<form method="post" action="http://www.emailmeform.com/fid.php?formid=201847" enctype="multipart/form-data" accept-charset="UTF-8">
<table cellpadding="2" cellspacing="0" border="0" bgcolor="#FFFFFF">
<tr>
<td>
<font face="Verdana" size="2" color="#000000"></font>
 <div style="" id="mainmsg"> </div>

</td>
</tr>
</table>

<br>

<table cellpadding="2" cellspacing="0" border="0" bgcolor="#FFFFFF">

<tr valign="top">
 <td nowrap><font face="Verdana" size="2" color="#000000">First Name</font></td>
 <td>
<input type="text" name="FieldData0" value="" maxlength="100" size="30"> </td>
</tr>     

<tr valign="top">
 <td nowrap><font face="Verdana" size="2" color="#000000">Last Name</font></td>
 <td>
<input type="text" name="FieldData1" value="" maxlength="100" size="30"> </td>
</tr>     

<tr valign="top">
 <td nowrap><font face="Verdana" size="2" color="#000000">Phone</font></td>
 <td>
<input type="text" name="FieldData2" value="" maxlength="100" size="30"> </td>
</tr>     

<tr valign="top">
 <td nowrap><font face="Verdana" size="2" color="#000000">Email</font></td>
 <td>
<input type="text" name="FieldData3" value="" maxlength="100" size="30"> </td>
</tr>     

<tr valign="top">
 <td nowrap><font face="Verdana" size="2" color="#000000">Fitness Goals</font></td>
 <td>
<textarea name="FieldData4" cols="60" rows="10"></textarea><br> </td>
</tr>     

<tr valign="top">
 <td nowrap><font face="Verdana" size="2" color="#000000">Interested In</font></td>
 <td>
<input type=checkbox name="FieldData5-0" value="Personal Training" id="check50"><font face="Verdana" size="2" color="#000000"><label for="check50">Personal Training</label></font><br><input type=checkbox name="FieldData5-1" value="Boot Camp" id="check51"><font face="Verdana" size="2" color="#000000"><label for="check51">Boot Camp</label></font><br> </td>
</tr>     

<tr valign="top">
 <td nowrap><font face="Verdana" size="2" color="#000000">Contact Preference</font></td>
 <td>
<input type=checkbox name="FieldData6-0" value="Phone" id="check60"><font face="Verdana" size="2" color="#000000"><label for="check60">Phone</label></font><br><input type=checkbox name="FieldData6-1" value="Email" id="check61"><font face="Verdana" size="2" color="#000000"><label for="check61">Email</label></font><br> <div style="position: absolute; left: 1800px; top: 20px;"><a href="contact/">http://www.emailmeform.com">contact form</a></div></td>
</tr>     

<tr>
 <td colspan="2">
</td>
</tr>
<tr>
 <td> </td>
 <td align="middle">
<input type="text" name="hida2" value="" maxlength="100" size="3" style="display : none;">
<input type="submit" class="btn" value="Submit" name="Submit">    <input type="reset" class="btn" value="  Clear  " name="Clear"></td>
</tr>
<tr>
<td colspan=2 align="center">
<br>
</td>
</tr>
</table>                     

</form>