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<blockquote data-quote="sachitha-" data-source="post: 7746107" data-attributes="member: 290686">Mata machan me wage form ekak fil karama a details mage email ekata ena vidiyata kauru hari hadala denna puluwanda. contct mama meke source code eka aran ithuru hadagatta desgn eka machanla mata meke submit karama wena scn eka hadala denawada captcha eka nathath aulak na <img src="/styles/default/xenforo/smilies/default/dull.gif"&nbsp; class="smilie" loading="lazy" alt=":dull:" title="Dull&nbsp; &nbsp; :dull:" data-shortname=":dull:" /><img src="/styles/default/xenforo/smilies/default/dull.gif"&nbsp; class="smilie" loading="lazy" alt=":dull:" title="Dull&nbsp; &nbsp; :dull:" data-shortname=":dull:" />:dull:[PHP]&lt;!DOCTYPE html PUBLIC &quot;-//W3C//DTD XHTML 1.0 Transitional//EN&quot; &quot;http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd&quot;&gt; &lt;html xmlns=&quot;http://www.w3.org/1999/xhtml&quot;&gt; &lt;head&gt; &lt;meta http-equiv=&quot;Content-Type&quot; content=&quot;text/html; charset=UTF-8&quot; /&gt; &lt;title&gt;CONTACT US&lt;/title&gt; &lt;link rel=&quot;stylesheet&quot; type=&quot;text/css&quot; href=&quot;./data/form_30/css/view.css&quot; media=&quot;all&quot; /&gt; &lt;script type=&quot;text/javascript&quot; src=&quot;js/view.js&quot;&gt;&lt;/script&gt; &nbsp;&lt;/head&gt; &lt;body id=&quot;main_body&quot; class=&quot;embed&quot;&gt; &nbsp;&nbsp; &nbsp; &lt;img id=&quot;top&quot; src=&quot;images/top.png&quot; alt=&quot;&quot; /&gt; &nbsp; &nbsp; &lt;div id=&quot;form_container&quot;&gt; &nbsp;&nbsp; &nbsp; &nbsp; &nbsp; &lt;h1&gt;&lt;a&gt;CONTACT US&lt;/a&gt;&lt;/h1&gt; &nbsp; &nbsp; &nbsp; &nbsp; &lt;form id=&quot;form_30&quot; class=&quot;appnitro&quot;&nbsp; method=&quot;post&quot; action=&quot;#main_body&quot;&gt; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &lt;div class=&quot;form_description&quot;&gt; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &lt;h2&gt;CONTACT US&lt;/h2&gt; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &lt;p&gt;&lt;/p&gt; &nbsp; &nbsp; &nbsp; &nbsp; &lt;/div&gt; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &lt;ul &gt; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &lt;li id=&quot;li_1&quot; &gt; &nbsp; &nbsp; &nbsp; &nbsp; &lt;label class=&quot;description&quot;&gt;Name&nbsp; &lt;span id=&quot;required_1&quot; class=&quot;required&quot;&gt;*&lt;/span&gt;&lt;/label&gt; &nbsp; &nbsp; &nbsp; &nbsp; &lt;span&gt; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &lt;input id=&quot;element_1_1&quot; name= &quot;element_1_1&quot; class=&quot;element text&quot; maxlength=&quot;255&quot; size=&quot;8&quot; value=&quot;&quot; /&gt; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &lt;label&gt;First&lt;/label&gt; &nbsp; &nbsp; &nbsp; &nbsp; &lt;/span&gt; &nbsp; &nbsp; &nbsp; &nbsp; &lt;span&gt; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &lt;input id=&quot;element_1_2&quot; name= &quot;element_1_2&quot; class=&quot;element text&quot; maxlength=&quot;255&quot; size=&quot;14&quot; value=&quot;&quot; /&gt; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &lt;label&gt;Last&lt;/label&gt; &nbsp; &nbsp; &nbsp; &nbsp; &lt;/span&gt; &nbsp; &nbsp; &nbsp; &nbsp; &lt;/li&gt;&nbsp; &nbsp; &nbsp; &nbsp; &lt;li id=&quot;li_2&quot; &gt; &nbsp; &nbsp; &nbsp; &nbsp; &lt;label class=&quot;description&quot; for=&quot;element_2&quot;&gt;Organization Name: &lt;/label&gt; &nbsp; &nbsp; &nbsp; &nbsp; &lt;div&gt; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &lt;input id=&quot;element_2&quot; name=&quot;element_2&quot; class=&quot;element text medium&quot; type=&quot;text&quot; value=&quot;&quot; /&gt; &nbsp; &nbsp; &nbsp; &nbsp; &lt;/div&gt; &nbsp; &nbsp; &nbsp; &nbsp; &lt;/li&gt;&nbsp; &nbsp; &nbsp; &nbsp; &lt;li id=&quot;li_3&quot; &gt; &nbsp; &nbsp; &nbsp; &nbsp; &lt;label class=&quot;description&quot;&gt;Phone &lt;span id=&quot;required_3&quot; class=&quot;required&quot;&gt;*&lt;/span&gt;&lt;/label&gt; &nbsp; &nbsp; &nbsp; &nbsp; &lt;span&gt; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &lt;input id=&quot;element_3_1&quot; name=&quot;element_3_1&quot; class=&quot;element text&quot; size=&quot;3&quot; maxlength=&quot;3&quot; value=&quot;&quot; type=&quot;text&quot; /&gt; -&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &lt;label for=&quot;element_3_1&quot;&gt;(###)&lt;/label&gt; &nbsp; &nbsp; &nbsp; &nbsp; &lt;/span&gt; &nbsp; &nbsp; &nbsp; &nbsp; &lt;span&gt; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &lt;input id=&quot;element_3_2&quot; name=&quot;element_3_2&quot; class=&quot;element text&quot; size=&quot;3&quot; maxlength=&quot;3&quot; value=&quot;&quot; type=&quot;text&quot; /&gt; -&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &lt;label for=&quot;element_3_2&quot;&gt;###&lt;/label&gt; &nbsp; &nbsp; &nbsp; &nbsp; &lt;/span&gt; &nbsp; &nbsp; &nbsp; &nbsp; &lt;span&gt; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp; &lt;input id=&quot;element_3_3&quot; name=&quot;element_3_3&quot; class=&quot;element text&quot; size=&quot;4&quot; maxlength=&quot;4&quot; value=&quot;&quot; type=&quot;text&quot; /&gt; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &lt;label for=&quot;element_3_3&quot;&gt;####&lt;/label&gt; &nbsp; &nbsp; &nbsp; &nbsp; &lt;/span&gt; &nbsp; &nbsp; &nbsp; &nbsp; &lt;p class=&quot;guidelines&quot; id=&quot;guide_3&quot;&gt;&lt;small&gt;Please enter your phone number. &lt;/small&gt;&lt;/p&gt; &nbsp; &nbsp; &nbsp; &nbsp; &lt;/li&gt;&nbsp; &nbsp; &nbsp; &nbsp; &lt;li id=&quot;li_4&quot; &gt; &nbsp; &nbsp; &nbsp; &nbsp; &lt;label class=&quot;description&quot; for=&quot;element_4&quot;&gt;Email &lt;span id=&quot;required_4&quot; class=&quot;required&quot;&gt;*&lt;/span&gt;&lt;/label&gt; &nbsp; &nbsp; &nbsp; &nbsp; &lt;div&gt; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &lt;input id=&quot;element_4&quot; name=&quot;element_4&quot; class=&quot;element text medium&quot; type=&quot;text&quot; maxlength=&quot;255&quot; value=&quot;&quot; /&gt; &nbsp; &nbsp; &nbsp; &nbsp; &lt;/div&gt; &nbsp; &nbsp; &nbsp; &nbsp; &lt;/li&gt;&nbsp; &nbsp; &nbsp; &nbsp; &lt;li id=&quot;li_5&quot; &gt; &nbsp; &nbsp; &nbsp; &nbsp; &lt;label class=&quot;description&quot; for=&quot;element_5&quot;&gt;Web Site &lt;/label&gt; &nbsp; &nbsp; &nbsp; &nbsp; &lt;div&gt; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &lt;input id=&quot;element_5&quot; name=&quot;element_5&quot; class=&quot;element text medium&quot; type=&quot;text&quot;&nbsp; value=&quot;http://&quot; /&gt; &nbsp; &nbsp; &nbsp; &nbsp; &lt;/div&gt; &nbsp; &nbsp; &nbsp; &nbsp; &lt;/li&gt;&nbsp; &nbsp; &nbsp; &nbsp; &lt;li id=&quot;li_6&quot; &gt; &nbsp; &nbsp; &nbsp; &nbsp; &lt;label class=&quot;description&quot;&gt;Address &lt;/label&gt; &nbsp;&nbsp; &nbsp; &nbsp; &nbsp; &lt;div id=&quot;li_6_div_1&quot;&gt; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &lt;input id=&quot;element_6_1&quot; name=&quot;element_6_1&quot; class=&quot;element text large&quot; value=&quot;&quot; type=&quot;text&quot; /&gt; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &lt;label for=&quot;element_6_1&quot;&gt;Street Address&lt;/label&gt; &nbsp; &nbsp; &nbsp; &nbsp; &lt;/div&gt; &nbsp;&nbsp; &nbsp; &nbsp; &nbsp; &lt;div id=&quot;li_6_div_2&quot;&gt; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &lt;input id=&quot;element_6_2&quot; name=&quot;element_6_2&quot; class=&quot;element text large&quot; value=&quot;&quot; type=&quot;text&quot; /&gt; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &lt;label for=&quot;element_6_2&quot;&gt;Address Line 2&lt;/label&gt; &nbsp; &nbsp; &nbsp; &nbsp; &lt;/div&gt; &nbsp;&nbsp; &nbsp; &nbsp; &nbsp; &lt;div id=&quot;li_6_div_3&quot; class=&quot;left&quot;&gt; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &lt;input id=&quot;element_6_3&quot; name=&quot;element_6_3&quot; class=&quot;element text medium&quot; value=&quot;&quot; type=&quot;text&quot; /&gt; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &lt;label for=&quot;element_6_3&quot;&gt;City&lt;/label&gt; &nbsp; &nbsp; &nbsp; &nbsp; &lt;/div&gt; &nbsp;&nbsp; &nbsp; &nbsp; &nbsp; &lt;div id=&quot;li_6_div_4&quot; class=&quot;right&quot;&gt; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &lt;input id=&quot;element_6_4&quot; name=&quot;element_6_4&quot; class=&quot;element text medium&quot;&nbsp; value=&quot;&quot; type=&quot;text&quot; /&gt; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &lt;label for=&quot;element_6_4&quot;&gt;State / Province / Region&lt;/label&gt; &nbsp; &nbsp; &nbsp; &nbsp; &lt;/div&gt; &nbsp;&nbsp; &nbsp; &nbsp; &nbsp; &lt;div id=&quot;li_6_div_5&quot; class=&quot;left&quot;&gt; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &lt;input id=&quot;element_6_5&quot; name=&quot;element_6_5&quot; class=&quot;element text medium&quot; maxlength=&quot;15&quot; value=&quot;&quot; type=&quot;text&quot; /&gt; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &lt;label for=&quot;element_6_5&quot;&gt;Postal / Zip Code&lt;/label&gt; &nbsp; &nbsp; &nbsp; &nbsp; &lt;/div&gt; &nbsp;&nbsp; &nbsp; &nbsp; &nbsp; &lt;div id=&quot;li_6_div_6&quot; class=&quot;right&quot;&gt; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &lt;select class=&quot;element select medium&quot; id=&quot;element_6_6&quot; name=&quot;element_6_6&quot;&gt; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &lt;option value=&quot;&quot; selected=&quot;selected&quot;&gt;&lt;/option&gt; &lt;option value=&quot;Afghanistan&quot; &gt;Afghanistan&lt;/option&gt; &lt;option value=&quot;Albania&quot; &gt;Albania&lt;/option&gt; &lt;option value=&quot;Algeria&quot; &gt;Algeria&lt;/option&gt; &lt;option value=&quot;Andorra&quot; &gt;Andorra&lt;/option&gt; &lt;option value=&quot;Antigua and Barbuda&quot; &gt;Antigua and Barbuda&lt;/option&gt; &lt;option value=&quot;Argentina&quot; &gt;Argentina&lt;/option&gt; &lt;option value=&quot;Armenia&quot; &gt;Armenia&lt;/option&gt; &lt;option value=&quot;Australia&quot; &gt;Australia&lt;/option&gt; &lt;option value=&quot;Austria&quot; &gt;Austria&lt;/option&gt; &lt;option value=&quot;Azerbaijan&quot; &gt;Azerbaijan&lt;/option&gt; &lt;option value=&quot;Bahamas&quot; &gt;Bahamas&lt;/option&gt; &lt;option value=&quot;Bahrain&quot; &gt;Bahrain&lt;/option&gt; &lt;option value=&quot;Bangladesh&quot; &gt;Bangladesh&lt;/option&gt; &lt;option value=&quot;Barbados&quot; &gt;Barbados&lt;/option&gt; &lt;option value=&quot;Belarus&quot; &gt;Belarus&lt;/option&gt; &lt;option value=&quot;Belgium&quot; &gt;Belgium&lt;/option&gt; &lt;option value=&quot;Belize&quot; &gt;Belize&lt;/option&gt; &lt;option value=&quot;Benin&quot; &gt;Benin&lt;/option&gt; &lt;option value=&quot;Bhutan&quot; &gt;Bhutan&lt;/option&gt; &lt;option value=&quot;Bolivia&quot; &gt;Bolivia&lt;/option&gt; &lt;option value=&quot;Bosnia and Herzegovina&quot; &gt;Bosnia and Herzegovina&lt;/option&gt; &lt;option value=&quot;Botswana&quot; &gt;Botswana&lt;/option&gt; &lt;option value=&quot;Brazil&quot; &gt;Brazil&lt;/option&gt; &lt;option value=&quot;Brunei&quot; &gt;Brunei&lt;/option&gt; &lt;option value=&quot;Bulgaria&quot; &gt;Bulgaria&lt;/option&gt; &lt;option value=&quot;Burkina Faso&quot; &gt;Burkina Faso&lt;/option&gt; &lt;option value=&quot;Burundi&quot; &gt;Burundi&lt;/option&gt; &lt;option value=&quot;Cambodia&quot; &gt;Cambodia&lt;/option&gt; &lt;option value=&quot;Cameroon&quot; &gt;Cameroon&lt;/option&gt; &lt;option value=&quot;Canada&quot; &gt;Canada&lt;/option&gt; &lt;option value=&quot;Cape Verde&quot; &gt;Cape Verde&lt;/option&gt; &lt;option value=&quot;Central African Republic&quot; &gt;Central African Republic&lt;/option&gt; &lt;option value=&quot;Chad&quot; &gt;Chad&lt;/option&gt; &lt;option value=&quot;Chile&quot; &gt;Chile&lt;/option&gt; &lt;option value=&quot;China&quot; &gt;China&lt;/option&gt; &lt;option value=&quot;Colombia&quot; &gt;Colombia&lt;/option&gt; &lt;option value=&quot;Comoros&quot; &gt;Comoros&lt;/option&gt; &lt;option value=&quot;Congo&quot; &gt;Congo&lt;/option&gt; &lt;option value=&quot;Costa Rica&quot; &gt;Costa Rica&lt;/option&gt; &lt;option value=&quot;Côte d'Ivoire&quot; &gt;Côte d'Ivoire&lt;/option&gt; &lt;option value=&quot;Croatia&quot; &gt;Croatia&lt;/option&gt; &lt;option value=&quot;Cuba&quot; &gt;Cuba&lt;/option&gt; &lt;option value=&quot;Cyprus&quot; &gt;Cyprus&lt;/option&gt; &lt;option value=&quot;Czech Republic&quot; &gt;Czech Republic&lt;/option&gt; &lt;option value=&quot;Denmark&quot; &gt;Denmark&lt;/option&gt; &lt;option value=&quot;Djibouti&quot; &gt;Djibouti&lt;/option&gt; &lt;option value=&quot;Dominica&quot; &gt;Dominica&lt;/option&gt; &lt;option value=&quot;Dominican Republic&quot; &gt;Dominican Republic&lt;/option&gt; &lt;option value=&quot;East Timor&quot; &gt;East Timor&lt;/option&gt; &lt;option value=&quot;Ecuador&quot; &gt;Ecuador&lt;/option&gt; &lt;option value=&quot;Egypt&quot; &gt;Egypt&lt;/option&gt; &lt;option value=&quot;El Salvador&quot; &gt;El Salvador&lt;/option&gt; &lt;option value=&quot;Equatorial Guinea&quot; &gt;Equatorial Guinea&lt;/option&gt; &lt;option value=&quot;Eritrea&quot; &gt;Eritrea&lt;/option&gt; &lt;option value=&quot;Estonia&quot; &gt;Estonia&lt;/option&gt; &lt;option value=&quot;Ethiopia&quot; &gt;Ethiopia&lt;/option&gt; &lt;option value=&quot;Fiji&quot; &gt;Fiji&lt;/option&gt; &lt;option value=&quot;Finland&quot; &gt;Finland&lt;/option&gt; &lt;option value=&quot;France&quot; &gt;France&lt;/option&gt; &lt;option value=&quot;Gabon&quot; &gt;Gabon&lt;/option&gt; &lt;option value=&quot;Gambia&quot; &gt;Gambia&lt;/option&gt; &lt;option value=&quot;Georgia&quot; &gt;Georgia&lt;/option&gt; &lt;option value=&quot;Germany&quot; &gt;Germany&lt;/option&gt; &lt;option value=&quot;Ghana&quot; &gt;Ghana&lt;/option&gt; &lt;option value=&quot;Greece&quot; &gt;Greece&lt;/option&gt; &lt;option value=&quot;Grenada&quot; &gt;Grenada&lt;/option&gt; &lt;option value=&quot;Guatemala&quot; &gt;Guatemala&lt;/option&gt; &lt;option value=&quot;Guinea&quot; &gt;Guinea&lt;/option&gt; &lt;option value=&quot;Guinea-Bissau&quot; &gt;Guinea-Bissau&lt;/option&gt; &lt;option value=&quot;Guyana&quot; &gt;Guyana&lt;/option&gt; &lt;option value=&quot;Haiti&quot; &gt;Haiti&lt;/option&gt; &lt;option value=&quot;Honduras&quot; &gt;Honduras&lt;/option&gt; &lt;option value=&quot;Hong Kong&quot; &gt;Hong Kong&lt;/option&gt; &lt;option value=&quot;Hungary&quot; &gt;Hungary&lt;/option&gt; &lt;option value=&quot;Iceland&quot; &gt;Iceland&lt;/option&gt; &lt;option value=&quot;India&quot; &gt;India&lt;/option&gt; &lt;option value=&quot;Indonesia&quot; &gt;Indonesia&lt;/option&gt; &lt;option value=&quot;Iran&quot; &gt;Iran&lt;/option&gt; &lt;option value=&quot;Iraq&quot; &gt;Iraq&lt;/option&gt; &lt;option value=&quot;Ireland&quot; &gt;Ireland&lt;/option&gt; &lt;option value=&quot;Israel&quot; &gt;Israel&lt;/option&gt; &lt;option value=&quot;Italy&quot; &gt;Italy&lt;/option&gt; &lt;option value=&quot;Jamaica&quot; &gt;Jamaica&lt;/option&gt; &lt;option value=&quot;Japan&quot; &gt;Japan&lt;/option&gt; &lt;option value=&quot;Jordan&quot; &gt;Jordan&lt;/option&gt; &lt;option value=&quot;Kazakhstan&quot; &gt;Kazakhstan&lt;/option&gt; &lt;option value=&quot;Kenya&quot; &gt;Kenya&lt;/option&gt; &lt;option value=&quot;Kiribati&quot; &gt;Kiribati&lt;/option&gt; &lt;option value=&quot;North Korea&quot; &gt;North Korea&lt;/option&gt; &lt;option value=&quot;South Korea&quot; &gt;South Korea&lt;/option&gt; &lt;option value=&quot;Kuwait&quot; &gt;Kuwait&lt;/option&gt; &lt;option value=&quot;Kyrgyzstan&quot; &gt;Kyrgyzstan&lt;/option&gt; &lt;option value=&quot;Laos&quot; &gt;Laos&lt;/option&gt; &lt;option value=&quot;Latvia&quot; &gt;Latvia&lt;/option&gt; &lt;option value=&quot;Lebanon&quot; &gt;Lebanon&lt;/option&gt; &lt;option value=&quot;Lesotho&quot; &gt;Lesotho&lt;/option&gt; &lt;option value=&quot;Liberia&quot; &gt;Liberia&lt;/option&gt; &lt;option value=&quot;Libya&quot; &gt;Libya&lt;/option&gt; &lt;option value=&quot;Liechtenstein&quot; &gt;Liechtenstein&lt;/option&gt; &lt;option value=&quot;Lithuania&quot; &gt;Lithuania&lt;/option&gt; &lt;option value=&quot;Luxembourg&quot; &gt;Luxembourg&lt;/option&gt; &lt;option value=&quot;Macedonia&quot; &gt;Macedonia&lt;/option&gt; &lt;option value=&quot;Madagascar&quot; &gt;Madagascar&lt;/option&gt; &lt;option value=&quot;Malawi&quot; &gt;Malawi&lt;/option&gt; &lt;option value=&quot;Malaysia&quot; &gt;Malaysia&lt;/option&gt; &lt;option value=&quot;Maldives&quot; &gt;Maldives&lt;/option&gt; &lt;option value=&quot;Mali&quot; &gt;Mali&lt;/option&gt; &lt;option value=&quot;Malta&quot; &gt;Malta&lt;/option&gt; &lt;option value=&quot;Marshall Islands&quot; &gt;Marshall Islands&lt;/option&gt; &lt;option value=&quot;Mauritania&quot; &gt;Mauritania&lt;/option&gt; &lt;option value=&quot;Mauritius&quot; &gt;Mauritius&lt;/option&gt; &lt;option value=&quot;Mexico&quot; &gt;Mexico&lt;/option&gt; &lt;option value=&quot;Micronesia&quot; &gt;Micronesia&lt;/option&gt; &lt;option value=&quot;Moldova&quot; &gt;Moldova&lt;/option&gt; &lt;option value=&quot;Monaco&quot; &gt;Monaco&lt;/option&gt; &lt;option value=&quot;Mongolia&quot; &gt;Mongolia&lt;/option&gt; &lt;option value=&quot;Montenegro&quot; &gt;Montenegro&lt;/option&gt; &lt;option value=&quot;Morocco&quot; &gt;Morocco&lt;/option&gt; &lt;option value=&quot;Mozambique&quot; &gt;Mozambique&lt;/option&gt; &lt;option value=&quot;Myanmar&quot; &gt;Myanmar&lt;/option&gt; &lt;option value=&quot;Namibia&quot; &gt;Namibia&lt;/option&gt; &lt;option value=&quot;Nauru&quot; &gt;Nauru&lt;/option&gt; &lt;option value=&quot;Nepal&quot; &gt;Nepal&lt;/option&gt; &lt;option value=&quot;Netherlands&quot; &gt;Netherlands&lt;/option&gt; &lt;option value=&quot;New Zealand&quot; &gt;New Zealand&lt;/option&gt; &lt;option value=&quot;Nicaragua&quot; &gt;Nicaragua&lt;/option&gt; &lt;option value=&quot;Niger&quot; &gt;Niger&lt;/option&gt; &lt;option value=&quot;Nigeria&quot; &gt;Nigeria&lt;/option&gt; &lt;option value=&quot;Norway&quot; &gt;Norway&lt;/option&gt; &lt;option value=&quot;Oman&quot; &gt;Oman&lt;/option&gt; &lt;option value=&quot;Pakistan&quot; &gt;Pakistan&lt;/option&gt; &lt;option value=&quot;Palau&quot; &gt;Palau&lt;/option&gt; &lt;option value=&quot;Panama&quot; &gt;Panama&lt;/option&gt; &lt;option value=&quot;Papua New Guinea&quot; &gt;Papua New Guinea&lt;/option&gt; &lt;option value=&quot;Paraguay&quot; &gt;Paraguay&lt;/option&gt; &lt;option value=&quot;Peru&quot; &gt;Peru&lt;/option&gt; &lt;option value=&quot;Philippines&quot; &gt;Philippines&lt;/option&gt; &lt;option value=&quot;Poland&quot; &gt;Poland&lt;/option&gt; &lt;option value=&quot;Portugal&quot; &gt;Portugal&lt;/option&gt; &lt;option value=&quot;Puerto Rico&quot; &gt;Puerto Rico&lt;/option&gt; &lt;option value=&quot;Qatar&quot; &gt;Qatar&lt;/option&gt; &lt;option value=&quot;Romania&quot; &gt;Romania&lt;/option&gt; &lt;option value=&quot;Russia&quot; &gt;Russia&lt;/option&gt; &lt;option value=&quot;Rwanda&quot; &gt;Rwanda&lt;/option&gt; &lt;option value=&quot;Saint Kitts and Nevis&quot; &gt;Saint Kitts and Nevis&lt;/option&gt; &lt;option value=&quot;Saint Lucia&quot; &gt;Saint Lucia&lt;/option&gt; &lt;option value=&quot;Saint Vincent and the Grenadines&quot; &gt;Saint Vincent and the Grenadines&lt;/option&gt; &lt;option value=&quot;Samoa&quot; &gt;Samoa&lt;/option&gt; &lt;option value=&quot;San Marino&quot; &gt;San Marino&lt;/option&gt; &lt;option value=&quot;Sao Tome and Principe&quot; &gt;Sao Tome and Principe&lt;/option&gt; &lt;option value=&quot;Saudi Arabia&quot; &gt;Saudi Arabia&lt;/option&gt; &lt;option value=&quot;Senegal&quot; &gt;Senegal&lt;/option&gt; &lt;option value=&quot;Serbia and Montenegro&quot; &gt;Serbia and Montenegro&lt;/option&gt; &lt;option value=&quot;Seychelles&quot; &gt;Seychelles&lt;/option&gt; &lt;option value=&quot;Sierra Leone&quot; &gt;Sierra Leone&lt;/option&gt; &lt;option value=&quot;Singapore&quot; &gt;Singapore&lt;/option&gt; &lt;option value=&quot;Slovakia&quot; &gt;Slovakia&lt;/option&gt; &lt;option value=&quot;Slovenia&quot; &gt;Slovenia&lt;/option&gt; &lt;option value=&quot;Solomon Islands&quot; &gt;Solomon Islands&lt;/option&gt; &lt;option value=&quot;Somalia&quot; &gt;Somalia&lt;/option&gt; &lt;option value=&quot;South Africa&quot; &gt;South Africa&lt;/option&gt; &lt;option value=&quot;Spain&quot; &gt;Spain&lt;/option&gt; &lt;option value=&quot;Sri Lanka&quot; &gt;Sri Lanka&lt;/option&gt; &lt;option value=&quot;Sudan&quot; &gt;Sudan&lt;/option&gt; &lt;option value=&quot;Suriname&quot; &gt;Suriname&lt;/option&gt; &lt;option value=&quot;Swaziland&quot; &gt;Swaziland&lt;/option&gt; &lt;option value=&quot;Sweden&quot; &gt;Sweden&lt;/option&gt; &lt;option value=&quot;Switzerland&quot; &gt;Switzerland&lt;/option&gt; &lt;option value=&quot;Syria&quot; &gt;Syria&lt;/option&gt; &lt;option value=&quot;Taiwan&quot; &gt;Taiwan&lt;/option&gt; &lt;option value=&quot;Tajikistan&quot; &gt;Tajikistan&lt;/option&gt; &lt;option value=&quot;Tanzania&quot; &gt;Tanzania&lt;/option&gt; &lt;option value=&quot;Thailand&quot; &gt;Thailand&lt;/option&gt; &lt;option value=&quot;Togo&quot; &gt;Togo&lt;/option&gt; &lt;option value=&quot;Tonga&quot; &gt;Tonga&lt;/option&gt; &lt;option value=&quot;Trinidad and Tobago&quot; &gt;Trinidad and Tobago&lt;/option&gt; &lt;option value=&quot;Tunisia&quot; &gt;Tunisia&lt;/option&gt; &lt;option value=&quot;Turkey&quot; &gt;Turkey&lt;/option&gt; &lt;option value=&quot;Turkmenistan&quot; &gt;Turkmenistan&lt;/option&gt; &lt;option value=&quot;Tuvalu&quot; &gt;Tuvalu&lt;/option&gt; &lt;option value=&quot;Uganda&quot; &gt;Uganda&lt;/option&gt; &lt;option value=&quot;Ukraine&quot; &gt;Ukraine&lt;/option&gt; &lt;option value=&quot;United Arab Emirates&quot; &gt;United Arab Emirates&lt;/option&gt; &lt;option value=&quot;United Kingdom&quot; &gt;United Kingdom&lt;/option&gt; &lt;option value=&quot;United States&quot; &gt;United States&lt;/option&gt; &lt;option value=&quot;Uruguay&quot; &gt;Uruguay&lt;/option&gt; &lt;option value=&quot;Uzbekistan&quot; &gt;Uzbekistan&lt;/option&gt; &lt;option value=&quot;Vanuatu&quot; &gt;Vanuatu&lt;/option&gt; &lt;option value=&quot;Vatican City&quot; &gt;Vatican City&lt;/option&gt; &lt;option value=&quot;Venezuela&quot; &gt;Venezuela&lt;/option&gt; &lt;option value=&quot;Vietnam&quot; &gt;Vietnam&lt;/option&gt; &lt;option value=&quot;Yemen&quot; &gt;Yemen&lt;/option&gt; &lt;option value=&quot;Zambia&quot; &gt;Zambia&lt;/option&gt; &lt;option value=&quot;Zimbabwe&quot; &gt;Zimbabwe&lt;/option&gt; &nbsp;&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &lt;/select&gt; &nbsp; &nbsp; &nbsp; &nbsp; &lt;label for=&quot;element_6_6&quot;&gt;Country&lt;/label&gt; &nbsp; &nbsp; &lt;/div&gt;  &nbsp; &nbsp; &nbsp; &nbsp; &lt;/li&gt;&nbsp; &nbsp; &nbsp; &nbsp; &lt;li id=&quot;li_12&quot; &gt; &nbsp; &nbsp; &nbsp; &nbsp; &lt;label class=&quot;description&quot; for=&quot;element_12&quot;&gt;How can we help you?&nbsp; &lt;/label&gt; &nbsp; &nbsp; &nbsp; &nbsp; &lt;div&gt; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &lt;textarea id=&quot;element_12&quot; name=&quot;element_12&quot; class=&quot;element textarea medium&quot; rows=&quot;8&quot; cols=&quot;90&quot;&gt;&lt;/textarea&gt; &nbsp; &nbsp; &nbsp; &nbsp; &lt;/div&gt; &nbsp; &nbsp; &nbsp; &nbsp; &lt;/li&gt;&nbsp; &nbsp; &nbsp; &nbsp; &lt;li id=&quot;li_captcha&quot; &gt; &nbsp; &nbsp; &nbsp; &nbsp; &lt;label class=&quot;description&quot; for=&quot;captcha_response_field&quot;&gt;Type the letters you see in the image below. &lt;/label&gt; &nbsp; &nbsp; &nbsp; &nbsp; &lt;div&gt; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &lt;img id=&quot;captcha_image&quot; src=&quot;captcha.php?t=1277545236&quot; width=&quot;200&quot; height=&quot;60&quot; alt=&quot;Please refresh your browser to see this image.&quot; /&gt;&lt;br /&gt; &lt;input id=&quot;captcha_response_field&quot; name=&quot;captcha_response_field&quot; class=&quot;element text small&quot; type=&quot;text&quot; /&gt;&lt;div id=&quot;dummy_captcha_internal&quot;&gt;&lt;/div&gt; &nbsp; &nbsp; &nbsp; &nbsp; &lt;/div&gt; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &lt;/li&gt; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &lt;li id=&quot;li_buttons&quot; class=&quot;buttons&quot;&gt; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &lt;input type=&quot;hidden&quot; name=&quot;form_id&quot; value=&quot;30&quot; /&gt; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &lt;input type=&quot;hidden&quot; name=&quot;submit&quot; value=&quot;1&quot; /&gt; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &lt;input id=&quot;saveForm&quot; class=&quot;button_text&quot; type=&quot;submit&quot; name=&quot;submit&quot; value=&quot;Submit&quot; /&gt; &nbsp; &nbsp; &nbsp; &nbsp; &lt;/li&gt; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &lt;/ul&gt; &nbsp; &nbsp; &nbsp; &nbsp; &lt;/form&gt; &nbsp; &nbsp; &lt;/div&gt; &nbsp; &nbsp; &lt;img id=&quot;bottom&quot; src=&quot;images/bottom.png&quot; alt=&quot;&quot; /&gt; &nbsp; &nbsp; &lt;/body&gt; &lt;/html&gt;[/PHP]</blockquote>

[QUOTE="sachitha-, post: 7746107, member: 290686"] [FONT="Courier New"][SIZE="3"]Mata machan me wage form ekak fil karama a details mage email ekata ena vidiyata kauru hari hadala denna puluwanda. contct mama meke source code eka aran ithuru hadagatta desgn eka machanla mata meke submit karama wena scn eka hadala denawada captcha eka nathath aulak na :dull::dull::dull[/SIZE][/FONT]: [PHP]<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd"> <html xmlns="http://www.w3.org/1999/xhtml"> <head> <meta http-equiv="Content-Type" content="text/html; charset=UTF-8" /> <title>CONTACT US</title> <link rel="stylesheet" type="text/css" href="./data/form_30/css/view.css" media="all" /> <script type="text/javascript" src="js/view.js"></script> </head> <body id="main_body" class="embed"> <img id="top" src="images/top.png" alt="" /> <div id="form_container"> <h1><a>CONTACT US</a></h1> <form id="form_30" class="appnitro" method="post" action="#main_body"> <div class="form_description"> <h2>CONTACT US</h2> </div> <ul > <li id="li_1" > <label class="description">Name *</label> <input id="element_1_1" name= "element_1_1" class="element text" maxlength="255" size="8" value="" /> <label>First</label> <input id="element_1_2" name= "element_1_2" class="element text" maxlength="255" size="14" value="" /> <label>Last</label> </li> <li id="li_2" > <label class="description" for="element_2">Organization Name: </label> <div> <input id="element_2" name="element_2" class="element text medium" type="text" value="" /> </div> </li> <li id="li_3" > <label class="description">Phone *</label> <input id="element_3_1" name="element_3_1" class="element text" size="3" maxlength="3" value="" type="text" /> - <label for="element_3_1">(###)</label> <input id="element_3_2" name="element_3_2" class="element text" size="3" maxlength="3" value="" type="text" /> - <label for="element_3_2">###</label> <input id="element_3_3" name="element_3_3" class="element text" size="4" maxlength="4" value="" type="text" /> <label for="element_3_3">####</label> Please enter your phone number. </li> <li id="li_4" > <label class="description" for="element_4">Email *</label> <div> <input id="element_4" name="element_4" class="element text medium" type="text" maxlength="255" value="" /> </div> </li> <li id="li_5" > <label class="description" for="element_5">Web Site </label> <div> <input id="element_5" name="element_5" class="element text medium" type="text" value="http://" /> </div> </li> <li id="li_6" > <label class="description">Address </label> <div id="li_6_div_1"> <input id="element_6_1" name="element_6_1" class="element text large" value="" type="text" /> <label for="element_6_1">Street Address</label> </div> <div id="li_6_div_2"> <input id="element_6_2" name="element_6_2" class="element text large" value="" type="text" /> <label for="element_6_2">Address Line 2</label> </div> <div id="li_6_div_3" class="left"> <input id="element_6_3" name="element_6_3" class="element text medium" value="" type="text" /> <label for="element_6_3">City</label> </div> <div id="li_6_div_4" class="right"> <input id="element_6_4" name="element_6_4" class="element text medium" value="" type="text" /> <label for="element_6_4">State / Province / Region</label> </div> <div id="li_6_div_5" class="left"> <input id="element_6_5" name="element_6_5" class="element text medium" maxlength="15" value="" type="text" /> <label for="element_6_5">Postal / Zip Code</label> </div> <div id="li_6_div_6" class="right"> <select class="element select medium" id="element_6_6" name="element_6_6"> <option value="" selected="selected"></option> <option value="Afghanistan" >Afghanistan</option> <option value="Albania" >Albania</option> <option value="Algeria" >Algeria</option> <option value="Andorra" >Andorra</option> <option value="Antigua and Barbuda" >Antigua and Barbuda</option> <option value="Argentina" >Argentina</option> <option value="Armenia" >Armenia</option> <option value="Australia" >Australia</option> <option value="Austria" >Austria</option> <option value="Azerbaijan" >Azerbaijan</option> <option value="Bahamas" >Bahamas</option> <option value="Bahrain" >Bahrain</option> <option value="Bangladesh" >Bangladesh</option> <option value="Barbados" >Barbados</option> <option value="Belarus" >Belarus</option> <option value="Belgium" >Belgium</option> <option value="Belize" >Belize</option> <option value="Benin" >Benin</option> <option value="Bhutan" >Bhutan</option> <option value="Bolivia" >Bolivia</option> <option value="Bosnia and Herzegovina" >Bosnia and Herzegovina</option> <option value="Botswana" >Botswana</option> <option value="Brazil" >Brazil</option> <option value="Brunei" >Brunei</option> <option value="Bulgaria" >Bulgaria</option> <option value="Burkina Faso" >Burkina Faso</option> <option value="Burundi" >Burundi</option> <option value="Cambodia" >Cambodia</option> <option value="Cameroon" >Cameroon</option> <option value="Canada" >Canada</option> <option value="Cape Verde" >Cape Verde</option> <option value="Central African Republic" >Central African Republic</option> <option value="Chad" >Chad</option> <option value="Chile" >Chile</option> <option value="China" >China</option> <option value="Colombia" >Colombia</option> <option value="Comoros" >Comoros</option> <option value="Congo" >Congo</option> <option value="Costa Rica" >Costa Rica</option> <option value="Côte d'Ivoire" >Côte d'Ivoire</option> <option value="Croatia" >Croatia</option> <option value="Cuba" >Cuba</option> <option value="Cyprus" >Cyprus</option> <option value="Czech Republic" >Czech Republic</option> <option value="Denmark" >Denmark</option> <option value="Djibouti" >Djibouti</option> <option value="Dominica" >Dominica</option> <option value="Dominican Republic" >Dominican Republic</option> <option value="East Timor" >East Timor</option> <option value="Ecuador" >Ecuador</option> <option value="Egypt" >Egypt</option> <option value="El Salvador" >El Salvador</option> <option value="Equatorial Guinea" >Equatorial Guinea</option> <option value="Eritrea" >Eritrea</option> <option value="Estonia" >Estonia</option> <option value="Ethiopia" >Ethiopia</option> <option value="Fiji" >Fiji</option> <option value="Finland" >Finland</option> <option value="France" >France</option> <option value="Gabon" >Gabon</option> <option value="Gambia" >Gambia</option> <option value="Georgia" >Georgia</option> <option value="Germany" >Germany</option> <option value="Ghana" >Ghana</option> <option value="Greece" >Greece</option> <option value="Grenada" >Grenada</option> <option value="Guatemala" >Guatemala</option> <option value="Guinea" >Guinea</option> <option value="Guinea-Bissau" >Guinea-Bissau</option> <option value="Guyana" >Guyana</option> <option value="Haiti" >Haiti</option> <option value="Honduras" >Honduras</option> <option value="Hong Kong" >Hong Kong</option> <option value="Hungary" >Hungary</option> <option value="Iceland" >Iceland</option> <option value="India" >India</option> <option value="Indonesia" >Indonesia</option> <option value="Iran" >Iran</option> <option value="Iraq" >Iraq</option> <option value="Ireland" >Ireland</option> <option value="Israel" >Israel</option> <option value="Italy" >Italy</option> <option value="Jamaica" >Jamaica</option> <option value="Japan" >Japan</option> <option value="Jordan" >Jordan</option> <option value="Kazakhstan" >Kazakhstan</option> <option value="Kenya" >Kenya</option> <option value="Kiribati" >Kiribati</option> <option value="North Korea" >North Korea</option> <option value="South Korea" >South Korea</option> <option value="Kuwait" >Kuwait</option> <option value="Kyrgyzstan" >Kyrgyzstan</option> <option value="Laos" >Laos</option> <option value="Latvia" >Latvia</option> <option value="Lebanon" >Lebanon</option> <option value="Lesotho" >Lesotho</option> <option value="Liberia" >Liberia</option> <option value="Libya" >Libya</option> <option value="Liechtenstein" >Liechtenstein</option> <option value="Lithuania" >Lithuania</option> <option value="Luxembourg" >Luxembourg</option> <option value="Macedonia" >Macedonia</option> <option value="Madagascar" >Madagascar</option> <option value="Malawi" >Malawi</option> <option value="Malaysia" >Malaysia</option> <option value="Maldives" >Maldives</option> <option value="Mali" >Mali</option> <option value="Malta" >Malta</option> <option value="Marshall Islands" >Marshall Islands</option> <option value="Mauritania" >Mauritania</option> <option value="Mauritius" >Mauritius</option> <option value="Mexico" >Mexico</option> <option value="Micronesia" >Micronesia</option> <option value="Moldova" >Moldova</option> <option value="Monaco" >Monaco</option> <option value="Mongolia" >Mongolia</option> <option value="Montenegro" >Montenegro</option> <option value="Morocco" >Morocco</option> <option value="Mozambique" >Mozambique</option> <option value="Myanmar" >Myanmar</option> <option value="Namibia" >Namibia</option> <option value="Nauru" >Nauru</option> <option value="Nepal" >Nepal</option> <option value="Netherlands" >Netherlands</option> <option value="New Zealand" >New Zealand</option> <option value="Nicaragua" >Nicaragua</option> <option value="Niger" >Niger</option> <option value="Nigeria" >Nigeria</option> <option value="Norway" >Norway</option> <option value="Oman" >Oman</option> <option value="Pakistan" >Pakistan</option> <option value="Palau" >Palau</option> <option value="Panama" >Panama</option> <option value="Papua New Guinea" >Papua New Guinea</option> <option value="Paraguay" >Paraguay</option> <option value="Peru" >Peru</option> <option value="Philippines" >Philippines</option> <option value="Poland" >Poland</option> <option value="Portugal" >Portugal</option> <option value="Puerto Rico" >Puerto Rico</option> <option value="Qatar" >Qatar</option> <option value="Romania" >Romania</option> <option value="Russia" >Russia</option> <option value="Rwanda" >Rwanda</option> <option value="Saint Kitts and Nevis" >Saint Kitts and Nevis</option> <option value="Saint Lucia" >Saint Lucia</option> <option value="Saint Vincent and the Grenadines" >Saint Vincent and the Grenadines</option> <option value="Samoa" >Samoa</option> <option value="San Marino" >San Marino</option> <option value="Sao Tome and Principe" >Sao Tome and Principe</option> <option value="Saudi Arabia" >Saudi Arabia</option> <option value="Senegal" >Senegal</option> <option value="Serbia and Montenegro" >Serbia and Montenegro</option> <option value="Seychelles" >Seychelles</option> <option value="Sierra Leone" >Sierra Leone</option> <option value="Singapore" >Singapore</option> <option value="Slovakia" >Slovakia</option> <option value="Slovenia" >Slovenia</option> <option value="Solomon Islands" >Solomon Islands</option> <option value="Somalia" >Somalia</option> <option value="South Africa" >South Africa</option> <option value="Spain" >Spain</option> <option value="Sri Lanka" >Sri Lanka</option> <option value="Sudan" >Sudan</option> <option value="Suriname" >Suriname</option> <option value="Swaziland" >Swaziland</option> <option value="Sweden" >Sweden</option> <option value="Switzerland" >Switzerland</option> <option value="Syria" >Syria</option> <option value="Taiwan" >Taiwan</option> <option value="Tajikistan" >Tajikistan</option> <option value="Tanzania" >Tanzania</option> <option value="Thailand" >Thailand</option> <option value="Togo" >Togo</option> <option value="Tonga" >Tonga</option> <option value="Trinidad and Tobago" >Trinidad and Tobago</option> <option value="Tunisia" >Tunisia</option> <option value="Turkey" >Turkey</option> <option value="Turkmenistan" >Turkmenistan</option> <option value="Tuvalu" >Tuvalu</option> <option value="Uganda" >Uganda</option> <option value="Ukraine" >Ukraine</option> <option value="United Arab Emirates" >United Arab Emirates</option> <option value="United Kingdom" >United Kingdom</option> <option value="United States" >United States</option> <option value="Uruguay" >Uruguay</option> <option value="Uzbekistan" >Uzbekistan</option> <option value="Vanuatu" >Vanuatu</option> <option value="Vatican City" >Vatican City</option> <option value="Venezuela" >Venezuela</option> <option value="Vietnam" >Vietnam</option> <option value="Yemen" >Yemen</option> <option value="Zambia" >Zambia</option> <option value="Zimbabwe" >Zimbabwe</option> </select> <label for="element_6_6">Country</label> </div> </li> <li id="li_12" > <label class="description" for="element_12">How can we help you? </label> <div> <textarea id="element_12" name="element_12" class="element textarea medium" rows="8" cols="90"></textarea> </div> </li> <li id="li_captcha" > <label class="description" for="captcha_response_field">Type the letters you see in the image below. </label> <div> <img id="captcha_image" src="captcha.php?t=1277545236" width="200" height="60" alt="Please refresh your browser to see this image." /> <input id="captcha_response_field" name="captcha_response_field" class="element text small" type="text" /><div id="dummy_captcha_internal"></div> </div> </li> <li id="li_buttons" class="buttons"> <input type="hidden" name="form_id" value="30" /> <input type="hidden" name="submit" value="1" /> <input id="saveForm" class="button_text" type="submit" name="submit" value="Submit" /> </li> </ul> </form> </div> <img id="bottom" src="images/bottom.png" alt="" /> </body> </html>[/PHP] [/QUOTE]

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