<%' FP_ASP ASP Automatically generated by a FrontPage Component. Do not Edit.

On Error Resume Next
Session("FP_OldCodePage") = Session.CodePage
Session("FP_OldLCID") = Session.LCID
Session.CodePage = 1252
Err.Clear

strErrorUrl = ""

If Request.ServerVariables("REQUEST_METHOD") = "POST" Then
If Request.Form("VTI-GROUP") = "0" Then
	Err.Clear

	Set fp_conn =  Server.CreateObject("ADODB.Connection")
	FP_DumpError strErrorUrl, "Cannot create connection"

	Set fp_rs = Server.CreateObject("ADODB.Recordset")
	FP_DumpError strErrorUrl, "Cannot create record set"

	fp_conn.Open Application("RE_SignUp_ConnectionString")
	FP_DumpError strErrorUrl, "Cannot open database"

	fp_rs.Open "Results", fp_conn, 1, 3, 2 ' adOpenKeySet, adLockOptimistic, adCmdTable
	FP_DumpError strErrorUrl, "Cannot open record set"

	fp_rs.AddNew
	FP_DumpError strErrorUrl, "Cannot add new record set to the database"
	Dim arFormFields0(20)
	Dim arFormDBFields0(20)
	Dim arFormValues0(20)

	arFormFields0(0) = "PIN"
	arFormDBFields0(0) = "PIN"
	arFormValues0(0) = Request("PIN")
	arFormFields0(1) = "Sex"
	arFormDBFields0(1) = "Sex"
	arFormValues0(1) = Request("Sex")
	arFormFields0(2) = "BirthDateYear0"
	arFormDBFields0(2) = "BirthDateYear0"
	arFormValues0(2) = Request("BirthDateYear0")
	arFormFields0(3) = "Address0"
	arFormDBFields0(3) = "Address0"
	arFormValues0(3) = Request("Address0")
	arFormFields0(4) = "FirstName0"
	arFormDBFields0(4) = "FirstName0"
	arFormValues0(4) = Request("FirstName0")
	arFormFields0(5) = "ZipCode0"
	arFormDBFields0(5) = "ZipCode0"
	arFormValues0(5) = Request("ZipCode0")
	arFormFields0(6) = "AniniversaryDateDay0"
	arFormDBFields0(6) = "AniniversaryDateDay0"
	arFormValues0(6) = Request("AniniversaryDateDay0")
	arFormFields0(7) = "BirthDateMonth0"
	arFormDBFields0(7) = "BirthDateMonth0"
	arFormValues0(7) = Request("BirthDateMonth0")
	arFormFields0(8) = "City0"
	arFormDBFields0(8) = "City0"
	arFormValues0(8) = Request("City0")
	arFormFields0(9) = "LastName0"
	arFormDBFields0(9) = "LastName0"
	arFormValues0(9) = Request("LastName0")
	arFormFields0(10) = "Phone2"
	arFormDBFields0(10) = "Phone2"
	arFormValues0(10) = Request("Phone2")
	arFormFields0(11) = "MailList"
	arFormDBFields0(11) = "MailList"
	arFormValues0(11) = Request("MailList")
	arFormFields0(12) = "Phone3"
	arFormDBFields0(12) = "Phone3"
	arFormValues0(12) = Request("Phone3")
	arFormFields0(13) = "BirthDateDay0"
	arFormDBFields0(13) = "BirthDateDay0"
	arFormValues0(13) = Request("BirthDateDay0")
	arFormFields0(14) = "EMail0"
	arFormDBFields0(14) = "EMail0"
	arFormValues0(14) = Request("EMail0")
	arFormFields0(15) = "AniniversaryDateMonth0"
	arFormDBFields0(15) = "AniniversaryDateMonth0"
	arFormValues0(15) = Request("AniniversaryDateMonth0")
	arFormFields0(16) = "AniniversaryDateYear0"
	arFormDBFields0(16) = "AniniversaryDateYear0"
	arFormValues0(16) = Request("AniniversaryDateYear0")
	arFormFields0(17) = "REPIN"
	arFormDBFields0(17) = "REPIN"
	arFormValues0(17) = Request("REPIN")
	arFormFields0(18) = "EMailExtension0"
	arFormDBFields0(18) = "EMailExtension0"
	arFormValues0(18) = Request("EMailExtension0")
	arFormFields0(19) = "State0"
	arFormDBFields0(19) = "State0"
	arFormValues0(19) = Request("State0")

	FP_SaveFormFields fp_rs, arFormFields0, arFormDBFields0

	If Request.ServerVariables("HTTP_USER_AGENT") <> "" Then
		FP_SaveFieldToDB fp_rs, Request.ServerVariables("HTTP_USER_AGENT"), "Browser_type"
	End If
	If Request.ServerVariables("REMOTE_HOST") <> "" Then
		FP_SaveFieldToDB fp_rs, Request.ServerVariables("REMOTE_HOST"), "Remote_computer_name"
	End If
	FP_SaveFieldToDB fp_rs, Now, "Timestamp"
	If Request.ServerVariables("REMOTE_USER") <> "" Then
		FP_SaveFieldToDB fp_rs, Request.ServerVariables("REMOTE_USER"), "User_name"
	End If

	fp_rs.Update
	FP_DumpError strErrorUrl, "Cannot update the database"

	fp_rs.Close
	fp_conn.Close

	FP_FormConfirmation "text/html; charset=windows-1252",_
						"Form Confirmation",_
						"Thank you for submitting the following information:",_
						"RM_SignUp.htm",_
						"Return to the form."

End If
End If

Session.CodePage = Session("FP_OldCodePage")
Session.LCID = Session("FP_OldLCID")

%>
<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN">

<html>
<head>
	<title></title>
	<link rel="STYLESHEET" type="text/css" href="style.css">
</head>

<body leftmargin="0" topmargin="0" marginwidth="0" marginheight="0" background="file:///C:/projects/Relationship Manangement Products/Web/images/background.jpg">

<div style="position: absolute; width: 730px; height: 404px; z-index: 1; left: 110px; top: 29px" id="layer1">
	<font color="#EEEEEE">
	<img border="0" src="images/home_banner.jpg" width="773" height="563"></font></div>
<br>&nbsp;<br>&nbsp;<br>&nbsp;<div style="position: absolute; width: 38px; height: 20px; z-index: 5; left: 196px; top: 39px" id="layer7">
	<a href="RM_SignUp.htm">
	<img border="0" src="images/SignUp.gif" width="48" height="13"></a></div>
<div style="position: absolute; width: 60px; height: 16px; z-index: 6; left: 272px; top: 38px" id="layer8">
	<a href="RM_Rewards_Login.htm">
	<img border="0" src="images/Rewards.gif" width="56" height="13"></a></div>
<div style="position: absolute; width: 42px; height: 15px; z-index: 7; left: 384px; top: 39px" id="layer9">
	<a href="RM_News.htm">
	<img border="0" src="images/News.gif" width="34" height="13"></a></div>
<div style="position: absolute; width: 100px; height: 14px; z-index: 8; left: 470px; top: 38px" id="layer10">
	<a href="RM_Account_Maintenance.htm">
	<img border="0" src="images/Account_Maintenance.gif" width="126" height="13"></a></div>
<div style="position: absolute; width: 83px; height: 16px; z-index: 9; left: 629px; top: 37px" id="layer11">
	<a href="RM_Promotions.htm">
	<img border="0" src="images/Promotions.gif" width="76" height="13"></a></div>
<div style="position: absolute; width: 66px; height: 13px; z-index: 10; left: 753px; top: 38px" id="layer12">
	<a href="RM_Contact_Us.htm">
	<img border="0" src="images/Contact_Us.gif" width="69" height="13"></a></div>
<div style="position: absolute; width: 717px; height: 384px; z-index: 2; left: 137px; top: 201px; background-color: #EEEEEE" id="layer2">
	<p style="margin-top: 10px; margin-bottom: 10px; line-height:150%">&nbsp;</p>
	<!--webbot BOT="GeneratedScript" PREVIEW=" " startspan --><script Language="JavaScript" Type="text/javascript"><!--
function FrontPage_Form1_Validator(theForm)
{

  if (theForm.ZipCode0.value == "")
  {
    alert("Please enter a value for the \"ZipCode0\" field.");
    theForm.ZipCode0.focus();
    return (false);
  }

  if (theForm.ZipCode0.value.length < 5)
  {
    alert("Please enter at least 5 characters in the \"ZipCode0\" field.");
    theForm.ZipCode0.focus();
    return (false);
  }

  if (theForm.ZipCode0.value.length > 5)
  {
    alert("Please enter at most 5 characters in the \"ZipCode0\" field.");
    theForm.ZipCode0.focus();
    return (false);
  }

  var checkOK = "0123456789-";
  var checkStr = theForm.ZipCode0.value;
  var allValid = true;
  var validGroups = true;
  var decPoints = 0;
  var allNum = "";
  for (i = 0;  i < checkStr.length;  i++)
  {
    ch = checkStr.charAt(i);
    for (j = 0;  j < checkOK.length;  j++)
      if (ch == checkOK.charAt(j))
        break;
    if (j == checkOK.length)
    {
      allValid = false;
      break;
    }
    allNum += ch;
  }
  if (!allValid)
  {
    alert("Please enter only digit characters in the \"ZipCode0\" field.");
    theForm.ZipCode0.focus();
    return (false);
  }

  if (theForm.EMailExtension0.selectedIndex < 0)
  {
    alert("Please select one of the \"Please Enter E-Mail Extension\" options.");
    theForm.EMailExtension0.focus();
    return (false);
  }

  if (theForm.PIN.value == "")
  {
    alert("Please enter a value for the \"PIN\" field.");
    theForm.PIN.focus();
    return (false);
  }

  if (theForm.PIN.value.length < 4)
  {
    alert("Please enter at least 4 characters in the \"PIN\" field.");
    theForm.PIN.focus();
    return (false);
  }

  if (theForm.PIN.value.length > 4)
  {
    alert("Please enter at most 4 characters in the \"PIN\" field.");
    theForm.PIN.focus();
    return (false);
  }

  var checkOK = "0123456789-";
  var checkStr = theForm.PIN.value;
  var allValid = true;
  var validGroups = true;
  var decPoints = 0;
  var allNum = "";
  for (i = 0;  i < checkStr.length;  i++)
  {
    ch = checkStr.charAt(i);
    for (j = 0;  j < checkOK.length;  j++)
      if (ch == checkOK.charAt(j))
        break;
    if (j == checkOK.length)
    {
      allValid = false;
      break;
    }
    allNum += ch;
  }
  if (!allValid)
  {
    alert("Please enter only digit characters in the \"PIN\" field.");
    theForm.PIN.focus();
    return (false);
  }

  if (theForm.REPIN.value == "")
  {
    alert("Please enter a value for the \"REPIN\" field.");
    theForm.REPIN.focus();
    return (false);
  }

  if (theForm.REPIN.value.length < 4)
  {
    alert("Please enter at least 4 characters in the \"REPIN\" field.");
    theForm.REPIN.focus();
    return (false);
  }

  if (theForm.REPIN.value.length > 4)
  {
    alert("Please enter at most 4 characters in the \"REPIN\" field.");
    theForm.REPIN.focus();
    return (false);
  }

  var checkOK = "0123456789-";
  var checkStr = theForm.REPIN.value;
  var allValid = true;
  var validGroups = true;
  var decPoints = 0;
  var allNum = "";
  for (i = 0;  i < checkStr.length;  i++)
  {
    ch = checkStr.charAt(i);
    for (j = 0;  j < checkOK.length;  j++)
      if (ch == checkOK.charAt(j))
        break;
    if (j == checkOK.length)
    {
      allValid = false;
      break;
    }
    allNum += ch;
  }
  if (!allValid)
  {
    alert("Please enter only digit characters in the \"REPIN\" field.");
    theForm.REPIN.focus();
    return (false);
  }
  return (true);
}
//--></script><!--webbot BOT="GeneratedScript" endspan --><form method="POST" action="../../_derived/nortbots.htm" onsubmit="location.href='../../_derived/nortbots.htm';return false;" language="JavaScript" name="FrontPage_Form1" webbot-onSubmit="return FrontPage_Form1_Validator(this)" webbot-action="--WEBBOT-SELF--">
		<!--webbot bot="SaveDatabase" startspan SuggestedExt="asp" S-DataConnection="RE_SignUp" S-RecordSource="Results" U-Database-URL="fpdb/RE_SignUp.mdb" S-Builtin-Fields="HTTP_USER_AGENT REMOTE_HOST Timestamp REMOTE_USER" S-Builtin-DBFields="Browser_type Remote_computer_name Timestamp User_name" S-Form-Fields="PIN Sex BirthDateYear0 Address0 FirstName0 ZipCode0 AniniversaryDateDay0 BirthDateMonth0 City0 LastName0 Phone2 MailList Phone3 BirthDateDay0 EMail0 AniniversaryDateMonth0 AniniversaryDateYear0 REPIN EMailExtension0 State0" S-Form-DBFields="PIN Sex BirthDateYear0 Address0 FirstName0 ZipCode0 AniniversaryDateDay0 BirthDateMonth0 City0 LastName0 Phone2 MailList Phone3 BirthDateDay0 EMail0 AniniversaryDateMonth0 AniniversaryDateYear0 REPIN EMailExtension0 State0" U-ASP-Include-Url="_fpclass/fpdbform.inc" --><input TYPE="hidden" NAME="VTI-GROUP" VALUE="0"><!--#include file="_fpclass/fpdbform.inc"--><!--webbot bot="SaveDatabase" endspan i-checksum="40548" -->
		<p style="margin-top: 10px; margin-bottom: 10px; line-height:150%">&nbsp;&nbsp;&nbsp;&nbsp; 
		First Name:&nbsp;&nbsp;&nbsp;&nbsp; 
		<input type="text" name="FirstName0" size="20" tabindex="1">&nbsp;&nbsp;&nbsp; 
	Last Name:&nbsp; <input type="text" name="LastName0" size="40" tabindex="2">&nbsp;&nbsp;
	</p>
	<p style="margin-top: 10px; margin-bottom: 10px; line-height:150%">&nbsp;&nbsp;&nbsp;&nbsp; 
	Address:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;&nbsp;
	<input type="text" name="Address0" size="77" tabindex="3"></p>
	<p style="margin-top: 10px; margin-bottom: 10px; line-height:150%">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;City:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;&nbsp;<input type="text" name="City0" size="31" tabindex="4">&nbsp;&nbsp;&nbsp; State:&nbsp;&nbsp;<input type="text" name="State0" size="2" tabindex="5">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Zip Code:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
	<!--webbot bot="Validation" s-data-type="Integer" s-number-separators="x" b-value-required="TRUE" i-minimum-length="5" i-maximum-length="5" -->
	<input type="text" name="ZipCode0" size="5" tabindex="6" maxlength="5" value="99999"></p>
	<p style="margin-top: 10px; margin-bottom: 10px; line-height:150%">&nbsp;&nbsp;&nbsp;&nbsp; 
	E-Mail: &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;&nbsp;
	<input type="text" name="EMail0" size="42" tabindex="7">&nbsp;&nbsp;<font size="4">@
	</font>
	<!--webbot bot="Validation" s-display-name="Please Enter E-Mail Extension" b-value-required="TRUE" --><select size="1" name="EMailExtension0" tabindex="8">
	<option value="ACURALEGEND.COM">ACURALEGEND.COM</option>
	<option value="ADDRESS.COM">ADDRESS.COM</option>
	<option value="ADELPHIA.NET">ADELPHIA.NET</option>
    <OPTION value="ALTAVISTA.COM">ALTAVISTA.COM</OPTION> 
	<option value="ALTRO.COM">ALTRO.COM</option>
	<option value="ANDPAK.COM">ANDPAK.COM</option>
	<option value="AOL.COM">AOL.COM</option>
	<option value="ATTBI.COM">ATTBI.COM</option>
	<option value="CHARTER.NET">CHARTER.NET</option>
	<option value="CMC.NET">CMC.NET</option>
	<option value="COMCAST.NET">COMCAST.NET</option>
	<option value="COX.NET">COX.NET</option>
	<option value="CROSSLINK.COM">CROSSLINK.COM</option>
	<option value="EARTHLINK.NET">EARTHLINK.NET</option>
	<option value="EMAIL.COM">EMAIL.COM</option>
	<option value="EXCITE.COM">EXCITE.COM</option>
	<option value="FOOTBALLMAIL.COM">FOOTBALLMAIL.COM</option>
	<option value="FRIKO3.ONET.PL">FRIKO3.ONET.PL</option>
	<option value="GMAIL.COM">GMAIL.COM</option>
    <option value ="GO.COM">GO.COM</OPTION>
    <OPTION value="GOTO.COM">GOTO.COM</OPTION>
    <OPTION value="HOTBOT.COM">HOTBOT.COM</OPTION>
	<option value="HOTMAIL.COM">HOTMAIL.COM</option>
	<option value="HOTMAIL.NET">HOTMAIL.NET</option>
	<option value="ILOVERAVING.COM">ILOVERAVING.COM</option>
	<option value="INTEL.COM">INTEL.COM</option>
	<option value="KP.ORG">KP.ORG</option>
	<option value="LANSET.COM">LANSET.COM</option>
    <OPTION value="LYCOS.COM">LYCOS.COM</OPTION>
	<option value="MAIL.RU">MAIL.RU</option>
	<option value="MARSHALL-NETWORKS.COM">MARSHALL-NETWORKS.COM</option>
	<option value="MEDIAONE.COM">MEDIAONE.COM</option>
	<option value="MSN.COM">MSN.COM</option>
	<option value="NETSCAPE.NET">NETSCAPE.NET</option>
	<option value="NETZERO.COM">NETZERO.COM</option>
	<option value="NETZERO.NET">NETZERO.NET</option>
	<option value="ONEBOX.COM">ONEBOX.COM</option>
	<option value="PACBELL.NET">PACBELL.NET</option>
	<option value="PRODIGY.NET">PRODIGY.NET</option>
	<option value="SACRAMENTO.HEALD.EDU">SACRAMENTO.HEALD.ED</option>
	<option value="SBCGLOBAL.NET">SBCGLOBAL.NET</option>
	<option value="SFSU.EDU">SFSU.EDU</option>
	<option value="SLAC.STANFORD.EDU">SLAC.STANFORD.EDU</option>
	<option value="SUN.COM">SUN.COM</option>
	<option value="TYCOELECTRONICS.COM">TYCOELECTRONICS.CO</option>
	<option value="VISIONEVENT.COM">VISIONEVENT.COM</option>
	<option value="VSP.COM">VSP.COM</option>
    <OPTION value="WEBCRAWLER.COM">WEBCRAWLER.COM</OPTION>
	<option value="WEBTORICHES.COM">WEBTORICHES.COM</option>
	<option value="WHIMIT.COM">WHIMIT.COM</option>
	<option value="YAHOO.COM">YAHOO.COM</option>

	</select></p>
	<p style="margin-top: 10px; margin-bottom: 10px; line-height:150%">&nbsp;</td>&nbsp;&nbsp;&nbsp; Birthday&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;&nbsp;&nbsp;
		<td nowrap width="10"><spacer type="horizontal" width="10"></td>
		<td align="left" width="560" class="yregbelowfield">
<select name="BirthDateMonth0" size="1" tabindex="9"><option value="">[Select a Month]<option value="0">January<option value="1">February<option value="2">March<option value="3">April<option value="4">May<option value="5">June<option value="6">July<option value="7">August<option value="8">September<option value="9">October<option value="10">November<option value="11">December</select>
&nbsp;<input onfocus="this.value=''" maxlength="2" name="BirthDateDay0" size="2" value="dd" id="bday1" autocomplete=off tabindex="10" >&nbsp;,&nbsp;<input onfocus="this.value=''" maxlength="4" name="BirthDateYear0" size="4" value="yyyy" autocomplete=off tabindex="11" >&nbsp;&nbsp; 
	Anniversary Date:&nbsp; <spacer type="horizontal" width="10"></td>
		<td align="left" width="560" class="yregbelowfield">
<select name="AniniversaryDateMonth0" size="1" tabindex="12"><option value="">[Select a Month]<option value="0">January<option value="1">February<option value="2">March<option value="3">April<option value="4">May<option value="5">June<option value="6">July<option value="7">August<option value="8">September<option value="9">October<option value="10">November<option value="11">December</select>
&nbsp;<input onfocus="this.value=''" maxlength="2" name="AniniversaryDateDay0" size="2" value="dd" id="bday2" autocomplete=off tabindex="13" >&nbsp;,&nbsp;<input onfocus="this.value=''" maxlength="4" name="AniniversaryDateYear0" size="4" value="yyyy" autocomplete=off tabindex="14" >



	<p style="margin-top: 10px; margin-bottom: 10px; line-height:150%">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Phone :&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
	<input type="text" name="Phone2" size="14" value="999-999-9999" tabindex="15">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
	Fax:&nbsp;&nbsp;&nbsp;
	<input type="text" name="Phone3" size="14" value="999-999-9999" tabindex="16">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
	Male:&nbsp; 
	<input type="radio" value="Male" name="Sex" checked tabindex="17"> Female:
	<input type="radio" name="Sex" value="Female"></p>
	<p style="margin-top: 10px; margin-bottom: 10px; line-height:150%">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;PIN 
	Number:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
	<!--webbot bot="Validation" s-data-type="Integer" s-number-separators="x" b-value-required="TRUE" i-minimum-length="4" i-maximum-length="4" -->
	<input type="password" name="PIN" size="4" tabindex="17" maxlength="4">&nbsp;&nbsp;&nbsp; 
	Re-Enter PIN Number:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
	<!--webbot bot="Validation" s-data-type="Integer" s-number-separators="x" b-value-required="TRUE" i-minimum-length="4" i-maximum-length="4" -->
	<input type="password" name="REPIN" size="4" tabindex="18" maxlength="4"></p>
		<p style="line-height: 150%; margin-top: 10px; margin-bottom: 10px">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Would you like to be on our Mailing List?&nbsp;&nbsp;&nbsp;&nbsp; Yes:&nbsp;
	<input type="radio" name="MailList" value="Yes" checked> No:
	<input type="radio" name="MailList" value="No"></p>
		<p style="line-height: 150%; margin-top: 10px; margin-bottom: 10px">&nbsp;</p>
		<p style="line-height: 150%; margin-top: 10px; margin-bottom: 10px">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
		<input type="submit" value="Enroll" name="Enroll">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
		<input type="reset" value="Reset" name="B4"></p>
	</form>
	<div style="position: absolute; width: 370px; height: 74px; z-index: 1; left: -1px; top: -59px" id="layer4">
		<font face="Georgia" size="7" color="#800080">Rewards Sign Up</font></div>
	</div>
<div style="position: absolute; width: 295px; height: 92px; z-index: 3; left: 550px; top: 71px" id="layer5">
	<img border="0" src="LoyalTrak%20Logo2.gif" width="291" height="67"></div>
<p><br>

</p>




</body>
</html>