Untitled

<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN">
<html>
<head>
<title>Believers Faith Outreach Ministries Registration</title>
<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1">

<style type="text/css" title="text/css">
/* <![CDATA[ */
/*-- general appearance --*/
body {
	font-family:verdana;
	font-size:11px;
	background-color: #ddccff;
}



.required {color:red;}

legend {font-weight:bold;
margin:22px;}

form div {margin-bottom:6px;}

div label {display:block; float:left; width:100px;}

div input {
padding:2px;
display:inline; 
width:200px; 
height:25px; 
font-size:14px;}
div textarea {width:200px; font-size:12px}

form #submit_button {display:block; margin-left:100px}

/* ]]> */
.style1 {
	font-size: 12mm;
	font-weight: bold;
}
.style5 {
	font-size: 9mm;
	font-weight: bold;
}
.style7 {font-family: Verdana, Arial, Helvetica, sans-serif}
.style8 {
	color: #000000;
	font-size: 14px;
}
</style>

</head>
<body>

<h1 align="center"><span class="style1"><font face="Edwardian Script ITC">Breaking The Chains Walking In Power</font></span><br>
  <span class="style5"><font face="Arial, Helvetica, sans-serif">Prophetic Breakthrough Revival</font></span><br>
  <span class="style1"><font face="Edwardian Script ITC">Conference 2006 </font></span></h1>
<p align="center" class="style5">REGISTRATION FORM </p>
<form action="registration_process.php" method="post">
<p class="style7">
  <input type="hidden" name="cmd" value="process" />
  
</p>
<fieldset>
<legend><span class="style8">Registration Information</span></legend>

<div>
<label for="">Title</label>
<select name="title" id="title">
<option>Mr.</option>
<option>Mrs.</option>
<option>Miss</option>
<option>Ms.</option>
</select>
</div>

<div>
<label for="">First Name</label>
<input name="firstname" type="text" id="firstname"  />
</div>

<div>
<label for="">Last Name</label>
<input name="lastname" type="text" id="lastname"  />
</div>

<div>
<label>E-mail</label>
<input name="email" type="text" id="email" size="50" maxlength="100" />
</div>


<div>
<label for="">Phone (home)</label>
<input name="hmphone" type="text" id="hmphone"  />
</div>

<div>
<label for="">Phone (work)</label>
<input name="wrkphone" type="text" id="wrkphone"  />
</div>

<div>
<label for="">Church </label>
<textarea name="church" cols="50" rows="3" id="church"></textarea>
</div>

<div>
<label for="">Occupation </label>
<input name="occupation" type="text" id="occupation" value="" />
</div>

<div>
<label for="">Country</label>
<input name="country" type="text" id="country"  />
</div>

<div>
<label for="">State</label>
<input name="state" type="text" id="state"  />
</div>

<div>
<label for="">City</label>
<input name="city" type="text" id="city"  />
</div>

<div>
<label for="">Street</label>
<input name="street" type="text" id="street" value="" size="50" />
</div>

<div>
<label for="">Postal Address</label>
<input name="postal" type="text" id="postal"  />
</div>


</fieldset>

<fieldset>
<legend><span class="style8">Arrival/Accomodations/Departure</span></legend>

<div>
<label for="">Date of Arrival</label>
<input type="text" name="arrival_date" />
</div>

<div>
<label for="">Time</label>
<input type="text" name="arrival_time" />
</div>

<div>
<label for="">Airline</label>
<input type="text" name="airline" />
</div>

<div>
<label for="">Flight</label>
<input type="text" name="flight" />
</div>

<div>
<label for="">Hotel</label>
<input type="text" name="hotel" />
</div>

<div>
<label for="">Date of Departure</label>
<input type="text" name="departure_date" />
</div>

<div>

<input type="submit" value="Register" id="submit_button" />
</div>
</fieldset>

</form>

</body>
</html>