<table>
<form action="http://oi.vresp.com/" method="post">
<input type=hidden name=fid value="1262910590">
<tr><td>Email Address:</td><td><input type=TEXT name="email_address"></td></tr>
<tr><td>First Name:</td><td><input type=TEXT name="first_name"></td></tr>
<tr><td>Last Name:</td><td><input type=TEXT name="last_name"></td></tr>
<tr><td colspan=2><input type=checkbox value=1 name=optin>I want to receive mailings from Formative</td></tr>
<tr><td colspan=2><input type=hidden name=form_submitted value=1>
<input hspace=5 type=image border=0 src="http://oi.vresp.com/join_now.gif" name="form_submitted" value="submit"></form></td></tr>
</table>