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This table is used for column layout.
Standard Form
<!--#rem **** CHANGE LOG *****
This is the change log for this template. It will consist of a date, 'search code' for finding the template and a note of the change

The Standard Form is almost an exact clone of the Service Request Form (Form ID 2040)
This form functions as an "Anonymous" form because the Name and Email field aren't
required for the site visitor, instead the information is entered by the person creating the form


DATE            SEARCH CODE             NOTE
10/09/14                                        Template created
10/14/14        CL101414                        Created hidden fields for the Email From Name and Email From Address
**** End CHANGE LOG **** -->

<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN">
<HTML LANG="en">
<HEAD>
<TITLE><!--#if expr="<X-FC-FIELD SITEPREF.1197 LENGTH>>1"--><X-FC-FIELD SITEPREF.1197 STRING> - <!--#endif--><X-FC-ITEM DATA[Subject]></TITLE>
<meta name="description" content="<!--#if expr="(<X-FC-FIELD 8022 LENGTH>>1)"--><X-FC-FIELD 8022 STRING><!--#else--><X-FC-ITEM DATA[Subject]><!--#endif-->">
<meta name="keywords" content="<X-FC-ITEM DATA[Name]>,<X-FC-ITEM DATA[Subject]><!--#if expr="(<X-FC-FIELD 1900 LENGTH>>1)"-->,<X-FC-FIELD 1900 STRING><!--#endif-->">
<X-FC-WHITESPACE STRIP>
<!--TS=<X-FC-REQUEST-TIME>-->
<!--#rem Include Server Variables-->
<!--#include virtual="/.templates/SSF/serverVar.inc"-->
<!--version=<!--#echo var="ifeVersion"-->-->
<!--formid=2041-->
<!--#rem Get Global Data -->
<!--#set var="formMarker" value="2040"-->
<!--#rem Determine core browser type in order to account for variations in CSS implementation.
1 - MSIE (WIN)
2 - MSIE (MAC)
3 - Firefox (WIN)
4 - Firefox (MAC)
5 - Camino (MAC)
6 - Safari (ALL)
-->
<!--#set var="cssbrowser" value="0"-->
<!--#set var="host_MSIE" expr="@indexof($HTTP_USER_AGENT,'MSIE')"-->
<!--#if expr="$host_MSIE!=-1"-->
        <!--#set var="platCheck" expr="@indexof($HTTP_USER_AGENT,'Windows')"-->
        <!--#if expr="$platCheck!=-1"-->
                <!--#set var="cssbrowser" value="1"-->
        <!--#else-->
                <!--#set var="cssbrowser" value="2"-->
        <!--#endif-->
<!--#endif-->
<!--#set var="host_FF" expr="@indexof($HTTP_USER_AGENT,'Firefox')"-->
<!--#if expr="$host_FF!=-1"-->
        <!--#set var="platCheck" expr="@indexof($HTTP_USER_AGENT,'Windows')"-->
        <!--#if expr="$platCheck!=-1"-->
                <!--#set var="cssbrowser" value="3"-->
        <!--#else-->
                <!--#set var="cssbrowser" value="4"-->
        <!--#endif-->
<!--#endif-->
<!--#set var="host_CMO" expr="@indexof($HTTP_USER_AGENT,'Camino')"-->
<!--#if expr="$host_CMO!=-1"-->
        <!--#set var="cssbrowser" value="5"-->
<!--#endif-->
<!--#set var="host_SFI" expr="@indexof($HTTP_USER_AGENT,'Safari')"-->
<!--#if expr="$host_SFI!=-1"-->
        <!--#set var="cssbrowser" value="6"-->
<!--#endif-->
<!--#rem Set included styles and include global stylesheet-->
        <!--#set var="attachinc" value="0"-->
        <!--#set var="calendarinc" value="0"-->
        <!--#set var="confcontinc" value="0"-->
        <!--#set var="detailcentinc" value="0"-->
        <!--#set var="formsinc" value="1"-->
        <!--#set var="inccalinc" value="0"-->
        <!--#set var="inccentnavinc" value="0"-->
        <!--#set var="inctablesinc" value="0"-->
        <!--#set var="intentionsinc" value="0"-->
        <!--#set var="inthomeinc" value="0"-->
        <!--#set var="logininc" value="0"-->
        <!--#set var="slidenewinc" value="0"-->
        <!--#set var="slideshowinc" value="0"-->
        <!--#set var="tablestylesinc" value="1"-->
        <!--#set var="tablestylesdeptinc" value="0"-->
        <!--#set var="tablestyleshomeinc" value="0"-->
<!--#rem Set Global Variables-->
<!--#set var="isHomePage" value="0"-->
<!--#set var="isACal" value="0"-->
<!--#set var="sortDate" value="<X-FC-SERVER-TIME %#y%m%d>"-->
<!--#set var="loginAVal" value=""-->
<!--#if expr="<X-FC-LOGGED-IN>"-->
        <!--#set var="loginAVal" value="/Login/__WWW"-->
        <!--#set var="loginCVal" expr="@substr('<X-FC-FIELD SITEPREF.2021 DEFAULT=/Pages/ STRING>',0,1)"-->
        <!--#set var="theLoginLoc" expr="@substr(`<X-FC-OBJURL NOSLASH>`,12,200)"-->
        <!--#set var="theLocation" expr="@lower('$theLoginLoc')"-->
        <!--#set var="theLocOrig" value="$theLoginLoc"-->
<!--#else-->
        <!--#set var="theLocation" expr="@lower(`<X-FC-OBJURL NOSLASH>`)"-->
        <!--#set var="theLocOrig" value="<X-FC-OBJURL SLASH>"-->
<!--#endif-->
<!--#set var="theSubject" value="<X-FC-ITEM DATA[Subject]>"-->
<!--#set var="totPageCol" value="<X-FC-FIELD SITEPREF.2034 DEFAULT=2 NUMBER>"-->
<!--#set var="isPrint" value="1"-->
<!--#set var="lastUpdate" value="0"-->
<!--#set var="pageNine" value="<X-FC-FIELD SITEPREF.1205 DEFAULT=0 NUMBER>"-->
<!--#if expr="$pageNine=0"-->
        <!--#set var="totalSpan" expr="<X-FC-FIELD SITEPREF.2034 DEFAULT=2 NUMBER>+2"-->
<!--#else-->
        <!--#set var="totalSpan" value="<X-FC-FIELD SITEPREF.2034 DEFAULT=2 NUMBER>"-->
<!--#endif-->
<!--#set var="isSubtitle" value="0"-->
<!--#if expr="<X-FC-FIELD 1400 LENGTH>>1"-->
        <!--#set var="isSubtitle" value="1"-->
        <!--#set var="theSubtitle" value="<X-FC-FIELD 1400 STRING>"-->
<!--#endif-->
<!--#set var="printPage" value="0"-->
<!--#if expr="(<X-FC-URL-PARAMETER textPage EXISTS>)||(<X-FC-FIELD SITEPREF.1579 DEFAULT=1 NUMBER>=0)||(<X-FC-FIELD 3900 DEFAULT=0 NUMBER>=1)"-->
        <!--#set var="printPage" value="1"-->
<!--#endif-->
<!--#set var="isDynav" value="0"-->
<!--#set var="slideImg" value="slideImg"-->
<!--#set var="subjArray" value="subjArray"-->
<!--#rem Set Page Variables-->
<!--#set var="checkIfBoxes" value="1099"-->
<!--#set var="checkYesBoxes" value="0"-->
<!--#while expr="++$checkIfBoxes<1151"-->
        <!--#if expr="<X-FC-FIELD $checkIfBoxes LENGTH>!=0"-->
                <!--#set var="checkYesBoxes" value="1"-->
        <!--#endif-->
<!--#endwhile-->
<!--#set var="selectQ" value="0"-->
<!--#set var="selectCount" value="0"-->
<!--#set var="selectStart" value="1500"-->
<!--#while expr="++$selectCount<=4"-->
        <!--#if expr="<X-FC-FIELD `$selectStart` LENGTH>>1"-->
                <!--#set var="selectQ" value="1"-->
        <!--#endif-->
        <!--#set var="selectStart" expr="$selectStart+10"-->
<!--#endwhile-->
<X-FC-WHITESPACE RETAIN>
<meta http-equiv="content-type" content="text/html; charset=<X-FC-CHARSET>">
<meta http-equiv="cache-control" content="No-Cache, Must-Revalidate">
<meta name="author" content="<X-FC-FIELD SITEPREF.1197 STRING>">
<meta name="language" content="en/us">
<meta name="revised" content="<X-FC-ITEM DATA[Date]>">
<meta name="google_lmd" content="<X-FC-ITEM DATA[Date]>">
<meta name="robots" content="index,follow">
<meta name="revisit-after" content="30 days">
<script type="text/javascript">
<!--
<X-FC-WHITESPACE STRIP>
        var isReady=0;
        function makeReady(){
                isReady=1;
        }
        function goSearch(sTextPos){
                if(document.Search.elements[sTextPos].value==""){
                        document.Search.elements[sTextPos].value="index";
                }
        }
        var totalCheckboxes = 0;
        function checkDaBox(CID){
                if(document.srform.elements[CID].checked==false){document.srform.elements[CID].checked=true;}
                else{document.srform.elements[CID].checked=false;}
        }
        function routeAddress() {
                var i = document.srform.department_select.selectedIndex;
                document.srform.to_address.value = document.srform.department_select.options[i].value;
                document.srform.department_output.value = document.srform.department_select.options[i].text;
        }
        function radioSelSet(sel_field,sel_value){
                var currSelField = document.getElementById(sel_field);
                currSelField.value = sel_value;
        }
        function multiCheckSet(checkAnswer,checkState,checkValue) {
                var checkAnswerField = document.getElementById(checkAnswer);
                var checkValueBase = checkAnswerField.value;
                if (checkState==1) {
                        checkAnswerField.value = checkValueBase + checkValue;
                }
                else if (checkState==0) {
                        var checkValueReplace = checkValueBase.replace(checkValue,"");
                        checkAnswerField.value = checkValueReplace;
                }
        }
        function verifyForm() {
<!--#if expr="$checkYesBoxes=1"-->
                var boardsSelected = "";
                var currentSelected = "";
                for (i=0;i<totalCheckboxes;i++) {
                        if (document.srform.elements[i].checked) {
                                currentSelected = document.srform.elements[i].value;
                                boardsSelected = boardsSelected.concat(currentSelected, ", ");
                        }
                }
<!--#endif-->
                var isReady = 0;
<!--#if expr="<X-FC-FIELD 1500 LENGTH>>1&&<X-FC-FIELD 1508 DEFAULT=1 NUMBER>=1"-->
                var checkSelOneID = document.getElementById('select_question_1_answer');
                var checkSelOne = document.srform.select_1500.selectedIndex;
                checkSelOneID.value = document.srform.select_1500.options[checkSelOne].text;
<!--#endif-->
<!--#if expr="<X-FC-FIELD 1510 LENGTH>>1&&<X-FC-FIELD 1518 DEFAULT=1 NUMBER>=1"-->
                var checkSelTwoID = document.getElementById('select_question_2_answer');
                var checkSelTwo = document.srform.select_1510.selectedIndex;
                checkSelTwoID.value = document.srform.select_1510.options[checkSelTwo].text;
<!--#endif-->
<!--#if expr="<X-FC-FIELD 1520 LENGTH>>1&&<X-FC-FIELD 1528 DEFAULT=1 NUMBER>=1"-->
                var checkSelThreeID = document.getElementById('select_question_3_answer');
                var checkSelThree = document.srform.select_1520.selectedIndex;
                checkSelThreeID.value = document.srform.select_1520.options[checkSelThree].text;
<!--#endif-->
<!--#if expr="<X-FC-FIELD 1530 LENGTH>>1&&<X-FC-FIELD 1538 DEFAULT=1 NUMBER>=1"-->
                var checkSelFourID = document.getElementById('select_question_4_answer');
                var checkSelFour = document.srform.select_1530.selectedIndex;
                checkSelFourID.value = document.srform.select_1530.options[checkSelFour].text;
<!--#endif-->
                if (document.srform.user_required_name.value == "") {isReady = 1;}
                if (document.srform.from_address.value == "") {isReady = 1;}
<!--#if expr="<X-FC-FIELD 2000 DEFAULT=0 NUMBER>=1"-->
                if (document.srform.street_address.value == "") {isReady = 1;}
<!--#endif-->
<!--#if expr="<X-FC-FIELD 2001 DEFAULT=0 NUMBER>=1"-->
                if (document.srform.city_address.value == "") {isReady = 1;}
<!--#endif-->
<!--#if expr="<X-FC-FIELD 2002 DEFAULT=0 NUMBER>=1"-->
                if (document.srform.state_address.value == "") {isReady = 1;}
<!--#endif-->
<!--#if expr="<X-FC-FIELD 2003 DEFAULT=0 NUMBER>=1"-->
                if (document.srform.zip_address.value == "") {isReady = 1;}
<!--#endif-->
<!--#if expr="<X-FC-FIELD 2004 DEFAULT=0 NUMBER>=1"-->
                if (document.srform.phone_address.value == "") {isReady = 1;}
<!--#endif-->
<!--#if expr="<X-FC-FIELD 2006 DEFAULT=0 NUMBER>=1"-->
                if (document.srform.altphone_address.value == "") {isReady = 1;}
<!--#endif-->
<!--#if expr="<X-FC-FIELD 2005 DEFAULT=0 NUMBER>=1"-->
                if (document.srform.fax_address.value == "") {isReady = 1;}
<!--#endif-->
<!--#if expr="<X-FC-FIELD 2007 DEFAULT=0 NUMBER>=1"-->
                if (document.srform.organization_address.value == "") {isReady = 1;}
<!--#endif-->
                if (isReady == 0) {
<!--#if expr="<X-FC-FIELD 1012 DEFAULT=0 NUMBER>=1"-->
                        if (document.srform.digital_signature.checked) {
<!--#endif-->
<!--#if expr="$checkYesBoxes=1"-->
                                var checkTotalField = document.getElementById('checkbox_selected');
                                checkTotalField.value = boardsSelected;
<!--#endif-->
                                document.srform.submit();
<!--#if expr="<X-FC-FIELD 1012 DEFAULT=0 NUMBER>=1"-->
                        }
                        else {
                                alert("You must check the DIGITAL SIGNATURE box.");
                        }
<!--#endif-->
                }
                else {
                        alert("You have not filled out required fields.  Please fill out the form completely.");
                }
        }
<X-FC-WHITESPACE RETAIN>
//-->
</script>
<X-FC-WHITESPACE STRIP>
<!--#if expr="'$printPage'='1'"-->
        <!--#rem Open Printer-Friendly Header-->
<X-FC-WHITESPACE RETAIN>
<style type="text/css">
<!--
#spam1 #spam2 { display: none; }
<!--#include virtual="/.templates/css/printstyles.inc"-->
-->
</style>
<!--TES=<X-FC-REQUEST-TIME>-->
<X-FC-WHITESPACE STRIP>
</HEAD>
<BODY ONLOAD="makeReady()">
<noscript>
        <DIV TITLE="Notice of JavaScript Incompatibility" STYLE="font-size:1em;font-family:arial,sans-serif;display:block;">Your browser either does not support JavaScript or you have JavaScript disabled.  Please enable JavaScript or view this page in <A TITLE="Link to Text Version" TABINDEX="<!--#echo var="TICOUNT"--><!--#set var="TICOUNT" expr="++$TICOUNT"-->" HREF="<X-FC-OBJURL>?Access=1">Text Version</A>.</DIV>
</noscript>
<X-FC-WHITESPACE RETAIN>
<!--INCLUDE SSI printHead.inc-->
<!--#include virtual="/.templates/<X-FC-FIELD SITEPREF.1466 DEFAULT="" STRING>/printHead.inc"-->
<!--/INCLUDE-->
<X-FC-WHITESPACE STRIP>
<A NAME="startcontent" TITLE="Content Begins"></A>
        <!--#rem Close Printer-Friendly Header-->
<!--#else-->
        <!--#rem Open Standard Tabling-->
        <!--#if expr="<X-FC-FIELD SITEPREF.1593 DEFAULT=0 NUMBER>=1"-->
<X-FC-WHITESPACE RETAIN>
<script type="text/javascript" src="/.templates/javascript/fade.js"></script>
<X-FC-WHITESPACE STRIP>
        <!--#endif-->
<X-FC-WHITESPACE RETAIN>
<style type="text/css">
<!--
#spam1 #spam2 { display: none; }
<!--#include virtual="/.templates/css/allstyles.inc"-->
-->
</style>
<!--TES=<X-FC-REQUEST-TIME>-->
<!--INCLUDE SSI preHead.inc-->
<!--#include virtual="/.templates/<X-FC-FIELD SITEPREF.1466 DEFAULT="" STRING>/prehead.inc"-->
<!--/INCLUDE-->
<X-FC-WHITESPACE STRIP>
</HEAD>
<BODY ONLOAD="makeReady()">
<noscript>
        <DIV TITLE="Notice of JavaScript Incompatibility" STYLE="font-size:1em;font-family:arial,sans-serif;display:block;">Your browser either does not support JavaScript or you have JavaScript disabled.  Please enable JavaScript or view this page in <A TITLE="Link to Text Version" TABINDEX="<!--#echo var="TICOUNT"--><!--#set var="TICOUNT" expr="++$TICOUNT"-->" HREF="<X-FC-OBJURL>?Access=1">Text Version</A>.</DIV>
</noscript>
        <!--#rem Open Content orientation from .sitepref-->
<A HREF="#startcontent" TITLE="Navigation Skip Link" TABINDEX="<!--#echo var="TICOUNT"--><!--#set var="TICOUNT" expr="++$TICOUNT"-->" STYLE="display:none;">Skip Navigation</A>
<X-FC-WHITESPACE RETAIN>
<!--INCLUDE SSI outerHead.inc-->
<!--#include virtual="/.templates/<X-FC-FIELD SITEPREF.1466 DEFAULT="" STRING>/outerHead.inc"-->
<!--/INCLUDE-->
<X-FC-WHITESPACE STRIP>
        <!--#rem Open Outer Shell from .sitepref-->
<DIV CLASS="outerDiv"<!--#if expr="<X-FC-FIELD SITEPREF.2022 DEFAULT=1 NUMBER>=1"--> STYLE="text-align:center;margin-left:auto;margin-right:auto;"<!--#endif-->>
        
<X-FC-WHITESPACE RETAIN>
<!--INCLUDE SSI header.inc-->
<!--#include virtual="/.templates/<X-FC-FIELD SITEPREF.1466 DEFAULT="" STRING>/header.inc"-->
<!--/INCLUDE-->
<X-FC-WHITESPACE STRIP>
        <!--#rem Open Inner Shell from .sitepref-->
<TABLE CLASS="innerTable" CELLSPACING="<X-FC-FIELD SITEPREF.1159 DEFAULT=0 NUMBER>" SUMMARY="Layout Table for Column Presentation">
        <THEAD>
        <TR STYLE="display:none;">
                <TH COLSPAN="<!--#echo var="totalSpan"-->">This table is used for column layout.</TH>
        </TR>
        </THEAD>
        <TBODY>
<X-FC-WHITESPACE RETAIN>
<!--INCLUDE SSI pageHead.inc-->
<!--#include virtual="/.templates/<X-FC-FIELD SITEPREF.1466 DEFAULT="" STRING>/pagehead.inc"-->
<!--/INCLUDE-->
<X-FC-WHITESPACE STRIP>
        <TR ALIGN="center" VALIGN="top">
        <!--#if expr="($totPageCol>1)&&(`<X-FC-FIELD SITEPREF.1171 DEFAULT=160 STRING>`!=`0`)"-->
                <TD CLASS="innerLeft">
<X-FC-WHITESPACE RETAIN>
<!--INCLUDE SSI leftNav.inc-->
<!--#include virtual="/.templates/<X-FC-FIELD SITEPREF.1466 DEFAULT="" STRING>/leftnav.inc"-->
<!--/INCLUDE-->
<X-FC-WHITESPACE STRIP>
                <!--#if expr="<X-FC-FIELD SITEPREF.1512 DEFAULT=0 NUMBER>=2"-->
                        <!--#rem Dynamic Navigation-->
                        <!--#set var="isDynav" value="1"-->
                        <!--#set var="dynavtype" value="folder"-->
<X-FC-WHITESPACE RETAIN>
<!--#include virtual="<X-FC-OBJURL-UP>/?formid=-205&folders=1-40"-->
<X-FC-WHITESPACE STRIP>
                        <!--#set var="dynavtype" value="item"-->
<X-FC-WHITESPACE RETAIN>
<!--#include virtual="<X-FC-OBJURL-UP>/?formid=-205&items=1-100"-->
<X-FC-WHITESPACE STRIP>
                        <!--#set var="isDynav" value="0"-->
                <!--#endif-->
<X-FC-WHITESPACE RETAIN>
<!--INCLUDE SSI leftNavFoot.inc-->
<!--#include virtual="/.templates/<X-FC-FIELD SITEPREF.1466 DEFAULT="" STRING>/leftnavfoot.inc"-->
<!--/INCLUDE-->
<X-FC-WHITESPACE STRIP>
                </TD>
        <!--#endif-->
        <!--#if expr="$pageNine=0"-->
                <TD WIDTH="9"<!--#if expr="(`<X-FC-FIELD SITEPREF.1171 DEFAULT=160 STRING>`!=`0`)&&(<X-FC-FIELD SITEPREF.2035 DEFAULT=1 NUMBER>=1)"--> CLASS="nineLeft"<!--#endif-->>
                        <SPAN TITLE="Spacer" STYLE="width:9px;height:200px;display:block;overflow:hidden">&nbsp;</SPAN>
                </TD>
        <!--#endif-->
                <TD CLASS="innerCent">
                        <A NAME="startcontent" TITLE="Content Begins"></A>
        <!--#if expr="<X-FC-FIELD SITEPREF.1227 DEFAULT=0 NUMBER>=1&&<X-FC-FIELD SITEPREF.3100 DEFAULT=0 NUMBER>=0"-->
<X-FC-WHITESPACE RETAIN>
<!--#include virtual="/.templates/SSF/breadcrumb.inc"-->
<X-FC-WHITESPACE STRIP>
        <!--#endif-->
<X-FC-WHITESPACE RETAIN>
<!--#rem INCLUDE SSI pageBegin.inc-->
<!--#include virtual="/.templates/<X-FC-FIELD SITEPREF.1466 DEFAULT="" STRING>/pagebegin.inc"-->
<!--#rem /INCLUDE-->
<X-FC-WHITESPACE STRIP>
                        <!--#echo var="theSubject"-->
        <!--#if expr="$isSubtitle=1"-->
<X-FC-WHITESPACE RETAIN>
<!--#rem INCLUDE SSI pageMid.inc-->
<!--#include virtual="/.templates/<X-FC-FIELD SITEPREF.1466 DEFAULT="" STRING>/pagemid.inc"-->
<!--#rem /INCLUDE-->
<X-FC-WHITESPACE STRIP>
                        <!--#echo var="theSubtitle"-->
        <!--#endif-->
<X-FC-WHITESPACE RETAIN>
<!--#rem INCLUDE SSI pageEnd.inc-->
<!--#include virtual="/.templates/<X-FC-FIELD SITEPREF.1466 DEFAULT="" STRING>/pageend.inc"-->
<!--#rem /INCLUDE-->
<X-FC-WHITESPACE STRIP>
        <!--#if expr="<X-FC-FIELD SITEPREF.1227 DEFAULT=0 NUMBER>=1&&<X-FC-FIELD SITEPREF.3100 DEFAULT=0 NUMBER>=1"-->
<X-FC-WHITESPACE RETAIN>
<!--#include virtual="/.templates/SSF/breadcrumb.inc"-->
<X-FC-WHITESPACE STRIP>
        <!--#endif-->
        <!--#rem Close Standard Tabling-->
<!--#endif-->
<!--#if expr="<X-FC-BODY EXISTS>"-->
                        <!--BODY--><X-FC-BODY><!--/BODY-->
<!--#endif-->

                        <form NAME="srform" CLASS="srform" ID="formstyle" action="http://mailer.whatifnet.com/fcMailer.php" method="POST" title="<!--#echo var="theSubject"-->">
<!--#if expr="$checkYesBoxes=1"-->
        <!--#set var="counter" value="0"-->
        <!--#set var="column1" value="1100"-->
        <!--#set var="column2" value="1125"-->
        <!--#set var="check1" value="1700"-->
        <!--#set var="check2" value="1725"-->
                <!--#if expr="<X-FC-FIELD 2400 LENGTH>>1"-->
                                <DIV CLASS="formsHead"><X-FC-FIELD 2400 STRING></DIV>
                <!--#else-->
                                <DIV CLASS="formsHead">Choose from the following:</DIV>
                <!--#endif-->
                                <TABLE CLASS="formsTable" SUMMARY="<!--#echo var="theSubject"-->" TITLE="<!--#echo var="theSubject"-->">
                                        <THEAD>
                                        <TR>
                                                <TH STYLE="display:none;" TITLE="Checkboxes">Checkboxes</TH>
                                                <TH STYLE="display:none;" TITLE="Checkbox Description">Checkbox Description</TH>
                                                <TH STYLE="display:none;" TITLE="Checkboxes">Checkboxes</TH>
                                                <TH STYLE="display:none;" TITLE="Checkbox Description">Checkbox Description</TH>
                                        </TR>
                                        </THEAD>
                                        <TBODY>
        <!--#set var="altRowCount" value="0"-->
        <!--#set var="checkCountHREF" value="0"-->
        <!--#while expr="++$counter<26"-->
                <!--#set var="totalcolspan" expr="<X-FC-FIELD $column1 LENGTH> + <X-FC-FIELD $column2 LENGTH>"-->
                <!--#if expr="$totalcolspan!=0"-->
                                        <TR VALIGN="top">
                                                <TD WIDTH="20" CLASS="formsTableH<!--#if expr="$altRowCount=0"-->One<!--#else-->Two<!--#endif-->">
                        <!--#if expr="<X-FC-FIELD $column1 LENGTH>!=0"-->
                                                        <INPUT TYPE="checkbox" CLASS="checkbox" name="checkbox<!--#echo var="column1"-->" ID="checkbox<!--#echo var="column1"-->" title="<X-FC-FIELD $column1 STRING>" VALUE="<X-FC-FIELD $column1 STRING>"<!--#if expr="<X-FC-FIELD $check1 NUMBER>=1"--> CHECKED<!--#endif--> TABINDEX="<!--#echo var="TICOUNT"--><!--#set var="TICOUNT" expr="++$TICOUNT"-->">
                        <!--#else-->
                                                        <DIV CLASS="formsItems">&nbsp;</DIV>
                        <!--#endif-->
                                                </TD>
                                                <TD WIDTH="50%" CLASS="formsTableH<!--#if expr="$altRowCount=0"-->One<!--#else-->Two<!--#endif-->">
                                                        <DIV CLASS="formsItems">
                        <!--#if expr="<X-FC-FIELD $column1 LENGTH>!=0"-->
                                                                <A HREF="#" ONCLICK="checkDaBox(<!--#echo var="checkCountHREF"--><!--#set var="checkCountHREF" expr="++$checkCountHREF"-->)" TITLE="Select Checkbox for <X-FC-FIELD $column1 STRING>" TABINDEX="<!--#echo var="TICOUNT"--><!--#set var="TICOUNT" expr="++$TICOUNT"-->">
                                                                <X-FC-FIELD $column1 STRING>
                                                                </A>
<X-FC-WHITESPACE RETAIN>
<script type="text/javascript">
<!--
totalCheckboxes++;
//-->
</script>
<X-FC-WHITESPACE STRIP>
                        <!--#else-->
                                                                &nbsp;
                        <!--#endif-->
                                                        </DIV>
                                                </TD>
                                                <TD WIDTH="20" CLASS="formsTableH<!--#if expr="$altRowCount=0"-->One<!--#else-->Two<!--#endif-->">
                        <!--#if expr="<X-FC-FIELD $column2 LENGTH>!=0"-->
                                                        <INPUT TYPE="checkbox" CLASS="checkbox" name="checkbox<!--#echo var="column2"-->" ID="checkbox<!--#echo var="column2"-->" ID="checkbox" title="<X-FC-FIELD $column2 STRING>" VALUE="<X-FC-FIELD $column2 STRING>"<!--#if expr="<X-FC-FIELD $check2 NUMBER>=1"--> CHECKED<!--#endif--> TABINDEX="<!--#echo var="TICOUNT"--><!--#set var="TICOUNT" expr="++$TICOUNT"-->">
                        <!--#else-->
                                                        <DIV CLASS="formsItems">&nbsp;</DIV>
                        <!--#endif-->
                                                </TD>
                                                <TD WIDTH="50%" CLASS="formsTableH<!--#if expr="$altRowCount=0"-->One<!--#else-->Two<!--#endif-->">
                                                        <DIV CLASS="formsItems">
                        <!--#if expr="<X-FC-FIELD $column2 LENGTH>!=0"-->
                                                                <A HREF="#" ONCLICK="checkDaBox(<!--#echo var="checkCountHREF"--><!--#set var="checkCountHREF" expr="++$checkCountHREF"-->)" TITLE="Select Checkbox for <X-FC-FIELD $column2 STRING>" TABINDEX="<!--#echo var="TICOUNT"--><!--#set var="TICOUNT" expr="++$TICOUNT"-->">
                                                                <X-FC-FIELD $column2 STRING>
                                                                </A>
<X-FC-WHITESPACE RETAIN>
<script type="text/javascript">
<!--
totalCheckboxes++;
//-->
</script>
<X-FC-WHITESPACE STRIP>
                        <!--#else-->
                                                                &nbsp;
                        <!--#endif-->
                                                        </DIV>
                                                </TD>
                                        </TR>
                        <!--#if expr="$altRowCount!=0"-->
                                <!--#set var="altRowCount" value="0"-->
                        <!--#else-->
                                <!--#set var="altRowCount" value="1"-->
                        <!--#endif-->
                <!--#endif-->
                <!--#set var="column1" expr="++$column1"-->
                <!--#set var="column2" expr="++$column2"-->
                <!--#set var="check1" expr="++$check1"-->
                <!--#set var="check2" expr="++$check2"-->
        <!--#endwhile-->
                                        </TBODY>
                                </TABLE>
                                <input type="hidden" name="question[]" id="checkbox_header" value="<!--#if expr="<X-FC-FIELD 2400 LENGTH>>1"--><X-FC-FIELD 2400 STRING><!--#else-->Checkbox Choices<!--#endif-->">
                                <input type="hidden" name="answer[]" id="checkbox_selected" value="No Items Selected">
<!--#endif-->
                                <DIV CLASS="formsHead">Please provide the following information:</DIV>
                                <TABLE CLASS="formsTable" SUMMARY="<!--#echo var="theSubject"-->" TITLE="<!--#echo var="theSubject"-->">
                                        <THEAD>
                                        <TR>
                                                <TH STYLE="display:none;" TITLE="Field Description">Field Description</TH>
                                                <TH STYLE="display:none;" TITLE="Field Data">Field Data</TH>
                                                <TH STYLE="display:none;" TITLE="Required Field">Required Field</TH>
                                        </TR>
                                        </THEAD>
                                        <TBODY>

<!--#if expr="(<X-FC-FIELD 2105 DEFAULT=1 NUMBER>=1)"-->
                                        <TR CLASS="formsTable">
                                                <TD WIDTH="25%" CLASS="formsTableOne">
                                                        <DIV CLASS="formsItems"><label for="street_address"><X-FC-FIELD 1402 DEFAULT="Address:" STRING></label></DIV>
                                                        <input type="hidden" name="header_address" value="<X-FC-FIELD 1402 DEFAULT="Address:" STRING>">
                                                </TD>
                                                <TD WIDTH="55%" CLASS="formsTableTwo">
                                                        <input type="text" CLASS="text" name="street_address" id="street_address" title="<X-FC-FIELD 1402 DEFAULT="Address:" STRING>" TABINDEX="<!--#echo var="TICOUNT"--><!--#set var="TICOUNT" expr="++$TICOUNT"-->">
                                                </TD>
                                                <TD WIDTH="20%" CLASS="formsTableOne">
                                                        <DIV CLASS="formsItems" STYLE="font-size:.69em;color:#990000;font-weight:bold;">
        <!--#if expr="(<X-FC-FIELD 2000 DEFAULT=0 NUMBER>=1)"-->
                                                                required
        <!--#else-->
                                                                &nbsp;
        <!--#endif-->
                                                        </DIV>
                                                </TD>
                                        </TR>
<!--#else-->
                                        <TR STYLE="display:none;">
                                                <TD COLSPAN="3">
                                                        <input type="hidden" name="street_address" value="">
                                                        <input type="hidden" name="header_address" value="">
                                                </TD>
                                        </TR>
<!--#endif-->
<!--#if expr="(<X-FC-FIELD 2106 DEFAULT=1 NUMBER>=1)"-->
                                        <TR CLASS="formsTable">
                                                <TD WIDTH="25%" CLASS="formsTableOne">
                                                        <DIV CLASS="formsItems"><label for="city_address"><X-FC-FIELD 1403 DEFAULT="City:" STRING></label></DIV>
                                                        <input type="hidden" name="header_city" value="<X-FC-FIELD 1403 DEFAULT="City:" STRING>">
                                                </TD>
                                                <TD WIDTH="55%" CLASS="formsTableTwo">
                                                        <input type="text" CLASS="text" name="city_address" id="city_address" title="<X-FC-FIELD 1403 DEFAULT="City:" STRING>" TABINDEX="<!--#echo var="TICOUNT"--><!--#set var="TICOUNT" expr="++$TICOUNT"-->">
                                                </TD>
                                                <TD WIDTH="20%" CLASS="formsTableOne">
                                                        <DIV CLASS="formsItems" STYLE="font-size:.69em;color:#990000;font-weight:bold;">
        <!--#if expr="(<X-FC-FIELD 2001 DEFAULT=0 NUMBER>=1)"-->
                                                                required
        <!--#else-->
                                                                &nbsp;
        <!--#endif-->
                                                        </DIV>
                                                </TD>
                                        </TR>
<!--#else-->
                                        <TR STYLE="display:none;">
                                                <TD COLSPAN="3">
                                                        <input type="hidden" name="city_address" value="">
                                                        <input type="hidden" name="header_city" value="">
                                                </TD>
                                        </TR>
<!--#endif-->
<!--#if expr="(<X-FC-FIELD 2107 DEFAULT=1 NUMBER>=1)"-->
                                        <TR CLASS="formsTable">
                                                <TD WIDTH="25%" CLASS="formsTableOne">
                                                        <DIV CLASS="formsItems"><label for="state_address"><X-FC-FIELD 1404 DEFAULT="State:" STRING></label></DIV>
                                                        <input type="hidden" name="header_state" value="<X-FC-FIELD 1404 DEFAULT="State:" STRING>">
                                                </TD>
                                                <TD WIDTH="55%" CLASS="formsTableTwo">
                                                        <input type="text" CLASS="text" name="state_address" id="state_address" title="<X-FC-FIELD 1404 DEFAULT="State:" STRING>" TABINDEX="<!--#echo var="TICOUNT"--><!--#set var="TICOUNT" expr="++$TICOUNT"-->">
                                                </TD>
                                                <TD WIDTH="20%" CLASS="formsTableOne">
                                                        <DIV CLASS="formsItems" STYLE="font-size:.69em;color:#990000;font-weight:bold;">
        <!--#if expr="(<X-FC-FIELD 2002 DEFAULT=0 NUMBER>=1)"-->
                                                                required
        <!--#else-->
                                                                &nbsp;
        <!--#endif-->
                                                        </DIV>
                                                </TD>
                                        </TR>
<!--#else-->
                                        <TR STYLE="display:none;">
                                                <TD COLSPAN="3">
                                                        <input type="hidden" name="state_address" value="">
                                                                <input type="hidden" name="header_state" value="">
                                                </TD>
                                        </TR>
<!--#endif-->
<!--#if expr="(<X-FC-FIELD 2108 DEFAULT=1 NUMBER>=1)"-->
                                        <TR CLASS="formsTable">
                                                <TD WIDTH="25%" CLASS="formsTableOne">
                                                        <DIV CLASS="formsItems"><label for="zip_address"><X-FC-FIELD 1405 DEFAULT="Zip:" STRING></label></DIV>
                                                        <input type="hidden" name="header_zip" value="<X-FC-FIELD 1405 DEFAULT="Zip:" STRING>">
                                                </TD>
                                                <TD WIDTH="55%" CLASS="formsTableTwo">
                                                        <input type="text" CLASS="text" name="zip_address" id="zip_address" title="<X-FC-FIELD 1405 DEFAULT="Zip:" STRING>" TABINDEX="<!--#echo var="TICOUNT"--><!--#set var="TICOUNT" expr="++$TICOUNT"-->">
                                                </TD>
                                                <TD WIDTH="20%" CLASS="formsTableOne">
                                                        <DIV CLASS="formsItems" STYLE="font-size:.69em;color:#990000;font-weight:bold;">
        <!--#if expr="(<X-FC-FIELD 2003 DEFAULT=0 NUMBER>=1)"-->
                                                                required
        <!--#else-->
                                                                &nbsp;
        <!--#endif-->
                                                        </DIV>
                                                </TD>
                                        </TR>
<!--#else-->
                                        <TR STYLE="display:none;">
                                                <TD COLSPAN="3">
                                                        <input type="hidden" name="zip_address" value="">
                                                        <input type="hidden" name="header_zip" value="">
                                                </TD>
                                        </TR>
<!--#endif-->
<!--#if expr="(<X-FC-FIELD 2109 DEFAULT=1 NUMBER>=1)"-->
                                        <TR CLASS="formsTable">
                                                <TD WIDTH="25%" CLASS="formsTableOne">
                                                        <DIV CLASS="formsItems"><label for="phone_address"><X-FC-FIELD 1406 DEFAULT="Phone:" STRING></label></DIV>
                                                        <input type="hidden" name="header_phone" value="<X-FC-FIELD 1406 DEFAULT="Phone:" STRING>">
                                                </TD>
                                                <TD WIDTH="55%" CLASS="formsTableTwo">
                                                        <input type="text" CLASS="text" name="phone_address" id="phone_address" title="<X-FC-FIELD 1406 DEFAULT="Phone:" STRING>" TABINDEX="<!--#echo var="TICOUNT"--><!--#set var="TICOUNT" expr="++$TICOUNT"-->">
                                                </TD>
                                                <TD WIDTH="20%" CLASS="formsTableOne">
                                                        <DIV CLASS="formsItems" STYLE="font-size:.69em;color:#990000;font-weight:bold;">
        <!--#if expr="(<X-FC-FIELD 2004 DEFAULT=0 NUMBER>=1)"-->
                                                                required
        <!--#else-->
                                                                &nbsp;
        <!--#endif-->
                                                        </DIV>
                                                </TD>
                                        </TR>
<!--#else-->
                                        <TR STYLE="display:none;">
                                                <TD COLSPAN="3">
                                                        <input type="hidden" name="phone_address" value="">
                                                        <input type="hidden" name="header_phone" value="">
                                                </TD>
                                        </TR>
<!--#endif-->
<!--#if expr="(<X-FC-FIELD 2110 DEFAULT=1 NUMBER>=1)"-->
                                        <TR CLASS="formsTable">
                                                <TD WIDTH="25%" CLASS="formsTableOne">
                                                        <DIV CLASS="formsItems"><label for="altphone_address"><X-FC-FIELD 1407 DEFAULT="Alt Phone:" STRING></label></DIV>
                                                        <input type="hidden" name="header_altphone" value="<X-FC-FIELD 1407 DEFAULT="Alt Phone:" STRING>">
                                                </TD>
                                                <TD WIDTH="55%" CLASS="formsTableTwo">
                                                        <input type="text" CLASS="text" name="altphone_address" id="altphone_address" title="<X-FC-FIELD 1407 DEFAULT="Alt Phone:" STRING>" TABINDEX="<!--#echo var="TICOUNT"--><!--#set var="TICOUNT" expr="++$TICOUNT"-->">
                                                </TD>
                                                <TD WIDTH="20%" CLASS="formsTableOne">
                                                        <DIV CLASS="formsItems" STYLE="font-size:.69em;color:#990000;font-weight:bold;">
        <!--#if expr="(<X-FC-FIELD 2006 DEFAULT=0 NUMBER>=1)"-->
                                                                required
        <!--#else-->
                                                                &nbsp;
        <!--#endif-->
                                                        </DIV>
                                                </TD>
                                        </TR>
<!--#else-->
                                        <TR STYLE="display:none;">
                                                <TD COLSPAN="3">
                                                        <input type="hidden" name="altphone_address" value="">
                                                        <input type="hidden" name="header_altphone" value="">
                                                </TD>
                                        </TR>
<!--#endif-->
<!--#if expr="(<X-FC-FIELD 2111 DEFAULT=1 NUMBER>=1)"-->
                                        <TR CLASS="formsTable">
                                                <TD WIDTH="25%" CLASS="formsTableOne">
                                                        <DIV CLASS="formsItems"><label for="fax_address"><X-FC-FIELD 1401 DEFAULT="Fax:" STRING></label></DIV>
                                                        <input type="hidden" name="header_fax" value="<X-FC-FIELD 1401 DEFAULT="Fax:" STRING>">
                                                </TD>
                                                <TD WIDTH="55%" CLASS="formsTableTwo">
                                                        <input type="text" CLASS="text" name="fax_address" id="fax_address" title="<X-FC-FIELD 1401 DEFAULT="Fax:" STRING>" TABINDEX="<!--#echo var="TICOUNT"--><!--#set var="TICOUNT" expr="++$TICOUNT"-->">
                                                </TD>
                                                <TD WIDTH="20%" CLASS="formsTableOne">
                                                        <DIV CLASS="formsItems" STYLE="font-size:.69em;color:#990000;font-weight:bold;">
        <!--#if expr="(<X-FC-FIELD 2005 DEFAULT=0 NUMBER>=1)"-->
                                                                required
        <!--#else-->
                                                                &nbsp;
        <!--#endif-->
                                                        </DIV>
                                                </TD>
                                        </TR>
<!--#else-->
                                        <TR STYLE="display:none;">
                                                <TD COLSPAN="3">
                                                        <input type="hidden" name="fax_address" value="">
                                                        <input type="hidden" name="header_fax" value="">
                                                </TD>
                                        </TR>
<!--#endif-->
<!--#if expr="(<X-FC-FIELD 2112 DEFAULT=1 NUMBER>=1)"-->
                                        <TR CLASS="formsTable">
                                                <TD WIDTH="25%" CLASS="formsTableOne">
                                                        <DIV CLASS="formsItems"><label for="organization_address"><X-FC-FIELD 1408 DEFAULT="Organization:" STRING></label></DIV>
                                                        <input type="hidden" name="header_organization" value="<X-FC-FIELD 1408 DEFAULT="Organization:" STRING>">
                                                </TD>
                                                <TD WIDTH="55%" CLASS="formsTableTwo">
                                                        <input type="text" CLASS="text" name="organization_address" id="organization_address" title="<X-FC-FIELD 1408 DEFAULT="Organization:" STRING>" TABINDEX="<!--#echo var="TICOUNT"--><!--#set var="TICOUNT" expr="++$TICOUNT"-->">
                                                </TD>
                                                <TD WIDTH="20%" CLASS="formsTableOne">
                                                        <DIV CLASS="formsItems" STYLE="font-size:.69em;color:#990000;font-weight:bold;">
        <!--#if expr="(<X-FC-FIELD 2007 DEFAULT=0 NUMBER>=1)"-->
                                                                required
        <!--#else-->
                                                                &nbsp;
        <!--#endif-->
                                                        </DIV>
                                                </TD>
                                        </TR>
<!--#else-->
                                        <TR STYLE="display:none;">
                                                <TD COLSPAN="3">
                                                        <input type="hidden" name="organization_address" value="">
                                                        <input type="hidden" name="header_organization" value="">
                                                </TD>
                                        </TR>
<!--#endif-->
                                        </TBODY>
                                </TABLE>
<!--#if expr="$selectQ=1"-->
        <!--#set var="selectCount" value="0"-->
        <!--#set var="selectStart" value="1500"-->
        <!--#set var="exampleStart" value="1600"-->
        <!--#while expr="++$selectCount<=4"-->
                <!--#if expr="<X-FC-FIELD `$selectStart` LENGTH>>1"-->
                                <DIV CLASS="formsHead"><label for="select_<!--#echo var="selectStart"-->"><X-FC-FIELD `$selectStart` STRING></label></DIV>
                        <!--#if expr="<X-FC-FIELD `$selectStart+8` DEFAULT=1 NUMBER>=1"-->
                                <TABLE CLASS="formsTable" SUMMARY="<!--#echo var="theSubject"-->" TITLE="<!--#echo var="theSubject"-->">
                                        <THEAD>
                                                <TR STYLE="display:none;">
                                                        <TH STYLE="display:none;" TITLE="Field Data">Field Data</TH>
                                                </TR>
                                        </THEAD>
                                        <TBODY>
                                                <TR CLASS="formsTable" valign="top">
                                                        <TD>
                                                                <input type="hidden" name="question[]" id="select_question_<!--#echo var="selectCount"-->_text" value="<X-FC-FIELD `$selectStart` STRING>">
                                                                <SELECT name="select_<!--#echo var="selectStart"-->" id="select_<!--#echo var="selectStart"-->" title="<X-FC-FIELD `$selectStart` STRING>" TABINDEX="<!--#echo var="TICOUNT"--><!--#set var="TICOUNT" expr="++$TICOUNT"-->">
                                <!--#set var="optionCount" value="0"-->
                                <!--#while expr="++$optionCount<=7"-->
                                        <!--#if expr="<X-FC-FIELD `$selectStart+$optionCount` LENGTH>>1"-->
                                                                        <OPTION<!--#if expr="$optionCount=1"--> SELECTED="selected"<!--#endif-->><X-FC-FIELD `$selectStart+$optionCount` STRING></OPTION>
                                        <!--#endif-->
                                <!--#endwhile-->
                                                                </SELECT>
                                                                <input type="hidden" name="answer[]" id="select_question_<!--#echo var="selectCount"-->_answer" value="<X-FC-FIELD `$selectStart+1` STRING>">
                                                        </TD>
                                                </TR>
                                        </tbody>
                                </table>
                        <!--#else-->
                                <TABLE CLASS="formsTable" SUMMARY="<!--#echo var="theSubject"-->" TITLE="<!--#echo var="theSubject"-->">
                                        <THEAD>
                                                <TR STYLE="display:none;">
                                                        <TH STYLE="display:none;" TITLE="Field Data">Field Data</TH>
                                                </TR>
                                        </THEAD>
                                        <TBODY>
                                                <TR CLASS="formsTable" valign="top">
                                                        <TD>
                                                                <input type="hidden" name="question[]" id="select_question_<!--#echo var="selectCount"-->_text" value="<X-FC-FIELD `$selectStart` STRING>">
                                <!--#set var="optionCount" value="0"-->
                                <!--#set var="isSelectExample" value="0"-->
                                <!--#while expr="++$optionCount<=7"-->
                                        <!--#if expr="<X-FC-FIELD `$exampleStart+$optionCount` LENGTH>>1"-->
                                                <!--#set var="isSelectExample" value="1"-->
                                        <!--#endif-->
                                <!--#endwhile-->
                                <!--#set var="optionCount" value="0"-->
                                <!--#if expr="$isSelectExample=1"-->
                                                                <TABLE BORDER="0" WIDTH="100%" CELLSPACING="1" CELPADDING="1" SUMMARY="<!--#echo var="theSubject"-->" TITLE="<!--#echo var="theSubject"-->">
                                                                        <THEAD>
                                                                                <TR>
                                                                                        <TH STYLE="display:none;" TITLE="Field Description">Field Description</TH>
                                                                                        <TH STYLE="display:none;" TITLE="Field Data">Field Data</TH>
                                                                                </TR>
                                                                        </THEAD>
                                                                        <TBODY>
                                        <!--#while expr="++$optionCount<=7"-->
                                                <!--#if expr="<X-FC-FIELD `$selectStart+$optionCount` LENGTH>>1"-->
                                                                                <TR ALIGN="left">
                                                                                        <TD>
                                                        <!--#if expr="<X-FC-FIELD `$exampleStart+$optionCount` LENGTH>>1"-->
                                                                                                <IMG BORDER="0" SRC="<!--#set var="imgFolTest" expr="@substr('<X-FC-FIELD `$exampleStart+$optionCount` STRING>',0,7)"--><!--#if expr="'$imgFolTest'='/images'"--><!--#echo var="imageService"--><!--#endif--><X-FC-FIELD `$exampleStart+$optionCount` STRING>" ALT="<X-FC-FIELD `$selectStart+$optionCount` STRING>"><BR>
                                                        <!--#else-->
                                                                                                &nbsp;
                                                        <!--#endif-->
                                                                                        </TD>
                                                                                        <TD>
                                                                                                <TABLE BORDER="0" WIDTH="100%" CELLSPACING="1" CELPADDING="1" SUMMARY="<!--#echo var="theSubject"-->" TITLE="<!--#echo var="theSubject"-->">
                                                                                                        <THEAD>
                                                                                                                <TR>
                                                                                                                        <TH STYLE="display:none;" TITLE="Field Description">Field Description</TH>
                                                                                                                        <TH STYLE="display:none;" TITLE="Field Data">Field Data</TH>
                                                                                                                </TR>
                                                                                                        </THEAD>
                                                                                                        <TBODY>
                                                                                                                <TR ALIGN="left" VALIGN="middle">
                                                                                                                        <TD>
                                                                                                                                <input type="radio" name="radio_<!--#echo var="selectCount"-->" id="radio_<!--#echo var="selectCount"-->_<!--#echo var="optionCount"-->" value="<X-FC-FIELD `$selectStart+$optionCount` STRING>" title="<X-FC-FIELD `$selectStart+$optionCount` STRING>"<!--#if expr="$optionCount=1"--> CHECKED="checked"<!--#endif--> onclick="radioSelSet('select_question_<!--#echo var="selectCount"-->_answer',this.value);" TABINDEX="<!--#echo var="TICOUNT"--><!--#set var="TICOUNT" expr="++$TICOUNT"-->">
                                                                                                                        </TD>
                                                                                                                        <TD WIDTH="100%">
                                                                                                                                <DIV CLASS="formsItems" STYLE="font-size:1em;"><label for="radio_<!--#echo var="selectCount"-->_<!--#echo var="optionCount"-->"><X-FC-FIELD `$selectStart+$optionCount` STRING></label></DIV>
                                                                                                                        </TD>
                                                                                                                </TR>
                                                                                                        </TBODY>
                                                                                                </TABLE>
                                                                                        </TD>
                                                                                </TR>
                                                <!--#endif-->
                                        <!--#endwhile-->
                                                                        </TBODY>
                                                                </TABLE>
                                <!--#else-->
                                        <!--#while expr="++$optionCount<=7"-->
                                                <!--#if expr="<X-FC-FIELD `$selectStart+$optionCount` LENGTH>>1"-->
                                                                <DIV CLASS="formsItems"><input type="radio" name="radio_<!--#echo var="selectCount"-->" id="radio_<!--#echo var="selectCount"-->_<!--#echo var="optionCount"-->" value="<X-FC-FIELD `$selectStart+$optionCount` STRING>" title="<X-FC-FIELD `$selectStart+$optionCount` STRING>"<!--#if expr="$optionCount=1"--> CHECKED="checked"<!--#endif--> onclick="radioSelSet('select_question_<!--#echo var="selectCount"-->_answer',this.value);" TABINDEX="<!--#echo var="TICOUNT"--><!--#set var="TICOUNT" expr="++$TICOUNT"-->">
                                                                &nbsp;<label for="radio_<!--#echo var="selectCount"-->_<!--#echo var="optionCount"-->"><X-FC-FIELD `$selectStart+$optionCount` STRING></label></DIV>
                                                <!--#endif-->
                                        <!--#endwhile-->
                                <!--#endif-->
                                                                <input type="hidden" name="answer[]" id="select_question_<!--#echo var="selectCount"-->_answer" value="<X-FC-FIELD `$selectStart+1` STRING>">
                                                        </TD>
                                                </TR>
                                        </TBODY>
                                </TABLE>
                        <!--#endif-->
                <!--#endif-->
                <!--#set var="selectStart" expr="$selectStart+10"-->
                <!--#set var="exampleStart" expr="$exampleStart+10"-->
        <!--#endwhile-->
<!--#endif-->
<!--#set var="isAddQ" value="0"-->
<!--#if expr="<X-FC-FIELD 2100 DEFAULT=0 NUMBER>=1 || <X-FC-FIELD 2101 DEFAULT=0 NUMBER>=1 || <X-FC-FIELD 2103 DEFAULT=0 NUMBER>=1 || <X-FC-FIELD 2104 DEFAULT=0 NUMBER>=1"-->
        <!--#set var="isAddQ" value="1"-->
<!--#endif-->
<!--#if expr="$isAddQ=1"-->
        <!--#if expr="<X-FC-FIELD 2100 DEFAULT=0 NUMBER>=1"-->
                                <DIV CLASS="formsHead"><label for="additional_question"><X-FC-FIELD 1207 STRING></label></DIV>
                                <input type="hidden" name="question[]" id="additional_question_1_text" value="<X-FC-FIELD 1207 STRING>">
                                <TEXTAREA name="answer[]" CLASS="commentArea" ID="additional_question_1" title="<X-FC-FIELD 1207 STRING>" TABINDEX="<!--#echo var="TICOUNT"--><!--#set var="TICOUNT" expr="++$TICOUNT"-->"></TEXTAREA>
        <!--#endif-->
        <!--#if expr="<X-FC-FIELD 2101 DEFAULT=0 NUMBER>=1"-->
                                <DIV CLASS="formsHead"><label for="additional_question_2"><X-FC-FIELD 1208 STRING></label></DIV>
                                <input type="hidden" name="question[]" id="additional_question_2_text" value="<X-FC-FIELD 1208 STRING>">
                                <TEXTAREA name="answer[]" CLASS="commentArea" ID="additional_question_2" title="<X-FC-FIELD 1208 STRING>" TABINDEX="<!--#echo var="TICOUNT"--><!--#set var="TICOUNT" expr="++$TICOUNT"-->"></TEXTAREA>
        <!--#endif-->
        <!--#if expr="<X-FC-FIELD 2103 DEFAULT=0 NUMBER>=1"-->
                                <DIV CLASS="formsHead"><label for="additional_question_3"><X-FC-FIELD 1210 STRING></label></DIV>
                                <input type="hidden" name="question[]" id="additional_question_3_text" value="<X-FC-FIELD 1210 STRING>">
                                <TEXTAREA name="answer[]" CLASS="commentArea" ID="additional_question_3" title="<X-FC-FIELD 1210 STRING>" TABINDEX="<!--#echo var="TICOUNT"--><!--#set var="TICOUNT" expr="++$TICOUNT"-->"></TEXTAREA>
        <!--#endif-->
        <!--#if expr="<X-FC-FIELD 2104 DEFAULT=0 NUMBER>=1"-->
                                <DIV CLASS="formsHead"><label for="additional_question_4"><X-FC-FIELD 1211 STRING></label></DIV>
                                <input type="hidden" name="question[]" id="additional_question_4_text" value="<X-FC-FIELD 1211 STRING>">
                                <TEXTAREA name="answer[]" CLASS="commentArea" ID="additional_question_4" title="<X-FC-FIELD 1211 STRING>" TABINDEX="<!--#echo var="TICOUNT"--><!--#set var="TICOUNT" expr="++$TICOUNT"-->"></TEXTAREA>
        <!--#endif-->
<!--#endif-->
<!--#set var="SITE" value="0"-->
<!--#set var="FIELD" value="4001"-->
<!--#while expr="<X-FC-FIELD 4003.`$SITE` LENGTH>"-->
        <!--#set var="multifieldCount" value="0"-->
                                <div class="formsHead"><label for="multipart_<!--#echo var="SITE"-->_answer"><X-FC-FIELD 4003.`$SITE` STRING></label></div>
                                <input type="hidden" name="question[]" id="multipart_<!--#echo var="SITE"-->_question" value="<X-FC-FIELD 4003.`$SITE` STRING>">
        <!--#if expr="<X-FC-FIELD 4005.`$SITE` DEFAULT=1>=1"-->
                <!--#rem Yes/No -->
                                <div class="formsItems">
                <!--#if expr="<X-FC-FIELD 4009.`$SITE` DEFAULT=0>=1"-->
                        <!--#rem "No Selection" Option -->
                                        <input type="radio" name="multiradio_<!--#echo var="SITE"-->" id="multiradio_<!--#echo var="SITE"-->_<!--#echo var="multifieldCount"-->" value="No Selection" title="No Selection" CHECKED="checked" TABINDEX="<!--#echo var="TICOUNT"--><!--#set var="TICOUNT" expr="++$TICOUNT"-->" onclick="radioSelSet('multipart_<!--#echo var="SITE"-->_answer',this.value);"><label for="multipart_<!--#echo var="SITE"-->_<!--#echo var="multifieldCount"-->">&nbsp;No Selection</label><!--#set var="multifieldCount" expr="++$multifieldCount"--><br>
                <!--#endif-->
                                        <input type="radio" name="multiradio_<!--#echo var="SITE"-->" id="multiradio_<!--#echo var="SITE"-->_<!--#echo var="multifieldCount"-->" value="Yes" title="Yes"<!--#if expr="<X-FC-FIELD 4009.`$SITE` DEFAULT=0>=0"--> CHECKED="checked"<!--#endif--> TABINDEX="<!--#echo var="TICOUNT"--><!--#set var="TICOUNT" expr="++$TICOUNT"-->" onclick="radioSelSet('multipart_<!--#echo var="SITE"-->_answer',this.value);"><label for="multipart_<!--#echo var="SITE"-->_<!--#echo var="multifieldCount"-->">&nbsp;Yes</label><!--#set var="multifieldCount" expr="++$multifieldCount"--><br>
                                        <input type="radio" name="multiradio_<!--#echo var="SITE"-->" id="multiradio_<!--#echo var="SITE"-->_<!--#echo var="multifieldCount"-->" value="No" title="No" TABINDEX="<!--#echo var="TICOUNT"--><!--#set var="TICOUNT" expr="++$TICOUNT"-->" onclick="radioSelSet('multipart_<!--#echo var="SITE"-->_answer',this.value);"><label for="multipart_<!--#echo var="SITE"-->_<!--#echo var="multifieldCount"-->">&nbsp;No</label><!--#set var="multifieldCount" expr="++$multifieldCount"--><br>
                                </div>
                                <input type="hidden" name="answer[]" id="multipart_<!--#echo var="SITE"-->_answer" value="<!--#if expr="<X-FC-FIELD 4009.`$SITE` DEFAULT=0>=0"-->Yes<!--#else-->No Selection<!--#endif-->">
        <!--#elif expr="<X-FC-FIELD 4007.`$SITE` DEFAULT=0>=1"-->
                <!--#rem Multiple choice -->
                                <div class="formsItems">
                <!--#if expr="<X-FC-FIELD 4010.`$SITE` DEFAULT=0>=1"-->
                        <!--#rem checkbox style -->
                        <!--#if expr="<X-FC-FIELD 4009.`$SITE` DEFAULT=0>=1"-->
                                <!--#rem "No Selection" Option -->
                                        <input type="checkbox" class="checkbox" name="multicheck_<!--#echo var="SITE"-->_<!--#echo var="multifieldCount"-->" id="multicheck_<!--#echo var="SITE"-->_<!--#echo var="multifieldCount"-->"  title="No Selection" VALUE="No Selection, " TABINDEX="<!--#echo var="TICOUNT"--><!--#set var="TICOUNT" expr="++$TICOUNT"-->" ONCLICK="multiCheckSet('multipart_<!--#echo var="SITE"-->_answer',this.checked,this.value);"><label for="multicheck_<!--#echo var="SITE"-->_<!--#echo var="multifieldCount"-->">&nbsp;No Selection</label><!--#set var="multifieldCount" expr="++$multifieldCount"--><br>
                        <!--#endif-->
                        <!--#set var="checkField" value="4011"-->
                        <!--#while expr="++$checkField<4018"-->
                                <!--#if expr="<X-FC-FIELD `$checkField`.`$SITE` LENGTH>"-->
                                        <input type="checkbox" class="checkbox" name="multicheck_<!--#echo var="SITE"-->_<!--#echo var="multifieldCount"-->" id="multicheck_<!--#echo var="SITE"-->_<!--#echo var="multifieldCount"-->"  title="<X-FC-FIELD `$checkField`.`$SITE` STRING>" VALUE="<X-FC-FIELD `$checkField`.`$SITE` STRING>, " TABINDEX="<!--#echo var="TICOUNT"--><!--#set var="TICOUNT" expr="++$TICOUNT"-->" ONCLICK="multiCheckSet('multipart_<!--#echo var="SITE"-->_answer',this.checked,this.value);"><label for="multicheck_<!--#echo var="SITE"-->_<!--#echo var="multifieldCount"-->">&nbsp;<X-FC-FIELD `$checkField`.`$SITE` STRING></label><!--#set var="multifieldCount" expr="++$multifieldCount"--><br>
                                <!--#endif-->
                        <!--#endwhile-->
                                <input type="hidden" name="answer[]" id="multipart_<!--#echo var="SITE"-->_answer" value="">
                <!--#else-->
                        <!--#rem radio style -->
                        <!--#if expr="<X-FC-FIELD 4009.`$SITE` DEFAULT=0>=1"-->
                                <!--#rem "No Selection" Option -->
                                        <input type="radio" name="multiradio_<!--#echo var="SITE"-->" id="multiradio_<!--#echo var="SITE"-->_<!--#echo var="multifieldCount"-->" value="No Selection" title="No Selection" CHECKED="checked" TABINDEX="<!--#echo var="TICOUNT"--><!--#set var="TICOUNT" expr="++$TICOUNT"-->" onclick="radioSelSet('multipart_<!--#echo var="SITE"-->_answer',this.value);"><label for="multipart_<!--#echo var="SITE"-->_<!--#echo var="multifieldCount"-->">&nbsp;No Selection</label><!--#set var="multifieldCount" expr="++$multifieldCount"--><br>
                        <!--#endif-->
                        <!--#set var="checkField" value="4011"-->
                        <!--#while expr="++$checkField<4018"-->
                                <!--#if expr="<X-FC-FIELD `$checkField`.`$SITE` LENGTH>"-->
                                        <input type="radio" name="multiradio_<!--#echo var="SITE"-->" id="multiradio_<!--#echo var="SITE"-->_<!--#echo var="multifieldCount"-->" value="<X-FC-FIELD `$checkField`.`$SITE` STRING>" title="<X-FC-FIELD `$checkField`.`$SITE` STRING>"<!--#if expr="<X-FC-FIELD 4009.`$SITE` DEFAULT=0>=0&&'$checkField'='4012'"--> CHECKED="checked"<!--#endif--> TABINDEX="<!--#echo var="TICOUNT"--><!--#set var="TICOUNT" expr="++$TICOUNT"-->" onclick="radioSelSet('multipart_<!--#echo var="SITE"-->_answer',this.value);"><label for="multipart_<!--#echo var="SITE"-->_<!--#echo var="multifieldCount"-->">&nbsp;<X-FC-FIELD `$checkField`.`$SITE` STRING></label><!--#set var="multifieldCount" expr="++$multifieldCount"--><br>
                                <!--#endif-->
                        <!--#endwhile-->
                                <input type="hidden" name="answer[]" id="multipart_<!--#echo var="SITE"-->_answer" value="<!--#if expr="<X-FC-FIELD 4009.`$SITE` DEFAULT=0>=0"--><X-FC-FIELD 4012.`$SITE` STRING><!--#else-->No Selection<!--#endif-->">
                <!--#endif-->
                                </div>
        <!--#elif expr="<X-FC-FIELD 4008.`$SITE` DEFAULT=0>=1"-->
                <!--#rem Short answer -->
                                <TEXTAREA name="answer[]" CLASS="commentArea" ID="multipart_<!--#echo var="SITE"-->_answer" title="<X-FC-FIELD `$checkField`.`$SITE` STRING>" TABINDEX="<!--#echo var="TICOUNT"--><!--#set var="TICOUNT" expr="++$TICOUNT"-->"></TEXTAREA>
        <!--#endif-->
        <!--#set var="SITE" expr="++$SITE"-->
<!--#endwhile-->
<!--#if expr="<X-FC-FIELD 2102 DEFAULT=0 NUMBER>=1"-->
                                <TABLE CLASS="formsTable" SUMMARY="Digital Signature" TITLE="Digital Signature">
                                        <THEAD>
                                        <TR>
                                                <TH STYLE="display:none;" TITLE="Field Description">Field Description</TH>
                                                <TH STYLE="display:none;" TITLE="Field Data">Field Data</TH>
                                        </TR>
                                        </THEAD>
                                        <TBODY>
                                        <TR>
        <!--#if expr="<X-FC-FIELD 1012 DEFAULT=0 NUMBER>=1"-->
                                                <TD CLASS="formsTableHOne">
                                                        <SPAN STYLE="display:none;"><label for="digital_signature">Digital Signature is Required</label></SPAN>
                                                        <INPUT TYPE="CHECKBOX" NAME="digital_signature" id="digital_signature" NAME="Digital Signature Required" TABINDEX="<!--#echo var="TICOUNT"--><!--#set var="TICOUNT" expr="++$TICOUNT"-->">
                                                </TD>
        <!--#endif-->
                                                <TD WIDTH="100%" CLASS="formsTableTwo">
                                                        <DIV CLASS="formsItems"><X-FC-FIELD 1209 STRING></DIV>
                                                </TD>
                                        </TR>
                                        </TBODY>
                                </TABLE>
<!--#endif-->
                                        <DIV STYLE="text-align:center;padding:8px;">
                                                <INPUT TYPE="button" CLASS="button" name="submit_form" ID="submit_form" VALUE="<X-FC-FIELD 3100 DEFAULT=Send STRING>" title="<!--#echo var="theSubject"-->" ONCLICK="verifyForm()" TABINDEX="<!--#echo var="TICOUNT"--><!--#set var="TICOUNT" expr="++$TICOUNT"-->">
                                                &nbsp;&nbsp;
                                                <INPUT TYPE="reset" CLASS="button" name="reset_form" ID="reset_form" VALUE="Reset" title="Reset This Form" TABINDEX="<!--#echo var="TICOUNT"--><!--#set var="TICOUNT" expr="++$TICOUNT"-->">
                                        </DIV>

                                        <!--#rem CL101414 -->
                                        <!--#rem add the "From" name for the email ass a hidden field -->
                                        <input type="hidden" name="user_required_name" id="user_required_name" value="<X-FC-FIELD 1820 DEFAULT="VTS Form Submission" STRING>">

                                        <!--#rem store the Email Field into a variable (template_email) so we can do stuff with it. FC doesn't seem to let you use fields directly -->
                                        <!--#set var="template_email" expr="<X-FC-FIELD 1821 DEFAULT="support@vt-s.net" STRING>" -->

                                        <!--#rem the fcmailer.php file considers an email "valid" if an @ symbol is found anywhere in the string-->
<!--#set var="valid_email" expr="@indexof($template_email,'@')"-->

<!--#rem if valid_email doesn't equal -1, it means the email is valid and we can use it -->
<!--#if expr="$valid_email!=-1"-->
        <input type="hidden" id="from_address" name="from_address" value="<X-FC-FIELD 1821 DEFAULT="support@vt-s.net" STRING>">
<!--#else-->
        <!--#rem if there isn't an @symbol it means they didn't enter a "valid" email, so we pick for them noreply@vt-s.net" -->
        <input type="hidden" id="from_address" name="from_address" value="info@virtualtownhall.net">
<!--#endif-->
                                        <!--#rem end 101414 -->




                                        <input type="hidden" name="mailer" value="<!--#echo var="mailServe"-->">
<!--#if expr="'<X-FC-FIELD 1015 STRING>'=''"-->
                                        <input type="hidden" name="mail_template" value="servereqresponsev9_3">
                                        <input type="hidden" name="source_ip" value="<!--#echo var="REMOTE_ADDR"-->">
                                        <input type="hidden" name="redirect" value="<X-FC-FIELD 1300 STRING>">
<!--#else-->
                                        <input type="hidden" name="mail_template" value="<X-FC-FIELD 1015 STRING>">
                                        <input type="hidden" name="html_template" value="<X-FC-FIELD 1015 STRING>.html">
<!--#endif-->
                                        <input type="hidden" name="error_template" value="error.html">
                                        <input type="hidden" name="department_output" value="Nothing Selected">
                                        <input type="hidden" name="subject" value="<X-FC-ITEM DATA[Subject]>">
                                        <input type="hidden" name="date_submitted" value="<X-FC-SERVER-TIME Short>">
                                        <input type="hidden" name="to_address" value="<X-FC-FIELD 3002 STRING>@<!--#echo var="mailAdd"-->">
                                        <input type="hidden" name="town_name" value="<X-FC-ITEM DATA[Subject]>">
                                        <input type="hidden" name="arrayvars" value="1">
                        </FORM>
<!--#if expr="'$printPage'='1'"-->
        <!--#rem Open Printer-Friendly Footer-->
<X-FC-WHITESPACE RETAIN>
<!--INCLUDE SSI printFoot.inc-->
<!--#include virtual="/.templates/<X-FC-FIELD SITEPREF.1466 DEFAULT="" STRING>/printFoot.inc"-->
<!--/INCLUDE-->
<X-FC-WHITESPACE STRIP>
        <!--#rem Close Printer-Friendly Footer-->
<!--#else-->
        <!--#rem Open Standard Tabling-->
<X-FC-WHITESPACE RETAIN>
<!--INCLUDE SSI pageFoot.inc-->
<!--#include virtual="/.templates/<X-FC-FIELD SITEPREF.1466 DEFAULT="" STRING>/pageFoot.inc"-->
<!--/INCLUDE-->
<X-FC-WHITESPACE STRIP>
                </TD>
        <!--#if expr="$pageNine=0"-->
                <TD WIDTH="9"<!--#if expr="('<X-FC-FIELD SITEPREF.1172 DEFAULT=0 STRING>'!='0') && (<X-FC-FIELD SITEPREF.2035 DEFAULT=1 NUMBER>=1)"--> CLASS="nineRight"<!--#endif-->>
                        <SPAN TITLE="Spacer" STYLE="width:9px;height:200px;display:block;overflow:hidden">&nbsp;</SPAN>
                </TD>
        <!--#endif-->
        <!--#if expr="($totPageCol>=1) && ('<X-FC-FIELD SITEPREF.1172 DEFAULT=0 STRING>'!='0')"-->
                <TD CLASS="innerRight">
<X-FC-WHITESPACE RETAIN>
<!--INCLUDE SSI pageRightTop.inc-->
<!--#include virtual="/.templates/<X-FC-FIELD SITEPREF.1466 DEFAULT="" STRING>/pagerighttop.inc"-->
<!--/INCLUDE-->
<X-FC-WHITESPACE STRIP>
                <!--#if expr="<X-FC-FIELD SITEPREF.1512 DEFAULT=0 NUMBER>=4"-->
                        <!--#rem Dynamic Navigation-->
                        <!--#set var="isDynav" value="1"-->
                        <!--#set var="dynavtype" value="folder"-->
<X-FC-WHITESPACE RETAIN>
<!--#include virtual="<X-FC-OBJURL-UP>/?formid=-205&folders=1-40"-->
<X-FC-WHITESPACE STRIP>
                        <!--#set var="dynavtype" value="item"-->
<X-FC-WHITESPACE RETAIN>
<!--#include virtual="<X-FC-OBJURL-UP>/?formid=-205&items=1-100"-->
<X-FC-WHITESPACE STRIP>
                        <!--#set var="isDynav" value="0"-->
                <!--#endif-->
<X-FC-WHITESPACE RETAIN>
<!--INCLUDE SSI pageRight.inc-->
<!--#include virtual="/.templates/<X-FC-FIELD SITEPREF.1466 DEFAULT="" STRING>/pageright.inc"-->
<!--/INCLUDE-->
<X-FC-WHITESPACE STRIP>
                </TD>
        <!--#endif-->
        </TR>
        </TBODY>
</TABLE>
        <!--#rem Close Inner Shell-->
<X-FC-WHITESPACE RETAIN>
<!--INCLUDE SSI footer.inc-->
<!--#include virtual="/.templates/<X-FC-FIELD SITEPREF.1466 DEFAULT="" STRING>/footer.inc"-->
<!--/INCLUDE-->
<X-FC-WHITESPACE STRIP>
        <!--#rem Close Outer Shell-->
</DIV>
<X-FC-WHITESPACE RETAIN>
<!--INCLUDE SSI outerHead.inc-->
<!--#include virtual="/.templates/<X-FC-FIELD SITEPREF.1466 DEFAULT="" STRING>/outerFoot.inc"-->
<!--/INCLUDE-->
<X-FC-WHITESPACE STRIP>
<!--#endif-->
<X-FC-WHITESPACE RETAIN>
<!--TE=<X-FC-REQUEST-TIME>-->
</BODY>
</HTML>