On-Line Membership Application Form

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0 height="100%"><tr> <td valign="top" height=150 BGCOLOR="#006699" TEXT="#080000"> <div> <FONT SIZE="6" COLOR="#FFFFFF" FACE="Arial" ><B>T.I.S.I. (NZ) Sangam</B></FONT><FONT SIZE="1" COLOR="#FFFFCC" FACE="Arial" ><B>     |  </B></FONT><FONT SIZE="4" COLOR="#FFFFCC" FACE="Arial" ><B>   </B></FONT><A HREF="index.htm" TARGET="_top" TITLE="T.I.S.I. (NZ) Sangam"><U><B>Home Page</B></U></A><B>    </B><A HREF="id4.htm" TARGET="_top" TITLE="Documents Newsletters"><U><B>Back to Documents & Newsletters</B></U></A></div> <bR> <div> <B>On-Line Membership Application Form</B>   |   <A HREF="id43.htm" TARGET="_top" TITLE="Guidelines for Branches"><U>Guidelines for Branches</U></A>   |   <A HREF="id44.htm" TARGET="_top" TITLE="Past Newsletters"><U>Past Newsletters</U></A>   |   <A HREF="id46.htm" TARGET="_top" TITLE="Branch Affiliation Application Form"><U>Branch Affiliation Application Form</U></A>   |   <A HREF="id72.htm" TARGET="_top" TITLE="Hon Justice Jai Ram Reddy Speech Fiji "><U>Hon Justice Jai Ram Reddy - Speech - Fiji 2003</U></A></div> <div> </div> </td> </tr><tr> <td valign="top" height=330 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <I>On-Line Membership Application Form</I></div> <div>  <form action="http://formmail.trellix.com/servlets/TlxMailer" method="POST" enctype="application/x-www-form-urlencoded"><input type="hidden" name="tlx_SortOrder" value="Name,Email,Parent's Names,Full Address,Occupation,Mother Tongue,Phone,Type of Membership,Branch"><input type="hidden" name="tlx_FormIndex" value="1"><input type="hidden" name="tlx_OKMessage" value="Thank you for your interest and support. We shall contact you shortly."><input type="hidden" name="tlx_SendMode" value="1"><input type="hidden" name="tlx_Subject" value="A Membership Application Form was submitted"><input type="hidden" name="tlx_EmailTo" value="sangam@xtra.co.nz"> <table cellpadding="0" cellspacing="1" border="0" align="center"> <tr> <td align="left">Your Full Name:<br> <input type="text" name="Name" size="80" maxlength="120"></td> </tr> <tr> <td align="left">Your e-Mail Address:<br> <input type="text" name="Email" size="80" maxlength="120"></td> </tr> <tr> <td align="left">Your Parent's Full Names:<br> <input type="text" name="Parent's Names" size="100" maxlength="150"></td> </tr> <tr> <td align="left">Your Full Postal Address:<br> <input type="text" name="Full Address" size="100" maxlength="150"></td> </tr> <tr> <td align="left">Your Occupation:<br> <input type="text" name="Occupation" size="100" maxlength="120"></td> </tr> <tr> <td align="left">Your Mother Tongue - Tamil/Telegu/Malyalum:<br> <input type="text" name="Mother Tongue" size="50" maxlength="100"></td> </tr> <tr> <td align="left">Your Telephone Number:<br> <input type="text" name="Phone" size="25" maxlength="50"></td> </tr> <tr> <td align="left">A am applying for Ordinary Life/Foundation Life/Honorary Life Membership:<br> <textarea name="Type of Membership" rows="5" cols="80"></textarea></td> </tr> <tr> <td align="left">Branch (if any):<br> <input type="text" name="Branch" size="50" maxlength="100"></td> </tr> <tr> <td align="right"><input type="reset"> <input type="submit" value="Send" name="tlx_send"></td> </tr> </table> </form>  </div> </td> </tr></table></body>