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<TITLE>Free Discounts  - Book On-line</TITLE></head>
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<center><table border=0>
<tr><td>


<font face='Arial' size='+1' color='#AB0209'>

Free Discounts  - Book On-line

</font>


<br>
<SCRIPT LANGUAGE="JavaScript">
var BUILDER = '/servlet/psoft.masonry.Builder';
function validate(frm){
var i = 0;

for(i = 0; i < frm.field_67.length; i++)
if (frm.field_67[i].checked) break;
if (frm.field_67.length==i) return error(frm.field_67[0]);

if (frm.field_32.value=="") return error(frm.field_32);

for(i = 0; i < frm.field_33.length; i++)
if (frm.field_33[i].checked) break;
if (frm.field_33.length==i) return error(frm.field_33[0]);

if (frm.field_34.value=="") return error(frm.field_34);

if (frm.field_35.value=="") return error(frm.field_35);

if (frm.field_37.value=="") return error(frm.field_37);

var url = document.URL;
if (url.indexOf(BUILDER) == -1 && url.charAt(url.length)!='/') {
    url = url.substring(0, url.lastIndexOf('/')+1);
}
frm.domain.value=url;
return true;
}
function error(field){ alert('You did not fill all required fields!'); field.focus(); return false; }
</SCRIPT>
<form name="questionary" action="http://216.57.227.104:8080/servlet/psoft.customform.CustomForm" method="post">
<input type="hidden" name="domain" value="">
<input type="hidden" name="title" value="Free Discounts  - Book On-line">
<input type="hidden" name="esubj" value="Submitted Form Report">
<input type="hidden" name="name" value="uWHt0WxZeFQa">
<input type="hidden" name="submit_url" value="onsubmit.html">
<input type="hidden" name="error_url"  value="onerror.html">
<input type="hidden" name="order" value="67 31 32 33 34 35 36 37 38 68 ">
<table border=0 cellpedding=5 cellspacing=5>

<input type="hidden" name="name_67" value="Would you like to receive up to $250.00 in discounts?  Just book your appointment online and you are entered. (Good at our Madion, WI location only).">
<tr><td>


<font face='Arial' size='2' color='#333333'>

Would you like to receive up to $250.00 in discounts?  Just book your appointment online and you are entered. (Good at our Madion, WI location only).

</font>


 <font color="red" size="-1">*</font></td><td>

<input type="radio" name="field_67" id="field_671" value="Yes"><label for="field_671">


<font face='Arial' size='2' color='#333333'>

Yes

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</label> <input type="radio" name="field_67" id="field_672" value="No"><label for="field_672">


<font face='Arial' size='2' color='#333333'>

No

</font>


</label>


</td></tr>

<input type="hidden" name="name_31" value="Are you interested in an appointment?">
<tr><td>


<font face='Arial' size='2' color='#333333'>

Are you interested in an appointment?

</font>


 </td><td>

<input type="radio" name="field_31" id="field_311" value="Yes"><label for="field_311">


<font face='Arial' size='2' color='#333333'>

Yes

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</label> <input type="radio" name="field_31" id="field_312" value="No"><label for="field_312">


<font face='Arial' size='2' color='#333333'>

No

</font>


</label>


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<input type="hidden" name="name_32" value="How many people will there be?">
<tr><td>


<font face='Arial' size='2' color='#333333'>

How many people will there be?

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<input type="text" name="field_32" size="">


</td></tr>

<input type="hidden" name="name_33" value="Are you over 18 years old or will have a parent or guardian with you?">
<tr><td>


<font face='Arial' size='2' color='#333333'>

Are you over 18 years old or will have a parent or guardian with you?

</font>


 <font color="red" size="-1">*</font></td><td>

<input type="radio" name="field_33" id="field_331" value="Yes"><label for="field_331">


<font face='Arial' size='2' color='#333333'>

Yes

</font>


</label> <input type="radio" name="field_33" id="field_332" value="No"><label for="field_332">


<font face='Arial' size='2' color='#333333'>

No

</font>


</label>


</td></tr>

<input type="hidden" name="name_34" value="What is your name?">
<tr><td>


<font face='Arial' size='2' color='#333333'>

What is your name?

</font>


 <font color="red" size="-1">*</font></td><td>


<input type="text" name="field_34" size="">


</td></tr>

<input type="hidden" name="name_35" value="What is your address? ">
<tr><td>


<font face='Arial' size='2' color='#333333'>

What is your address? 

</font>


 <font color="red" size="-1">*</font></td><td>


<textarea name="field_35" rows="" cols=""></textarea>

</td></tr>

<input type="hidden" name="name_36" value="You must enter your Email Address to enter: ">
<tr><td>


<font face='Arial' size='2' color='#333333'>

You must enter your Email Address to enter: 

</font>


 </td><td>


<input type="text" name="field_36" size="">


</td></tr>

<input type="hidden" name="name_37" value="What are the best two telephone numbers to reach you? (home/cell)">
<tr><td>


<font face='Arial' size='2' color='#333333'>

What are the best two telephone numbers to reach you? (home/cell)

</font>


 <font color="red" size="-1">*</font></td><td>


<input type="text" name="field_37" size="">


</td></tr>

<input type="hidden" name="name_38" value="What day and time would you like your appointment to be? Sunday's are usually the most available. (Please give at least one additional day and time.)">
<tr><td>


<font face='Arial' size='2' color='#333333'>

What day and time would you like your appointment to be? Sunday's are usually the most available. (Please give at least one additional day and time.)

</font>


 </td><td>


<textarea name="field_38" rows="" cols=""></textarea>

</td></tr>

<input type="hidden" name="name_68" value="Book Online!">
<tr><td>


<font face='Arial' size='2' color='#333333'>

Book Online!

</font>


 </td><td>


<input type="text" name="field_68" size="">


</td></tr>

<tr><td colspan=2 align=center>
    <input onClick="return validate(form)" type="submit" value="Submit">
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</tr>
</table>
</form>
</td></tr></table></center>
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<br>
<center><table border="0" cellpadding="0" cellspacing="3"><tr><td align="center">
<a href="www.glamourportraitstudio.com"></a>
<br>
<font face="helvetica,verdana, arial" size="1">Copyright © 2002-2011 - Glamour Portrait Studio -  All rights reserved.</font>

</td></tr></table></center>
<br>

<br>
<FONT FACE="verdana, arial, helvetica" SIZE="1">
<center>
<nobr>|<a href="index.html">Home Page</A>|</nobr>

<nobr>|<a href="faq.html">FAQ</A>|</nobr>

<nobr>|<a href="catalog.0.html">Gift Certificates</A>|</nobr>

<nobr>|<a href="contact.html">Contact Us</A>|</nobr>

<nobr>|<a href="about.html">About Us</A>|</nobr>

<nobr>|Book On-line|</nobr>

<nobr>|<a href="links.html">Internet Links</A>|</nobr>
</center>
</font>

</TD>
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                    <TD WIDTH=159 HEIGHT="100%">
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                                <TD COLSPAN="2" WIDTH="159" HEIGHT="72" VALIGN="top">
                                    <img src="widgets/gen_289.1.gif" border=0 width=159 height=72 alt=""></TD>
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                            <TR>
                                <TD WIDTH="159" HEIGHT="100%" VALIGN="top" BACKGROUND="widgets/gen_290.1.gif">
                                    <TABLE WIDTH=159 HEIGHT="100%" BORDER="0" CELLPADDING="0" CELLSPACING="0" VALIGN="top">
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                                            <TD WIDTH="159" VALIGN="top" >
                                            <a href="index.html" onMouseOver="document.images['img7'].src='widgets/gen_296.1.gif'" onMouseOut="document.images['img7'].src='widgets/gen_295.1.gif'"><img src="widgets/gen_295.1.gif" alt="Home Page" name="img7" border="0"></a><br>
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                                            <a href="form.html" onMouseOver="document.images['img9'].src='widgets/gen_350.1.gif'" onMouseOut="document.images['img9'].src='widgets/gen_349.1.gif'"><img src="widgets/gen_349.1.gif" alt="Book On-line" name="img9" border="0"></a><br>
                                            <a href="links.html" onMouseOver="document.images['img19'].src='widgets/gen_308.1.gif'" onMouseOut="document.images['img19'].src='widgets/gen_307.1.gif'"><img src="widgets/gen_307.1.gif" alt="Internet Links" name="img19" border="0"></a><br>
                                            
                                            <a href="mailto:sales@glamourportraitstudio.com" onMouseOver="document.images['img_email'].src='widgets/gen_310.1.gif'" onMouseOut="document.images['img_email'].src='widgets/gen_309.1.gif'"><img src="widgets/gen_309.1.gif" alt="e-mail me" name="img_email" border="0"></a><br></TD>    
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