<!-- Alternate content for non-supporting browsers --> <table width="570" align="center" cellpadding="0" cellspacing="0"> <tr> <td width="4%"> </td> <td width="90%" valign="top"><br> <img src="images/lnew_member_text.gif" width="199" height="21"><br> <form action="new_member.php" method="post" target="_top"> <table width="100%" border="0" cellpadding="2" align="center"> <tr valign="top"> <td colspan="4"><p> </p></td> </tr> <tr valign="top"> <td width="120"><div align="right">Last Name:</div></td> <td width="129"><div align="left"><font size="1"> <input name="last_name" type="text" id="last_name" size="20"> </font></div></td> <td width="110"><div align="right">First Name:</div></td> <td width="126"><font face="Verdana, Arial, Helvetica, sans-serif" size="1"> <input name="first_name" type="text" id="first_name" size="20"> </font></td> </tr> <tr valign="top"> <td width="120"><div align="right">Middle Name:</div></td> <td width="129"><div align="left"><font face="Verdana, Arial, Helvetica, sans-serif" size="1"> <input name="middle_name" type="text" id="middle_name" size="20"> </font></div></td> <td width="110"><div align="right">Goes By:</div></td> <td width="126"><font size="1"> <input name="goes_by" type="text" id="goes_by" size="20"> </font><font face="Verdana, Arial, Helvetica, sans-serif" size="1"> </font></td> </tr> <tr valign="top"> <td width="120"><div align="right">Title:</div></td> <td width="129"><div align="left"><font size="1"> <input name="title" type="text" id="title" size="20"> </font></div></td> <td width="110"><div align="right">Date of Birth: </div></td> <td width="126"><font size="1"> <input name="birth_date" type="text" id="birth_date" size="20"> </font></td> </tr> <tr valign="top"> <td><div align="right">Joined How? </div></td> <td><font size="1"> <select name="joined_how" id="joined_how"> <option>Select</option> <option value="Declaration">Declaration</option> <option value="Baptism">Baptism</option> <option value="Confirmation">Confirmation</option> <option value="Reception">Reception</option> </select> </font></td> <td><div align="right">Date Confirmed:</div></td> <td><font size="1"> <input name="date_confirmed" type="text" id="date_confirmed" size="20"> </font></td> </tr> <tr valign="top"> <td><div align="right">Transferred (Church)</div></td> <td><font size="1"> <input name="transfered_church" type="text" id="transfered_church" size="20"> </font></td> <td><div align="right">Marital Status: </div></td> <td><font size="1"> <select name="marital_status" id="marital_status"> <option>Select</option> <option value="Married">Married</option> <option value="Single">Single</option> <option value="Partner">Partner</option> <option value="Widowed">Widowed</option> <option value="Divorced">Divorced</option> </select> </font></td> </tr> <tr valign="top"> <td><div align="right"><strong>Spouse/Partner:</strong></div></td> <td> </td> <td> </td> <td> </td> </tr> <tr valign="top"> <td><div align="right">Last Name:</div></td> <td><font size="1"> <input name="last_name2" type="text" id="last_name2" size="20"> </font></td> <td><div align="right">First Name:</div></td> <td><font face="Verdana, Arial, Helvetica, sans-serif" size="1"> <input name="first_name2" type="text" id="first_name2" size="20"> </font></td> </tr> <tr valign="top"> <td><div align="right">Middle Name:</div></td> <td><font face="Verdana, Arial, Helvetica, sans-serif" size="1"> <input name="middle_name2" type="text" id="middle_name2" size="20"> </font></td> <td><div align="right">Goes By:</div></td> <td><font size="1"> <input name="goes_by2" type="text" id="goes_by2" size="20"> </font></td> </tr> <tr valign="top"> <td><div align="right">Title:</div></td> <td><font size="1"> <input name="title2" type="text" id="title2" size="20"> </font></td> <td><div align="right">Date of Birth: </div></td> <td><font size="1"> <input name="birth_date2" type="text" id="birth_date2" size="20"> </font></td> </tr> <tr valign="top"> <td><div align="right"><strong>Children:</strong></div></td> <td><font size="1"> </font></td> <td><div align="right"></div></td> <td> </td> </tr> <tr valign="top"> <td><div align="right">Full Name: </div></td> <td><font size="1"> <input name="child_name1" type="text" id="child_name1" size="20"> </font></td> <td><div align="right">Birth Date: </div></td> <td><font size="1"> <input name="birth_date1" type="text" id="birth_date1" size="20"> </font></td> </tr> <tr valign="top"> <td><div align="right"></div></td> <td> </td> <td><div align="right">Baptismal Date: </div></td> <td><font size="1"> <input name="baptismal1" type="text" id="baptismal1" size="20"> </font></td> </tr> <tr valign="top"> <td><div align="right">Full Name: </div></td> <td><font size="1"> <input name="child_name2" type="text" id="child_name2" size="20"> </font></td> <td><div align="right">Birth Date: </div></td> <td><font size="1"> <input name="birth_date2" type="text" id="birth_date2" size="20"> </font></td> </tr> <tr valign="top"> <td><div align="right"></div></td> <td> </td> <td><div align="right">Baptismal Date: </div></td> <td><font size="1"> <input name="baptismal2" type="text" id="baptismal2" size="20"> </font></td> </tr> <tr valign="top"> <td><div align="right">Full Name: </div></td> <td><font size="1"> <input name="child_name3" type="text" id="child_name3" size="20"> </font></td> <td><div align="right">Birth Date: </div></td> <td><font size="1"> <input name="birth_date3" type="text" id="birth_date3" size="20"> </font></td> </tr> <tr valign="top"> <td><div align="right"></div></td> <td> </td> <td><div align="right">Baptismal Date: </div></td> <td><font size="1"> <input name="baptismal3" type="text" id="baptismal3" size="20"> </font></td> </tr> <tr valign="top"> <td><div align="right">Full Name: </div></td> <td><font size="1"> <input name="child_name4" type="text" id="child_name4" size="20"> </font></td> <td><div align="right">Birth Date: </div></td> <td><font size="1"> <input name="birth_date4" type="text" id="birth_date4" size="20"> </font></td> </tr> <tr valign="top"> <td><div align="right"></div></td> <td> </td> <td><div align="right">Baptismal Date: </div></td> <td><font size="1"> <input name="baptismal4" type="text" id="baptismal4" size="20"> </font></td> </tr> <tr valign="top"> <td><div align="right">Family Address: </div></td> <td colspan="3"><font size="1"> <input name="address" type="text" id="address" size="40"> </font></td> </tr> <tr valign="top"> <td><div align="right">City:</div></td> <td><font size="1"> <input name="city" type="text" id="city" size="20"> </font></td> <td><div align="right">State:</div></td> <td><font size="1"> <input name="state" type="text" id="state" size="20"> </font></td> </tr> <tr valign="top"> <td><div align="right">Zip:</div></td> <td><font size="1"> <input name="zip" type="text" id="zip" size="20"> </font></td> <td> </td> <td> </td> </tr> <tr valign="top"> <td width="120"><div align="right">Family Phone:</div></td> <td width="129"><font size="1"> <input name="Family_phone" type="text" id="Family_phone" size="20"> </font><font face="Verdana, Arial, Helvetica, sans-serif" size="1"> </font></td> <td width="110"> </td> <td width="126"> </td> </tr> <tr valign="top"> <td><div align="right">Business Phones:</div></td> <td><font size="1"> <input name="business_phone" type="text" id="business_phone" size="20"> </font></td> <td> </td> <td> </td> </tr> <tr valign="top"> <td><div align="right">Mobile Phones: </div></td> <td><font size="1"> <input name="mobile_phone" type="text" id="mobile_phone" size="20"> </font></td> <td> </td> <td> </td> </tr> <tr valign="top"> <td><div align="right">Family Email: </div></td> <td><font size="1"> <input name="family_email" type="text" id="family_email" size="20"> </font></td> <td> </td> <td> </td> </tr> <tr valign="top"> <td width="120" height="19"><div align="right"><font face="Verdana, Arial, Helvetica, sans-serif"><font face="Verdana, Arial, Helvetica, sans-serif"><font size="1"></font></font></font></div></td> <td width="129" height="19"><font face="Verdana, Arial, Helvetica, sans-serif" size="1"> <input type="submit" name="Submit" value="Submit"> <br> <img src="images/clear.gif" width="1" height="10"> </font></td> <td width="110"> </td> <td width="126"> </td> </tr> </table> </form> <p><br> </p></td> <td width="6%"> </td> </tr> </table>
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