>Retail Outlet: </td>
                  <td><input name="outlet" type="text" id="outlet" size="40" /></td>
                </tr>
                <tr>
                  <td><input type="hidden" name="submitted" value="TRUE" />
                      <input type="submit" name="submit" value="Enter Site" /></td>
                  <td>&nbsp;</td>
                </tr>
              </table></td>
            </tr>
          </table>
          </form>
      <p align="center">&nbsp;</p>
        <div align="center"><br />
      </div></td>
  </tr>
</table>
<p>
</p>