<form action="mailto:raltomondo@cox.net" method="post"
enctype="text/plain" name="survey" id="survey">
<table width="75%" cellpadding="1">
<tr>
<td width="4%"><div align="center">
<input type="radio" name="Internet" value="Internet"
tabindex="1" id="radiobutton">
<label for="radiobutton"></label>
</div></td>
<td
width="96%"><strong>Internet</strong></td>
</tr>
<tr>
<td><div align="center">
<input type="radio" name="Magazine" value="Magazine"
tabindex="2" id="radio">
<label for="radio"></label>
</div></td>
<td><strong>Magazine |
<label for="textfield">Magazine Name</label>
<input name="MagName" type="text" tabindex="3"
id="MagName" size="25">
</strong></td>
</tr>
<tr>
<td><div align="center">
<input type="radio" name="Other" value="Other"
tabindex="4" id="radio2">
<label for="radio2"></label>
</div></td>
<td><strong>Other |
<label for="textfield"> Comments</label>
<input name="textfield" type="text" id="textfield"
tabindex="5" size="60">
</strong></td>
</tr>
<tr>
<td colspan="2"><div align="center">
<label for="Submit"></label>
<input type="submit" name="Submit" value="Submit"
id="Submit">
<input type="reset" name="Reset" value="Reset"
id="Reset">
</div></td>
</tr>
</table>
</form>