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<?php include("Connecter/dataconn.php"); ?> <!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> <?php include("head.php"); ?> </head> <body> <?php include("top.php"); ?> <?php include("titlebar.php"); ?> <?php include("mast.php"); ?> <?php include("navbar.php"); ?> <?php include("contenttop.php"); ?> <?php include("sidebar.php"); ?> <?php include("mainbartop.php"); ?> <!--Content Goes here--> <table width="100%" border="0" cellpadding="0" cellspacing="7px"> <tr valign="top"> <td width="220px" style="border-right:1px solid #CCCCCC;"> <img src="feedback.jpg" /> <div style="color:#990000; padding:10px 0px 10px 0px;"><b>Feedbacks...</b></div> <div class="headings" style="padding-right:20px;">Feel free to give us your suggestions, feedbacks, comments and to ask your questions. You could also make a prayer request.</div> <div style="padding-left:100px"><img src="feedback.png" /></div> <img src="reqask.jpg" /> </td> <td> <div class="headingbigger">Feedbacks Form</div> <div> </div> <div>Please, Fill the form. The asterisked fields are required!</div> <div class="headingnormal"><?php echo $bb; ?></div> <div> </div> <form action="verifycap.php" method="post" name="form1" class="yey" id="form1" onsubmit="MM_validateForm('Your Name','','R','Your Email','','RisEmail','security_code','','R','Your Remark','','R');return document.MM_returnValue"> <table width="100%" cellpadding="1" cellspacing="2"> <tr valign="top"> <td style="font-weight:bold; text-align:center" width="100px">*Name</td> <td align="left" ><input name="namer" type="text" id="Your Name" size="40" required="required" /></td> </tr> <tr valign="top"> <td style="font-weight:bold; text-align:center">*Email</td> <td align="left" ><input name="email" type="text" id="Your Email" size="40" required="required" /></td> </tr> <tr valign="top"> <td style="font-weight:bold; text-align:center">Phone</td> <td align="left" ><input name="phone" type="text" id="Your Phone" size="40" /></td> </tr> <tr valign="top"> <td style="font-weight:bold; text-align:center">*Comments / Suggestions / Questions / Prayer Request</td> <td align="left" ><textarea name="remark" cols="30" rows="10" id="Your Remark" required="required"></textarea></td> </tr> <tr valign="top"> <td style="font-weight:bold; text-align:center"><img src="CaptchaSecurityImages.php" /></td> <td align="left"><b>Security Code:</b> <input id="security_code" name="security_code" type="text" size="40" required="required" /></td> </tr> <tr valign="top"> <td style="text-align:right; font-size:10px;" colspan="2"> <input name="addremark" type="submit" style="font-size:12px;" id="addremark" value=" Submit " /> </td> </tr> </table> </form> </td> </tr></table> <!--Content Ends here--> <?php include("mainbarbottom.php"); ?> <?php include("contentbottom.php"); ?> <?php include("footbar.php"); ?> <?php include("bottom.php"); ?> </body> </html>
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