rendered paste body<!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=ISO-8859-1" /><title>Untitled Document</title><style type="text/css"><!--.bgform { background-image: url(http://morillomiguens.com.ve/cimma/images/newsdoc/celpic_form.png); border: 1px solid #734616;}.brownborder { border: 1px solid #734616;}body,td,th { font-family: Geneva, Arial, Helvetica, sans-serif; font-size: 14px;}.style1 { color: #333333; font-weight: bold;}.style2 {color: #FF0000}.style4 {color: #006699}.style8 {color: #FFFFFF}body { background-color: #CDF3A3;}--></style></head><body><table width="100%" border="0" cellpadding="0" cellspacing="0" bgcolor="#FFFFFF" class="brownborder" id="Master"> <tr> <td scope="row"><table width="100%" border="0" cellpadding="0" cellspacing="0"> <tr> <td background="celpictop.png" scope="row"><img src="LOGO_MM&A_FORMACION_top.jpg" alt="Logo MM&A" width="280" height="129" /></td> </tr> <tr> <td bgcolor="#FFFFFF" scope="row"><table width="100%" border="0" cellspacing="0" cellpadding="4"> <tr> <td scope="row">Av. Bolívar Norte C. C P. Camoruco piso 8 oficinas de la4 a la 7 <br />Master: (58) (241) 8247555-8235200<br /><a href="http://www.morillomiguens.com.ve" target="_blank">http://www.morillomiguens.com.ve</a> <br />e-mail: <a href="mailto:cursos@morillomiguens.com.ve">cursos@morillomiguens.com.ve</a></td> </tr> </table> </td> </tr> </table> <table width="100%" border="0" cellpadding="2" cellspacing="5" id="empresa"> <tr> <td colspan="4" bgcolor="#60904D" scope="row"><div align="left" class="style8">DATOS DE LA EMPRESA </div></td> </tr> <tr> <td width="12%" scope="row"><div align="left">NOMBRE:</div></td> <td colspan="3"><input name="emp_name" type="text" class="bgform" id="emp_name" maxlength="20" /></td> </tr> <tr> <td valign="top" scope="row"><div align="left">DIRECCION FISCAL: </div></td> <td colspan="3"><textarea name="emp_dirfiscal" cols="50" rows="5" class="bgform" id="emp_dirfiscal"></textarea></td> </tr> <tr> <td scope="row"><div align="left">RIF:</div></td> <td width="38%"><input name="emp_rif" type="text" class="bgform" id="emp_rif" /></td> <td width="5%">NIT:</td> <td width="45%"><input name="emp_nit" type="text" class="bgform" id="emp_nit" /></td> </tr> <tr> <td scope="row"><div align="left">CONTACTO:</div></td> <td><input name="emp_contacto" type="text" class="bgform" id="emp_contacto" maxlength="20" /></td> <td>CARGO:</td> <td><input name="emp_cargo" type="text" class="bgform" id="emp_cargo" maxlength="20" /></td> </tr> <tr> <td scope="row"><div align="left">TELEFONO:</div></td> <td><input name="emp_telefono" type="text" class="bgform" id="emp_telefono" maxlength="20" /></td> <td>FAX:</td> <td><input name="emp_fax" type="text" class="bgform" id="emp_fax" maxlength="20" /></td> </tr> <tr> <td scope="row"><div align="left">E-MAIL:</div></td> <td colspan="3"><input name="emp_email" type="text" class="bgform" id="emp_email" maxlength="40" /></td> </tr> </table></td> </tr> <tr> <td scope="row"><table width="100%" border="0" cellpadding="2" cellspacing="5" id="participantes"> <tr> <td colspan="6" bgcolor="#60904D" scope="row"><div align="left" class="style8">DATOS DE LOS PARTICIPANTES </div></td> </tr> <tr> <td colspan="6" scope="row"><div align="left">Seleccione aqui la cantidad de participantes: <select name="part_cantidad" size="1" class="bgform" id="part_cantidad"> <option value="1">1</option> <option value="2">2</option> <option value="3">3</option> <option value="4">4</option> <option value="5">5</option> <option value="6">6</option> <option value="7">7</option> <option value="8">8</option> <option value="9">9</option> <option value="10">10</option> <option value="11">11</option> <option value="12">12</option> <option value="13">13</option> <option value="14">14</option> <option value="15">15</option> <option value="16">16</option> <option value="17">17</option> <option value="18">18</option> <option value="19">19</option> <option value="20">20</option> </select> </div></td> </tr> <tr> <td width="16%" scope="row"><div align="center">NOMBRE</div></td> <td width="16%" scope="row"><div align="center">APELLIDO</div></td> <td width="16%" scope="row"><div align="center">C.I</div></td> <td width="16%" scope="row"><div align="center">CARGO</div></td> <td width="16%" scope="row"><div align="center">DEPARTAMENTO</div></td> <td width="16%" scope="row">TELEFONO</td> </tr> <tr> <td scope="row"><input name="part_name" type="text" class="bgform" id="part_name" maxlength="20" /></td> <td scope="row"><input name="part_apellido" type="text" class="bgform" id="part_apellido" maxlength="20" /></td> <td scope="row"><input name="part_ci" type="text" class="bgform" id="part_ci" maxlength="20" /></td> <td scope="row"><input name="part_cargo" type="text" class="bgform" id="part_cargo" maxlength="20" /></td> <td scope="row"><input name="part_dpto" type="text" class="bgform" id="part_dpto" maxlength="20" /></td> <td scope="row"><input name="part_telf" type="text" class="bgform" id="part_telf" maxlength="20" /></td> </tr> </table></td> </tr> <tr> <td scope="row"><table width="100%" border="0" cellpadding="2" cellspacing="5" id="seminario1"> <tr> <td colspan="2" bgcolor="#60904D" scope="row"><div align="left" class="style8">DATOS DEL SEMINARIO </div></td> </tr> <tr> <td width="10%" scope="row"><div align="left">NOMBRE:</div></td> <td scope="row"><input name="sem_name" type="text" class="bgform" id="sem_name" maxlength="20" /></td> </tr> <tr> <td scope="row">FECHA:</td> <td scope="row"><input name="sem_fecha" type="text" class="bgform" id="sem_fecha" value="Ejemplo: 24/09/2007" maxlength="20" /></td> </tr> <tr> <td scope="row">LUGAR:</td> <td scope="row"><input name="sem_lugar" type="text" class="bgform" id="sem_lugar" maxlength="20" /></td> </tr> </table> <table width="100%" border="0" cellpadding="2" cellspacing="5" id="seminario2"> <tr> <td width="11%" scope="row">MONTO:</td> <td width="39%" scope="row"><input name="sem_monto" type="text" class="bgform" id="sem_monto" maxlength="40" /></td> <td width="9%" scope="row">N° DE CHEQUE:</td> <td width="41%" scope="row"><input name="sem_cheque" type="text" class="bgform" id="sem_cheque" /></td> </tr> <tr> <td scope="row">N° DEPOSITO:</td> <td scope="row"><input name="sem_deposito" type="text" class="bgform" id="sem_deposito" /></td> <td scope="row">BANCO:</td> <td scope="row"><input name="sem_banco" type="text" class="bgform" id="sem_banco" /></td> </tr> <tr> <td valign="top" scope="row">OBSERVACIONES:</td> <td colspan="3" scope="row"><textarea name="sem_observaciones" cols="40" rows="5" class="bgform" id="sem_observaciones"></textarea></td> </tr> </table> <table width="100%" border="0" cellspacing="5" cellpadding="5"> <tr> <th scope="row"><p class="style1">INFORMACION GENERAL: </p> <p class="style2">Para formalizar su inscripción:</p> <p>Favor enviar esta planilla con una carta de postulación. Emitir cheque a nombre de <span class="style4">“Asociación MM&A Desarrollo y Formación Profesional”</span> o depositar en nuestras cuentas corrientes: </p> <table width="500" border="0" cellspacing="5" cellpadding="0"> <tr> <th width="149" class="style1" scope="row"><div align="left"><em><strong>Banco Provincial No:</strong></em></div></th> <td width="336"><span class="style4">0108- 0222- 90- 0100052811 </span></td> </tr> <tr> <th class="style1" scope="row"><div align="left"><em><strong>Banco BOD No:</strong></em></div></th> <td><span class="style4">0116-0039-52-0006362044</span></td> </tr> </table> <p class="style2">Favor enviar comprobante de depósito por fax y entregar el original al momento del evento contra factura.</p></th> </tr> </table> </td> </tr></table></body></html>