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<form name="form"
method="post"
action="mailto:yrwefun_at_uk2.net?SUBJECT=Internet Lead"
enctype="text/plain"
onSubmit="return validate_form()"></caption>
<tr>
<td></td>
</tr>
<tr>
<td VALIGN=TOP COLSPAN="2">
<center><b><i><font color="#000000"><font size=+3>International Executive
Guild's</font></font></i></b>
<br><b><font color="#000000"><font size=+2>Registration
Form</font></font></b>
<br><b><font color="#000000">(US and Canada Only)</font></b>
<br>
<hr WIDTH="100%"></center>
</td>
</tr>
<tr>
<td VALIGN=TOP COLSPAN="2"><i><font face="arial,helvetica"><font
color="#000000"><font size=+0>Please
fill out this form if you would like to be included on The International
Executive Guild's Who's Who. For accuracy and publication purposes, please
complete and send this form at the earliest opportunity. There is </font>no
charge or obligation<font size=+0> to be listed on The International
Executive
Guild's Who's Who.</font></font></font></i>
<br>
<hr WIDTH="100%"></td>
</tr>
<tr>
<td VALIGN=TOP></td>
</tr>
<tr>
<td ALIGN=RIGHT WIDTH="300"><b><font face="arial,helvetica"><font
color="#000000"><font size=-1>Your
Name</font></font></font></b></td>
<td ALIGN=LEFT WIDTH="300"><input type="text" value size="50" maxlength="250"
name="Name"></td>
</tr>
<tr>
<td ALIGN=RIGHT WIDTH="300"><b><font face="arial,helvetica"><font
color="#000000"><font size=-1>Your
Company</font></font></font></b></td>
<td ALIGN=LEFT WIDTH="300"><input type="text" value size="50" maxlength="250"
name="Company"></td>
</tr>
<tr>
<td ALIGN=RIGHT WIDTH="300"><b><font face="arial,helvetica"><font
color="#000000"><font size=-1>Title</font></font></font></b></td>
<td ALIGN=LEFT WIDTH="300"><input type="text" value size="50" maxlength="250"
name="Title"></td>
</tr>
<tr>
<td ALIGN=RIGHT WIDTH="300"><b><font face="arial,helvetica"><font
color="#000000"><font size=-1>Address</font></font></font></b></td>
<td ALIGN=LEFT WIDTH="300"><input type="text" value size="50" maxlength="250"
name="Address"></td>
</tr>
<tr>
<td ALIGN=RIGHT WIDTH="300"><b><font face="arial,helvetica"><font
color="#000000"><font size=-1>City</font></font></font></b></td>
<td ALIGN=LEFT WIDTH="300"><input type="text" value size="50" maxlength="250"
name="City"></td>
</tr>
<tr>
<td ALIGN=RIGHT WIDTH="300"><b><font face="arial,helvetica"><font
color="#000000"><font size=-1>State
or Province</font></font></font></b></td>
<td ALIGN=LEFT WIDTH="300"><input type="text" value size="12" maxlength="50"
name="State"></td>
</tr>
<tr>
<td ALIGN=RIGHT WIDTH="300"><b><font face="arial,helvetica"><font
color="#000000"><font size=-1>Country</font></font></font></b></td>
<td ALIGN=LEFT WIDTH="300"><select NAME="Country" Size="1"><option
SELECTED><font color="#000000">USA<option SELECTED>Canada</font></select></td>
</tr>
<tr>
<td ALIGN=RIGHT WIDTH="300"><b><font face="arial,helvetica"><font
color="#000000"><font size=-1>ZIP/Postal
Code</font></font></font></b></td>
<td ALIGN=LEFT VALIGN=CENTER WIDTH="300"><input type="text" value size="12"
maxlength="50" name="Zip"></td>
</tr>
<tr>
<td ALIGN=RIGHT WIDTH="300"><b><font face="arial,helvetica"><font
color="#000000"><font size=-1>Day
Time Telephone</font></font></font></b></td>
<td ALIGN=LEFT WIDTH="300"><input type="text" value size="22" maxlength="50"
name="busphone"></td>
</tr>
<tr>
<td>
<div align=right><b><font face="Arial,Helvetica"><font color="#000000"><font
size=-1>Home
Phone</font></font></font></b></div>
</td>
<td><input type="text" value size="22" maxlength="50"
name="homephone"><b><font color="#000000"><font size=-2>(Not
To Be Published)</font></font></b></td>
</tr>
<tr>
<td>
<div align=right><b><font face="Arial,Helvetica"><font color="#000000"><font
size=-1>Email</font></font></font></b></div>
</td>
<td><input type="text" value size="50" maxlength="100" name="Email"></td>
</tr>
<tr>
<td></td>
<td></td>
</tr>
</table>
<center>
<p>
<hr WIDTH="100%"><b><font face="ARIAL,HELVETICA"><font color="#000000"><font
size=-1>TO
HELP US IN CONSIDERING YOUR APPLICATION, PLEASE TELL US A LITTLE ABOUT
YOURSELF...</font></font></font></b>
<br>
<hr WIDTH="100%"></center>
<center><table WIDTH="81%" >
<tr>
<td ALIGN=RIGHT VALIGN=TOP WIDTH="300"><b><font face="arial,helvetica"><font
color="#000000"><font size=-1>Your
Business</font></font></font></b></td>
<td>
<div align=right><input type="text" value size="50" maxlength="200"
name="business"></div>
<font face="arial,helvetica"><font color="#000000"><font size=-1>(Financial
Svcs, Banking, Computer Hardware, Software, Professional Svcs, Chemicals,
Apparel, Aerospace, Food, Government, Utility, etc.
)</font></font></font></td>
</tr>
<tr>
<td ALIGN=RIGHT VALIGN=TOP WIDTH="300"><b><font face="arial,helvetica"><font
color="#000000"><font size=-1>Type
of Organization</font></font></font></b></td>
<td>
<div align=right><input type="text" value size="50" maxlength="250"
name="Orgtype"></div>
<font face="arial,helvetica"><font color="#000000"><font size=-1>(Mfg,
Dist/Wholesaler, Retailer, Law Firm,</font></font></font>
<br><font face="arial,helvetica"><font color="#000000"><font
size=-1>Investment
Bank, Commercial Bank, University,</font></font></font>
<br><font face="arial,helvetica"><font color="#000000"><font
size=-1>Financial
Consultants, Ad Agency, Contractor, Broker, etc.)</font></font></font></td>
</tr>
<tr>
<td VALIGN=TOP WIDTH="300">
<div align=right><b><font face="arial,helvetica"><font color="#000000"><font
size=-1>Your
Business Expertise</font></font></font></b></div>
</td>
<td>
<div align=right><input type="text" value size="50" maxlength="250"
name="expertise"></div>
<font face="arial,helvetica"><font color="#000000"><font size=-1>(Corp.Mgmt,
Marketing, Civil Engineering,</font></font></font>
<br><font face="arial,helvetica"><font color="#000000"><font size=-1>Tax
Law, Nuclear Physics, Database Development, Operations, Pathologist, Mortgage
Banking, etc.)</font></font></font></td>
</tr>
<tr>
<td ALIGN=RIGHT VALIGN=TOP WIDTH="300"><b><font face="arial,helvetica"><font
color="#000000"><font size=-1>Major
Product Line</font></font></font></b></td>
<td>
<div align=right><input type="text" value size="50" maxlength="250"
name="product"></div>
<font face="arial,helvetica"><font color="#000000"><font size=-1>(Integrated
Circuits, Commercial Aircraft, Adhesives, Cosmetics, Plastic Components,
Snack Foods, etc.)</font></font></font></td>
</tr>
</table></center>
<center>
<p><input NAME="submit" TYPE="submit" VALUE=" Submit By E-Mail "><input
NAME="reset" TYPE="reset" VALUE=" Clear Form "></form>
<br><b><font color="#000000"><font size=-1>Note: Submitting this form will
be made by email, not by use of www. Confirmation of its delivery
is made by browsing your outgoing mail.</font></font></b>
<br>
<hr WIDTH="100%"><b><i><font face="arial,helvetica"><font
color="#000000"><font size=-1>Thank
you for filling in this form, we will contact you with more information.
</font></font></font></i></b>
<br>
<hr WIDTH="100%">
<br><font color="#000000"><font size=-1>The International Executive Guild
is not affiliated or associated with Marquis Who's Who.</font></font>
<br>
<hr WIDTH="100%">
<br><b><font color="#000000"><font size=+1>List Removal</font></font></b>
<br><b><font color="#000000"><font size=-1>Please send an email with "REMOVE"
in the subject line to:</font></font></b>
<br><b><font color="#000000"><font size=-1><a href="mailto: yrwefun_at_uk2.net?subject=REMOVE">Click
Here</a></font></font></b></center>
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End of The Glorantha Digest V7 #650
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