<?xml version="1.0" encoding="UTF-8"?>

<form url="picture_upload_form.php"
 window="_self"
 method="POST"
 fontname="MS Sans Serif"
 width="412"
 height="614"
 bkcolor="0xC0C0C0"
 transparent="f"
 fontcolor="0x000000"
 outlinecolor="0x000000"
 themecolor="0xFF0000"
 fontcolor2="#000000"
 bkcolor2="#FFFFFF"
 includeresults="false"
 emailuser="true"
 verifymessage="The E-Mail address you entered does not match !"
 reqmessage="One or More Fields are Required"
 invalidemailmsg="is an invalid address, please correct it."
 transition="1"
 autoresponseincluderesults="f"
 autoresponseaddtotop="f"
 usephp="true"
 disableclicktoactiveprompt="true"
 extensions="*.txt;*.gif;*.jpg;*.jpeg;*.zip;*.doc;*.png;*.pdf;*.rtf"
>

<hidden
 name="subject"
 value="Practice Digital Picture Submission"
></hidden>

<textinput
 name="Name"
 x="12"
 y="64"
 w="377"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 required="true"
 editable="true"
>
</textinput>

<textinput
 name="Email"
 x="8"
 y="136"
 w="376"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 required="true"
 emailbox="true"
 editable="true"
  restrict="email"
>
</textinput>

<textinput
 name="Confirm Email"
 x="12"
 y="184"
 w="371"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 required="true"
 editable="true"
 emailvalidatebox="true"
  restrict="email"
>
</textinput>

<textarea
 name="Message"
 x="20"
 y="244"
 w="370"
 h="198"
 initvalue=""
 wordwrap="true"
 required="true"
 editable="true"
 bkcolor="0xFFFFFF"
  fontsize="12"
  fontname="Arial"
  fontcolor="0x000000"
></textarea>

<browsebutton
 name="Upload File Button"
 x="156"
 y="522"
 w="100"
 h="30"
 label="Upload File"
 fontname="Arial"
 fontcolor="0x000000"
  fontsize="12"
></browsebutton>

<submitbutton
 name="Submit Button"
 x="40"
 y="522"
 w="100"
 h="30"
 label="Submit"
 fontname="Arial"
 fontcolor="0x000000"
  fontsize="12"
></submitbutton>

<label
 name="My Text 1"
 x="16"
 y="212"
 w="109"
 h="16"
 text="Your Message:"
 fontbold="bold"
  fontname="Georgia"
  fontcolor="0x993300"
  fontsize="13"
></label>

<label
 name="My Text 3"
 x="12"
 y="112"
 w="157"
 h="16"
 text="Your E-Mail Address:"
 fontbold="bold"
  fontname="Georgia"
  fontcolor="0x800000"
  fontsize="13"
></label>

<label
 name="My Text 4"
 x="8"
 y="40"
 w="91"
 h="16"
 text="Your Name:"
 fontbold="bold"
  fontname="Georgia"
  fontcolor="0x800000"
  fontsize="13"
></label>

<label
 name="My Text 5"
 x="20"
 y="8"
 w="372"
 h="23"
 text="ClinicallySignificantProductions.com"
 fontbold="bold"
  fontname="Georgia"
  fontcolor="0x633232"
  fontsize="19"
></label>

<label
 name="My Text 6"
 x="12"
 y="164"
 w="181"
 h="16"
 text="Confirm E-Mail Address:"
 fontbold="bold"
  fontname="Georgia"
  fontcolor="0x800000"
  fontsize="13"
></label>

<label
 name="My Text 2"
 x="12"
 y="452"
 w="398"
 h="14"
 text="Having trouble with the form?  Simply email your photos to:"
 fontbold="bold"
  fontname="Georgia"
  fontcolor="0x800000"
  fontsize="11"
></label>

<label
 name="My Text 7"
 x="60"
 y="468"
 w="283"
 h="14"
 text="info@clinicallysignificantproductions.com"
 fontbold="bold"
  fontname="Georgia"
  fontcolor="0x800000"
  fontsize="11"
></label>

<label
 name="My Text 9"
 x="12"
 y="482"
 w="382"
 h="14"
 text="However you submit, look for a confirmation email within"
 fontbold="bold"
  fontname="Georgia"
  fontcolor="0x800000"
  fontsize="11"
></label>

<label
 name="My Text 8"
 x="16"
 y="496"
 w="358"
 h="14"
 text="24 hours.  If you don&apos;t receive this email check with us!"
 fontbold="bold"
  fontname="Georgia"
  fontcolor="0x800000"
  fontsize="11"
></label>

<label
 name="My Text 10"
 x="8"
 y="572"
 w="397"
 h="14"
 text="Click upload to browse to your photos on your computer then"
 fontbold="bold"
  fontname="Georgia"
  fontcolor="0x000000"
  fontsize="11"
></label>

<label
 name="My Text 11"
 x="11"
 y="587"
 w="390"
 h="14"
 text="click submit to submit this form and upload your pics to us."
 fontbold="bold"
  fontname="Georgia"
  fontcolor="0x000000"
  fontsize="11"
></label>

<label
 name="My Text 12"
 x="9"
 y="557"
 w="393"
 h="14"
 text="Instructions:  First fill out the form fields (all are required)"
 fontbold="bold"
  fontname="Georgia"
  fontcolor="0x000000"
  fontsize="11"
></label>

</form>