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<title>Submit your Inspirational Story</title>
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<table border="1" width="100%" bgcolor="#FFFFFF" height="50" cellpadding="4">
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    <td width="100%" bgcolor="#008080" valign="middle"><p align="center"><img src="world.gif"
    width="32" height="32" alt="world.gif (11187 bytes)" align="left"> <font
    face="verdana, helvetica" color="#FFFFC1"><big><big><strong>Send Personal Experience
    Stories to Us</strong></big></big></font></td>
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    <td valign="top"><font face="Verdana, helvetica"><small><br>
    </small></font><form method="POST" action="../../cgi-bin/form/bnbform.cgi">
      <input type="hidden" name="required"
      value="name, email, state, country, what_submit, subject, article"><input type="hidden"
      name="data_order"
      value="name, email, age, state, country, what_submit, subject, article, author, published_when, website"><input
      type="hidden" name="submit_to" value="webmaster@teenoutreach.com"><input type="hidden"
      name="autorespond" value="yes"><input type="hidden" name="automessage"
      value="inspirational.txt"><input type="hidden" name="outputfile" value="form.log"><input
      type="hidden" name="form_id" value="TOR Web Form: A submitted story about Depression"><input
      type="hidden" name="ok_url" value="http://www.teenoutreach.com/about/form/thanks.html"><input
      type="hidden" name="not_ok_url" value="http://www.teenoutreach.com/about/form/oops.html"><small><font
      face="Verdana, Arial, helvetica"><table border="0" width="100%">
        <tr>
          <td width="100%" colspan="2"><div align="left"><p></font><font
          face="Verdana, Arial, helvetica" size="2" color="#004080"><strong>Please fill in the form
          Completely. </small><br>
          </strong></font><font face="Verdana, Arial, helvetica" size="2" color="#000000">Anything
          with a &quot;</font><font face="Verdana, Arial, helvetica" size="2" color="#FF0000"><strong>*</strong></font><font
          face="Verdana, Arial, helvetica" size="2" color="#000000">&quot; must be filled in.</font></td>
        </tr>
        <tr>
          <td width="50%"><font face="Verdana, Arial, helvetica" size="2"><div align="right"><p></font><font
          face="Verdana, Arial, helvetica" size="2" color="#FF0000"><strong>*</strong></font><font
          face="Verdana, Arial, helvetica" size="1"> </font><font face="Verdana, Arial, helvetica"
          size="2">Name:</font></td>
          <small><td width="50%"><input type="text" name="name" size="20"></small></td>
        </tr>
        <tr>
          <td width="50%"><div align="right"><p><font face="Verdana, Arial, helvetica" size="2"
          color="#FF0000"><strong>*</strong></font><font face="Verdana, Arial, helvetica" size="2">&nbsp;
          Email Address:</font></td>
          <small><td width="50%"><input type="text" name="email" size="20"></small></td>
        </tr>
        <tr>
          <td width="50%" align="right"><font face="Verdana, Arial, helvetica" size="2">Age:</font></td>
          <small><td width="50%"><input type="text" name="age" size="20"></small></td>
        </tr>
        <tr>
          <td width="50%" align="right"><font face="Verdana, Arial, helvetica" size="2"
          color="#FF0000"><strong>*</strong></font><font face="Verdana, Arial, helvetica" size="2">&nbsp;
          Province/State:</font></td>
          <small><td width="50%"><input type="text" name="state" size="20"></small></td>
        </tr>
        <tr>
          <td width="50%" align="right"><font face="Verdana, Arial, helvetica" size="2"
          color="#FF0000"><strong>*</strong></font><font face="Verdana, Arial, helvetica" size="2"><small>
          &nbsp; </small>Country:</font></td>
          <td width="50%"><input type="text" name="country" size="20"></td>
        </tr>
        <tr>
          <td width="50%" align="right"><font face="Verdana, Arial, helvetica" size="2"
          color="#FF0000"><strong>*</strong></font><font face="Verdana, Arial, helvetica" size="2">
          &nbsp; What are you submitting?</font></td>
          <td width="50%"><select name="what_submit" size="1">
            <option value="NONE_CHOOSEN">(CHOOSE ONE)</option>
            <option value="Coping_with_Grief">Coping with Grief</option>
            <option value="Daily_Wisdom">Daily Wisdom</option>
            <option value="Daily_Scriptures">Daily Scriptures</option>
            <option value="Inspirational_Stories">Inspirational Stories</option>
            <option value="Thoughts">Thoughts for Successful Living (quotes)</option>
            <option value="Thoughts_teen">Thoughts for Successful Living (teen quotes)</option>
            <option value="What_Bible_Says">What the Bible Says</option>
            <option value="Depression_Story">A personal Story about Depression</option>
          </select></td>
          <small>
        </tr>
        <tr>
          </small><td width="50%" align="right"><font face="Verdana, Arial, helvetica" size="2"
          color="#FF0000"><strong>*</strong></font><small><font face="verdana, helvetica"> &nbsp;
          Subject:</font></small></td>
          <td width="50%"><small><input type="text" name="subject" size="20"></small></td>
          <small>
        </tr>
        <tr>
          </small><td width="100%" align="right" colspan="2"><small><font
          face="Verdana, Arial, helvetica" size="2"><div align="center"><center><p></font></small><strong><font
          face="Verdana, Arial, helvetica" size="2" color="#FF0000">*</font><small><font
          face="verdana, helvetica">&nbsp; Enter Your Submission</font></small></strong><br>
          <textarea cols="45" rows="12" name="article"></textarea></td>
          <small>
        </tr>
        <tr align="center">
          </small><td width="50%" align="right"><font face="verdana, helvetica"><small>Author Name
          (if applicable)</small></font></td>
          <td width="50%"><input type="text" name="author" size="20"></td>
          <small>
        </tr>
        <tr align="center">
          </small><td width="50%" align="right"><small><font face="Verdana, Arial, helvetica">When
          was it first published?</font></small></td>
          <td width="50%"><input type="text" name="published_when" size="20"></td>
          <small>
        </tr>
        <tr align="center">
          </small><td width="50%" align="right"><small><font face="Verdana, Arial, helvetica">Optional
          Website</font></small></td>
          <td width="50%"><input type="text" name="website" size="20" value="http://"></td>
          <small>
        </tr>
      </table>
      </small><div align="center"><center><p><input type="submit" value="Send It!"
      name="Send Article"><input type="reset" value="reset" name="Reset the Button"></p>
      </center></div>
    </form>
    </td>
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</table>
</center></div>

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