<table width="100%" border="0" cellspacing="0" cellpadding="0" bgcolor="#FFFFFF"> <tr> <td><span class=default> <!-- startprint --> <span class=default><a title="fundraising thermometer" target="_blank" href="http://www.FastTrackFundraising.com?src=FundTracker"><img alt="fundraising thermometer" align="right" border="0" src="http://www.fasttrackfundraising.com/fund-tracker.php?id=2944"></a> <img title="" height="190" alt="" width="200" src="uploaded_graphics/bday3.gif"><br> <br> <p>Prize4Life is three years old! Founded by Harvard Business School students in 2006, the organization has grown into an innovative, results-oriented not-for-profit working every day to accelerate the discovery of a treatment and a cure for ALS!</p> <p>Celebrate our third year by making your birthday gift and signing our Birthday Party Guest Book below. Show your support for a world without ALS and help us reach our 3<sup>rd</sup> Birthday Party goal of $30,000 (that's $10,000 per year) by our May 15<sup>th</sup> birthday! <em>Thank you for your support!</em></p> <p> <form method="post" action="https://www.paypal.com/cgi-bin/webscr"><input type="hidden" value="_s-xclick" name="cmd"> <input type="hidden" value="4081723" name="hosted_button_id"> <input type="image" alt="PayPal - The safer, easier way to pay online!" border="0" name="submit" src="https://www.paypal.com/en_US/i/btn/btn_donateCC_LG.gif"> <img height="1" alt="" width="1" border="0" src="https://www.paypal.com/en_US/i/scr/pixel.gif"> </form><br></span><span class=default><br><br> <table border=0 cellpadding=0 cellspacing=0> <tr> <form method="post" action="http://www.prize4life.org/page/4672" name="regForm" onSubmit="return checkForm()"> <td> <table border=0 cellpadding=0 cellspacing=0> <tr><td valign=top><div align=right><span class="formslabel">Your Name: * </span></div></td><!--<td> </td>--><td><input type="text" name="text_3229" value="" size="30" maxlength="40" class="defaultdata"><span class="formssidetext"> </span></td></tr><tr><td valign=top><div align=right><span class="formslabel">Your Email Address: * </span></div></td><!--<td> </td>--><td><input type="text" name="text_3230" value="" size="30" maxlength="40" class="defaultdata"><span class="formssidetext"> </span></td></tr><tr><td valign=top><div align=right><span class="formslabel">Attach a Fun Graphic!: </span></div></td><!--<td> </td>--><td><select name="select_3325" class="defaultdata" size="1" ><option value="" selected>- Select -</option><option value="01" >#1 Side Smile</option><option value="02" >#2 Big Smile</option><option value="03" >#3 Wink</option><option value="04" >#4 Smirk</option><option value="05" >#5 Eye Brows</option><option value="06" >#6 Surprised</option><option value="07" >#7 Whistling</option><option value="08 " >#8 Sunglasses</option></select><span class="formssidetext"> <br> <table width="100" border="0" cellspacing="2" cellpadding="2"> <tr> <td><div align="center">#1</div></td> <td><div align="center">#2</div></td> <td><div align="center">#3</div></td> <td><div align="center">#4</div></td> <td><div align="center">#5</div></td> <td><div align="center">#6</div></td> <td><div align="center">#7</div></td> <td><div align="center">#8</div></td> </tr> <tr> <td><img src="graphics_custom/nav/spacer.gif" width="6" height="6" /><img src="graphics_custom/small_icons/emoticons_01.gif" width="40" height="55" /></td> <td><img src="graphics_custom/nav/spacer.gif" width="6" height="6" /><img src="graphics_custom/small_icons/emoticons_02.gif" width="40" height="55" /></td> <td><img src="graphics_custom/nav/spacer.gif" width="6" height="6" /><img src="graphics_custom/small_icons/emoticons_03.gif" width="40" height="55" /></td> <td><img src="graphics_custom/nav/spacer.gif" width="6" height="6" /><img src="graphics_custom/small_icons/emoticons_04.gif" width="40" height="55" /></td> <td><img src="graphics_custom/nav/spacer.gif" width="6" height="6" /><img src="graphics_custom/small_icons/emoticons_05.gif" width="40" height="55" /></td> <td><img src="graphics_custom/nav/spacer.gif" width="6" height="6" /><img src="graphics_custom/small_icons/emoticons_06.gif" width="40" height="55" /></td> <td><img src="graphics_custom/nav/spacer.gif" width="6" height="6" /><img src="graphics_custom/small_icons/emoticons_07.gif" width="40" height="55" /></td> <td><img src="graphics_custom/nav/spacer.gif" width="6" height="6" /><img src="graphics_custom/small_icons/emoticons_08.gif" width="40" height="55" /></td> </tr> </table> </span></td></tr><tr><td valign=top><div align=right><span class="formslabel">Your Message: * </span></div></td><!--<td> </td>--><td><textarea name="textbox_3231" cols="50" rows="5" class="defaultdata"></textarea><span class="formssidetext"> <br>(Your name and message will be posted to this site below.<br>Your email address <u>will not be posted</u>.)</span></td></tr> <tr><td colspan=2> </td></tr> <tr> <td> </td> <td><span class=formsrequiredlabel>* indicates required information<br><br></span> <input type=hidden name=emailform_action value=submitted> <input type="hidden" name="formrendertime" value="1280605591"> <input type="hidden" name="formminimumdelay" value="10"> <input type="image" name="formsubmitbutton" src="graphics_custom/modules/forms/forms_submit.gif" align="absmiddle" border="0"> <a href="http://www.prize4life.org/page/4672"><img src="graphics_custom/modules/forms/forms_clear.gif" align="absmiddle" border="0"></a> </td> </tr> </table> </td> </form> </tr> </table> <!-- stopprint --> </span></td> </tr> </table>
