<HTML>
<HEAD>
<TITLE>Feedback Form</TITLE>
</HEAD>


<BODY onload="document.MyForm.Name.focus()">
<TABLE WIDTH=80% ALIGN=center>
 <TR>
  <TD>

	<fieldset>
       	 <legend>
		<B>Please fill out this form and submit it.</B>
	 </legend>

	<CENTER>
	<FORM NAME="MyForm" ACTION="process_form2.php" METHOD="post">

	<B>Name:</B>
	<INPUT NAME="Name" SIZE=30>
	<P>
	
	<B>Country/State</B>
	<INPUT NAME="Country" SIZE=30>
	<P>

	<B>Age:</B>
	<SELECT NAME="Age">
		<OPTION>18 - 25
		<OPTION>26 - 30
		<OPTION>31 - 35
		<OPTION>36 - 40
		<OPTION>41 - 50
		<OPTION> > 50
	</SELECT>
	<P>

	<B>Email:</B>
	<INPUT NAME="Email" SIZE=30>
	<P>

	<B>College Student/Graduate?</B>
	<INPUT NAME="College" TYPE="radio" VALUE="Yes">
	<B>Yes</B>
	<INPUT NAME="College" TYPE="radio" VALUE="No">
	<B>No</B>
	<P>

	<B> Iyad's Website is</B>

	<SELECT NAME="Rate">
		<OPTION>Bad
		<OPTION>Good
		<OPTION>Excellent
	</SELECT>

	<P>
	<B>Comments:</B>
	<TEXTAREA NAME="Comments" ROWS=8 COLS=30 WRAP="virtual"></TEXTAREA>


	<CENTER><INPUT TYPE="submit" VALUE="SUBMIT"></CENTER> 
	<INPUT TYPE="reset" VALUE="CLEAR">


	</FORM></CENTER>
	</fieldset>
</TD></TR></TABLE>

</BODY>
</HTML>


