Team:Valencia Biocampus/contactAux

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Revision as of 19:45, 26 September 2012 by TCarrillo (Talk | contribs)



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<form name="contactForm" id="contactForm" method="post" action="http://www.mycontactform.com/sendform/sendform.php" style="width: 100%; border: 0px solid #000000; margin: 0; padding: 0; background-color: #FFFFFF;">

 <label for="email" style="float: left; width: 30%; padding-top: 4px; font-family: Arial; color: #000000; font-size: 14px; font-weight: bold;">E-mail Address: *</label>
 <input name="email" type="email" id="email" size="20" maxlength="100" required="required" style="font-family: Arial; font-size: 14px; color: #000000; background-color: #FFFFFF; border: 1px solid #000000; padding: 2px;" />
 <label for="q1" style="float: left; width: 30%; padding-top: 4px; font-family: Arial; color: #000000; font-size: 14px; font-weight: bold;">Name: *</label> <input name="q1" type="text" id="q1" value="" size="30" maxlength="150" style="font-family: Arial; font-size: 14px; color: #000000; background-color: #FFFFFF; border: 1px solid #000000; padding: 2px;" />
 <label for="q2" style="float: left; width: 100%; display: block; padding-top: 4px; font-family: Arial; color: #000000; font-size: 14px; font-weight: bold;">Mailing Address: </label> <textarea name="q2" id="q2" cols="30" rows="3" style="font-family: Arial; font-size: 14px; color: #000000; background-color: #FFFFFF; border: 1px solid #000000; padding: 2px;" /></textarea>
 <label for="q3" style="float: left; width: 30%; padding-top: 4px; font-family: Arial; color: #000000; font-size: 14px; font-weight: bold;">City: </label> <input name="q3" type="text" id="q3" value="" size="20" maxlength="150" style="font-family: Arial; font-size: 14px; color: #000000; background-color: #FFFFFF; border: 1px solid #000000; padding: 2px;" />
 <label for="q4" style="float: left; width: 30%; padding-top: 4px; font-family: Arial; color: #000000; font-size: 14px; font-weight: bold;">State: </label> <select name="q4" id="q4" style="font-family: Arial; font-size: 14px; color: #000000; background-color: #FFFFFF; border: 1px solid #000000; padding: 2px;">

<option value="Alabama">Alabama</option> <option value="Alaska">Alaska</option> <option value="Arizona">Arizona</option> <option value="Arkansas">Arkansas</option> <option value="California">California</option> <option value="Colorado">Colorado</option> <option value="Connecticut">Connecticut</option> <option value="Delaware">Delaware</option> <option value="Florida">Florida</option> <option value="Georgia">Georgia</option> <option value="Hawaii">Hawaii</option> <option value="Idaho">Idaho</option> <option value="Illinois">Illinois</option> <option value="Indiana">Indiana</option> <option value="Iowa">Iowa</option> <option value="Kansas">Kansas</option> <option value="Kentucky">Kentucky</option> <option value="Louisiana">Louisiana</option> <option value="Maine">Maine</option> <option value="Maryland">Maryland</option> <option value="Massachusetts">Massachusetts</option> <option value="Michigan">Michigan</option> <option value="Minnesota">Minnesota</option> <option value="Mississippi">Mississippi</option> <option value="Missouri">Missouri</option> <option value="Montana">Montana</option> <option value="Nebraska">Nebraska</option> <option value="Nevada">Nevada</option> <option value="New Hampshire">New Hampshire</option> <option value="New Jersey">New Jersey</option> <option value="New Mexico">New Mexico</option> <option value="New York">New York</option> <option value="North Carolina">North Carolina</option> <option value="North Dakota">North Dakota</option> <option value="Ohio">Ohio</option> <option value="Oklahoma">Oklahoma</option> <option value="Oregon">Oregon</option> <option value="Pennsylvania">Pennsylvania</option> <option value="Rhode Island">Rhode Island</option> <option value="South Carolina">South Carolina</option> <option value="South Dakota">South Dakota</option> <option value="Tennessee">Tennessee</option> <option value="Texas">Texas</option> <option value="Utah">Utah</option> <option value="Vermont">Vermont</option> <option value="Virginia">Virginia</option> <option value="Washington">Washington</option> <option value="Washington, DC">Washington, DC</option> <option value="West Virginia">West Virginia</option> <option value="Wisconsin">Wisconsin</option> <option value="Wyoming">Wyoming</option> <option value="">--Territories--</option> <option value="American Samoa">American Samoa</option> <option value="Federated States of Micronesia">Federated States of Micronesia</option> <option value="Guam">Guam</option> <option value="Midway Islands">Midway Islands</option> <option value="Puerto Rico">Puerto Rico</option> <option value="U.S. Virgin Islands">U.S. Virgin Islands</option> </select>

 <label for="q5" style="float: left; width: 30%; padding-top: 4px; font-family: Arial; color: #000000; font-size: 14px; font-weight: bold;">Zip Code: </label> <input name="q5" id="q5" type="text" value="" size="10" maxlength="20" style="font-family: Arial; font-size: 14px; color: #000000; background-color: #FFFFFF; border: 1px solid #000000; padding: 2px;" />
 <label for="q6" style="float: left; width: 30%; padding-top: 4px; font-family: Arial; color: #000000; font-size: 14px; font-weight: bold;">Phone: </label> <input name="q6" type="text" id="q6" value="(xxx) xxx - xxxx" size="30" maxlength="150" style="font-family: Arial; font-size: 14px; color: #000000; background-color: #FFFFFF; border: 1px solid #000000; padding: 2px;" />
 <label for="q7" style="float: left; width: 30%; padding-top: 4px; font-family: Arial; color: #000000; font-size: 14px; font-weight: bold;">Message: </label> <textarea name="q7" id="q7" cols="45" rows="6" style="font-family: Arial; font-size: 14px; color: #000000; background-color: #FFFFFF; border: 1px solid #000000; padding: 2px;" /></textarea>

  <input name="user" type="hidden" id="user" value="vlcbiocampus" />
  <input name="formid" type="hidden" id="formid" value="386972" />
  <input name="subject" type="hidden" id="subject" value="question_valencia_biocampus" />
  <input name="submit" type="submit" value="Submit" style="font-family: ; font-size: ; color: ; background-color: ; border:  solid ; padding: 2px;" />
  <input name="reset" type="reset" value="Reset" style="font-family: ; font-size: ; color: ; background-color: ; border:  solid ; padding: 2px;" />
* Required <a href="http://www.mycontactform.com" target="_blank">Powered by myContactForm.com</a>

</form>