<!DOCTYPE html PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN">
<html>
<head>
<title>Blackwood Brigade Member Profile form</title>
</head>
<body background="images/B-AxeBgr3.gif">
<form action="blkdir-input.php3" method="post">
<table border="0">
<tr>
<td align="right"><label accesskey="F" for="fname">First Name:</label></td>
<td><input name="First_Name" type="text" value="" maxlength="20" id="fname" tabindex="1"></td>
<td align="right"><label accesskey="L" for="lname">Last Name:</label></td>
<td><input name="Last_Name" type="text" value="" maxlength="20" id="lname" tabindex="2"></td>
</tr>

<tr>
<td align="right"><label accesskey="S" for="scaname">SCA Name:</label></td>
<td colspan="3"><input maxlength="50" name="SCA_Name" type="text" value="" tabindex="3" id="scaname" size="50"></td>
</tr>

<tr>
<td align="right"><label accesskey="A" for="awrds">Awards: <small><small>(AoA, etc...)</small></small></label></td>
<td colspan="3"><input maxlength="50" name="Awards" size="50" type="text" value="" tabindex="4" id="awrds"></td>
</tr>

<tr>
<td colspan="4"><b>Address:</b></td>
</tr>

<tr>
<td align="right"><label accesskey="T" for="street">Street:</label></td>
<td><input maxlength="25" name="Street1" size="25" type="text" value="" tabindex="5" id="street"></td>
</tr>

<tr>
<td>&nbsp;</td>
<td><input maxlength="25" name="Street2" size="25" type="text" value="" tabindex="6"></td>
</tr>

<tr>
<td align="right"><label accesskey="C" for="city">City:</label></td>
<td align="right"><input maxlength="15" name="City" size="25" type="text" value="" tabindex="7" id="city"></td>
<td><label accesskey="E" for="state">State:</label> <input maxlength="2" name="State" size="2" type="text" value="" tabindex="8" id="state"></td>
<td><label accesskey="Z" for="zip">Zip:</label> <input maxlength="10" name="Zip" size="10" type="text" value="" tabindex="9" id="zip"></td>
</tr>

<tr>
<td colspan="4"><b>Phone Numbers:</b></td>
</tr>

<tr>
<td align="right"><label accesskey="H" for="home">Home:</label></td>
<td colspan="3"><input maxlength="14" name="Home" size="14" type="text" value="" tabindex="10" id="home"></td>
</tr>

<tr>
<td align="right"><label accesskey="W" for="work">Work:</label></td>
<td colspan="3"><input maxlength="17" name="Work" size="17" type="text" value="" tabindex="11" id="work"></td>
</tr>

<tr>
<td align="right"><label accesskey="C" for="cell">Cell/Pager:</label></td>
<td><input maxlength="14" name="Cell" size="14" type="text" value="" tabindex="12" id="cell"></td>
<td><label accesskey="P" for="cpbtn"><input checked name="CPbutton" type="radio" value="Cell" tabindex="13" id="cpbtn">Cell <input name="CPbutton" type="radio" value="Pager" tabindex="14" id=
"cpbtn">Pager </label></td>
</tr>

<tr>
<td colspan="4"><b>Email:</b></td>
</tr>

<tr>
<td align="right"><label accesskey="1" for="eprime">Primary:</label></td>
<td colspan="3"><input maxlength="50" name="Eprime" size="50" type="text" value="" tabindex="15" id="eprime"></td>
</tr>

<tr>
<td align="right"><label accesskey="2" for="esec">Secondary:</label></td>
<td colspan="3"><input maxlength="50" name="Esec" size="50" type="text" value="" tabindex="16" id="esec"></td>
</tr>

<tr>
<td align="right"><label accesskey="3" for="eter">Tertiary:</label></td>
<td colspan="3"><input maxlength="50" name="Eter" size="50" type="text" value="" tabindex="17" id="eter"></td>
</tr>

<tr>
<td align="right"><label accesskey="U" for="url">URL:</label></td>
<td colspan="3"><input maxlength="50" name="URL" size="50" type="text" value="" tabindex="18" id="url"></td>
</tr>

<tr>
<td colspan="4"><b>Other:</b></td>
</tr>

<tr>
<td align="right"><label accesskey="H" for="heraldry">Heraldry:</label></td>
<td colspan="3"><input maxlength="255" name="Heraldry" size="60" type="textarea" value="" tabindex="19" id="heraldry"></td>
</tr>

<tr>
<td align="right"><label accesskey="C" for="comments">Comments:</label></td>
<td colspan="3"><input maxlength="255" name="Comments" size="60" type="textarea" value="" tabindex="20" id="comments"></td>
</tr>

<tr>
<td colspan="4" align="center"><input type="submit" value="Submit" tabindex="21"> <input type="reset" value="Reset" tabindex="22"></td>
</tr>
</table>
</form>
</body>
</html>

