<div align="center">
<span style="color: #073763; font-family: 'Trebuchet MS', sans-serif; font-size: large;"></span></div>
<link href="http://www.emailmeform.com/builder/styles/dynamic.php?t=post" rel="stylesheet" type="text/css"></link>
<script src="http://www.emailmeform.com/builder/js/dynamic.php?t=post&t2=0" type="text/javascript">
</script>
<form action="http://www.emailmeform.com/builder/form/Ow97onjbEv" enctype="multipart/form-data" id="emf-form" method="post" name="emf-form">
<table bgcolor="transparent" border="0" cellpadding="2" cellspacing="0" style="text-align: left;"><tbody>
<tr> <td colspan="2"><b style="font-family: Verdana; font-size: 20px;">Please email with any questions or comments!</b>
<span style="color: black; font-family: Verdana;">
</span></td> </tr>
<tr valign="top"> <td align="">
<span style="color: black; font-family: Verdana; font-size: x-small;"><b>Name</b></span> <span style="color: red;"><small>*</small></span></td> </tr>
<tr> <td>
<input class="validate[required]" id="element_0" name="element_0" size="30" type="text" value="" />
<div style="color: black; padding-bottom: 8px;">
</div>
</td> </tr>
<tr valign="top"> <td align="">
<span style="color: black; font-family: Verdana; font-size: x-small;"><b>Email</b></span> <span style="color: red;"><small>*</small></span></td> </tr>
<tr> <td>
<input class="validate[required,custom[email]]" id="element_1" name="element_1" size="30" type="text" value="" />
<div style="color: black; padding-bottom: 8px;">
</div>
</td> </tr>
<tr valign="top"> <td align="">
<span style="color: black; font-family: Verdana; font-size: x-small;"><b>Website</b></span></td> </tr>
<tr> <td>
<input class="validate[optional,funcCall[url_ex,optional]]" id="element_2" name="element_2" size="30" type="text" value="http://" />
<div style="color: black; padding-bottom: 8px;">
<small><span style="font-family: Verdana;">We'd love to visit your website!</span></small></div>
</td> </tr>
<tr valign="top"> <td align="">
<span style="color: black; font-family: Verdana; font-size: x-small;"><b>Subject</b></span> <span style="color: red;"><small>*</small></span></td> </tr>
<tr> <td>
<input class="validate[required]" id="element_3" name="element_3" size="30" type="text" value="" />
<div style="color: black; padding-bottom: 8px;">
</div>
</td> </tr>
<tr valign="top"> <td align="">
<span style="color: black; font-family: Verdana; font-size: x-small;"><b>Message</b></span> <span style="color: red;"><small>*</small></span></td> </tr>
<tr> <td>
<textarea class="validate[required]" cols="60" id="element_4" name="element_4" rows="10"><br /> </textarea>
<div style="color: black; padding-bottom: 8px;">
</div>
</td> </tr>
<tr> <td colspan="2">
<table bgcolor="#8FC63D" cellpadding="5" cellspacing="0"><tbody>
<tr bgcolor="#003370"> <td colspan="2">
<span style="color: white; font-family: Verdana; font-size: x-small;"><b>Image Verification</b></span></td> </tr>
<tr> <td style="padding: 2px; width: 100px;">
<img alt="captcha" id="captcha_image" name="captcha_image" src="http://www.emailmeform.com/builder/captcha/index/c5ea1263b2fdfdd68e578a52c388322b" /></td> <td valign="top">
<div>
<span style="color: black;">Please enter the text from the image</span>:
<input class="validate[required,funcCall[valid_captcha]]" id="captcha_code" maxlength="10" name="captcha_code" size="10" type="text" /> [<a href="javascript:void(0);" id="captcha_code_refresh" name="captcha_code_refresh" onclick="document.getElementById('captcha_image').src = 'http://www.emailmeform.com/builder/captcha/index/'+Math.random();get_valid_captcha();return false;">Refresh Image</a>] [<a href="javascript:void(0);" id="captcha_code_about" name="captcha_code_about" onclick="window.open('http://www.emailmeform.com/captcha-instruction.html','_blank','width=400, height=500, left=' + (screen.width-450) + ', top=100');return false;">What's This?</a>]</div>
</td> </tr>
</tbody></table>
</td> </tr>
<tr> <td align="right" colspan="2">
<input name="element_counts" type="hidden" value="5" /> <input name="embed" type="hidden" value="forms" /><input type="submit" value="Send email" /><input type="reset" value="Clear" /></td> </tr>
</tbody></table>
</form>
<script type="text/javascript">
//<![CDATA[
$('body').append('
<div>
<font face="Verdana" size="2" color="#000000">Powered by<\/font><span style="position: relative; padding-left: 3px; bottom: -5px;"><img src="http://www.emailmeform.com/builder/images/footer-logo.png" /><\/span><font face="Verdana" size="2" color="#000000">EMF <\/font><a style="text-decoration:none;" href="http://www.emailmeform.com" target="_blank"><font face="Verdana" size="2" color="#000000"><font face="Verdana" size="2" color="#000000">Easy Form Builder<\/font><\/font><\/a><\/div><font face="Verdana" size="2" color="#000000"><a style="line-height:20px;font-size:70%;text-decoration:none;" href="http://www.emailmeform.com/report-abuse.html?http://www.emailmeform.com/builder/form/Ow97onjbEv" target="_blank">Report Abuse<\/a><\/font>')
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</script><script type="text/javascript">
//<![CDATA[
$(function(){
$("#emf-form").validationEngine({
validationEventTriggers:"blur",
scroll:false
});
$('.datepicker').datepicker({
showOn: 'button',
buttonImage: base_url+'images/calendar.png',
buttonImageOnly: true,
onSelect: function(dateText, inst) {
var selectedDate = new Date(dateText);
$('#'+inst.id+'year').val(selectedDate.getFullYear());
$('#'+inst.id+'year-mm').val(((selectedDate.getMonth()+1)>9)?(selectedDate.getMonth()+1):('0'+(selectedDate.getMonth()+1)));
$('#'+inst.id+'year-dd').val(selectedDate.getDate()>9?selectedDate.getDate():'0'+selectedDate.getDate());
$('.'+inst.id+'yearformError').remove();
$('.'+inst.id+'year-mmformError').remove();
$('.'+inst.id+'year-ddformError').remove();
},
changeMonth: true,
changeYear: true
});
if(document.getElementById('captcha_image')!=null){
get_valid_captcha();
}
if(document.getElementById('captcha_image')!=null){
var isSafari = (/Safari/.test(navigator.userAgent));
var firstTimeSession = 0;
function process_captcha(){
$('a#captcha_code_refresh').trigger('click');
get_valid_captcha();
}
function safari_submit_session_form() {
if (firstTimeSession == 0) {
firstTimeSession = 1;
$("#safari_sessionform").submit();
setTimeout('process_captcha()',2000);
}
}
if(isSafari){
$("body").append('<iframe id="safari_sessionframe" name="safari_sessionframe" onload="safari_submit_session_form();" src="http://www.emailmeform.com/get_safari_cookies.php" style="display:none;"><\/iframe><form id="safari_sessionform" enctype="application/x-www-form-urlencoded" action="http://www.emailmeform.com/get_safari_cookies.php" target="safari_sessionframe" action="post">
<\/form>');
}
}
});
//]]>
</script>
<div style="text-align: center;">
<span class="Apple-style-span" style="color: #38761d; font-family: 'Trebuchet MS', sans-serif;"><b>Receive Free Updates from At The Picket Fence!</b></span></div>
<form action="http://feedburner.google.com/fb/a/mailverify" method="post" onsubmit="window.open('http://feedburner.google.com/fb/a/mailverify?uri=AtThePicketFence', 'popupwindow', 'scrollbars=yes,width=550,height=520');return true" style="border: 1px solid #ccc; padding: 1px; text-align: center;" target="popupwindow">
Enter your email address:
<input name="email" style="width: 140px;" type="text" />
<input name="uri" type="hidden" value="AtThePicketFence" /><input name="loc" type="hidden" value="en_US" /><input type="submit" value="Free Updates" />
Delivered by <a href="http://feedburner.google.com/" target="_blank">FeedBurner</a></form>
