ASTRO DATING Registration Form<form method="post" action="http://www.emailmeform.com/fid.php?formid=334248" enctype="multipart/form-data" accept-charset="UTF-8">
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<font face="Verdana" size="2" color="#000000">Please fill in our form. We will use this information and the information from your birthchart analysis to help you find your ideal match. It helps if you upload a picture of yourself. Your picture won't be displayed on the website, it'll be sent to your potential possible dates,along with the information you have given us about yourself (not your email address- this remains private)and you will receive their picture as well.</font>
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 <td><font face="Verdana" size="2" color="#000000">Your Name </font></td>
 <td><input type="text" name="FieldData0" size="30"> </td>
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 <td><font face="Verdana" size="2" color="#000000">Your Email Address </font></td>
 <td><input type="text" name="FieldData1" size="30"> </td>
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 <td><font face="Verdana" size="2" color="#000000">Your Date of Birth </font></td>
 <td><input type="text" name="FieldData2" size="30"> </td>
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 <td><font face="Verdana" size="2" color="#000000">Your Place of Birth </font></td>
 <td><input type="text" name="FieldData3" size="30"> </td>
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 <td><font face="Verdana" size="2" color="#000000">Your Time of birth (if known) </font></td>
 <td><input type="text" name="FieldData4" size="30"> </td>
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 <td><font face="Verdana" size="2" color="#000000">Your Sex </font></td>
 <td><select name="FieldData5"><option value="Male">Male</option><option value="Female">Female</option></select> </td>
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 <td><font face="Verdana" size="2" color="#000000">Who you would like to meet </font></td>
 <td><select name="FieldData6"><option value="Man aged 18-25">Man aged 18-25</option><option value="Woman aged 18-25">Woman aged 18-25</option><option value="Man aged 25-30">Man aged 25-30</option><option value="Woman aged 25-30">Woman aged 25-30</option><option value="Man aged 30-40">Man aged 30-40</option><option value=" Woman aged 30-40"> Woman aged 30-40</option><option value=" Man aged 40-45"> Man aged 40-45</option><option value=" Woman aged 40-45"> Woman aged 40-45</option><option value=" Man aged 45-50 "> Man aged 45-50 </option><option value=" Woman aged 45-50"> Woman aged 45-50</option><option value=" Man aged 50-60 "> Man aged 50-60 </option><option value="Woman aged 50-60">Woman aged 50-60</option><option value=" Man aged 60-65"> Man aged 60-65</option><option value="Woman aged 60-65">Woman aged 60-65</option><option value=" Man aged 65+"> Man aged 65+</option><option value="Woman aged 65+">Woman aged 65+</option><option value="Man- age doesn't matter">Man- age doesn't matter</option><option value=" 
Woman-age doesn't matter"> 
Woman-age doesn't matter</option></select> </td>
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 <td><font face="Verdana" size="2" color="#000000">Your interests,hobbies </font></td>
 <td><textarea name="FieldData7" cols="60" rows="10"></textarea><br> </td>
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 <td><font face="Verdana" size="2" color="#000000">Where do you live? How many miles/km are you <br />
prepared to travel to meet your date? </font></td>
 <td><textarea name="FieldData8" cols="60" rows="10"></textarea><br> </td>
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 <td><font face="Verdana" size="2" color="#000000">Upload a picture of yourself here </font></td>
 <td><input type="file" name="FieldData9" value="" size="60"> </td>
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 <td><font face="Verdana" size="2" color="#000000">You can tell us a bit about your ideal date if <br />
you like. </font></td>
 <td><input type="text" name="FieldData10" size="30"> </td>
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 <td><input type="text" name="FieldData11" size="30"> </td>
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<td id="captcha_table_header_td"class="label" colspan="2"><font color="#FFFFFF" face="Verdana" size="2"><b>Image Verification</b></font></td>
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<td id="captcha_table_img_td" class="captcha" style="padding: 2px;" width="10"><img src="http://www.emailmeform.com/turing.php" id="captcha" alt="captcha"></td>
<td class="field" valign="top"><div><font color="#000000">Please enter the text from the image</font>:<br><input type="text" name="Turing" value="" maxlength="100" size="10">
 [ <a href="#" onclick=" document.getElementById('captcha').src = document.getElementById('captcha').src + '?' + (new Date()).getMilliseconds()">Refresh Image</a> ] [ <a href="http://www.emailmeform.com/?v=turing&amp;pt=popup" onClick="window.open('http://www.emailmeform.com/?v=turing&pt=popup','_blank','width=400, height=500, left=' + (screen.width-450) + ', top=100');return false;">What's This?</a> ]</div>
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<input type="text" name="hida2" value="" maxlength="100" size="3" style="display : none;">
<input type="submit" class="btn" value="Submit" name="Submit">&nbsp; &nbsp; <input type="reset" class="btn" value="  Clear  " name="Clear"></td>
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</form>	<div>
				<font size="1" face="Verdana" >Powered by<span style="position: relative; padding-left: 3px; bottom: -5px;"><img src="http://www.emailmeform.com/images/footer-logo.png" /></span>EMF <a style="text-decoration:none;" href="http://www.emailmeform.com">Contact Form</a></font>
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Thank you for completing our form.
We will shortly be in touch with information on your possible dates!