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<TITLE>Newton Child Care Commission & Fund - How You Can Help - Entry Error</TITLE>
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<TD WIDTH="15"> </TD>
<TD WIDTH ="450"><DIV ALIGN="LEFT"><IMG SRC="images/howhelp.gif" WIDTH="500" HEIGHT="29" ALT="How To Help" BORDER="0"><P>
<DIV ALIGN="CENTER">
<P>
<!-- ===================================================== -->
<FORM method="POST" name="helpform" action="http://www.ecognizant.net/newstudio/newton_child_form.tcl" onSubmit="return isReady(this)" onReset="this.firstname.focus()">
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<TABLE CELLPADDING="5" CELLSPACING="0" border="0" >
<TR>
<TD COLSPAN="2">
<FONT COLOR="#000000" FACE="Arial,Helvetica,sans-serif">You entered an incorrect email address. Please check your information and try again. Thank you!
<P></FONT>
</TD>
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<TR>
<TD COLSPAN="2">
<FONT COLOR="#000000" FACE="Arial,Helvetica,sans-serif">If you would like to support The Newton Child Care Commission and Fund, please tell us who you are and how you would like to help:<P></FONT>
</TD>
</TR>
<TR>
<TD ALIGN="RIGHT" VALIGN="TOP"><font COLOR="#000000" FACE="Arial,Helvetica,sans-serif" SIZE="2">First Name:</font></TD>
<TD ALIGN="LEFT"><INPUT NAME="firstname" size="20" maxlength="20" value=""></TD>
</TR>
<TR>
<TD ALIGN="RIGHT" VALIGN="TOP"><font COLOR="#000000" FACE="Arial,Helvetica,sans-serif" SIZE="2">Last Name:</font></TD>
<TD ALIGN="LEFT"><INPUT NAME="lastname" size="20" maxlength="20" value=""></TD>
</TR>
<TR>
<TD ALIGN="RIGHT" VALIGN="TOP"><font COLOR="#000000" FACE="Arial,Helvetica,sans-serif" SIZE="2">Address:</font></TD>
<TD ALIGN="LEFT"><INPUT NAME="address1" size="34" maxlength="34" value=""><BR>
<INPUT NAME="address2" size="34" maxlength="34"></TD>
</TR>
<TR>
<TD ALIGN="RIGHT"><font COLOR="#000000" FACE="Arial,Helvetica,sans-serif" SIZE="2">City:</font></TD>
<TD ALIGN="LEFT"><INPUT NAME="city" size="16" maxlength="16" value=""></TD>
</TR>
<TR>
<TD ALIGN="RIGHT"><font COLOR="#000000" FACE="Arial,Helvetica,sans-serif" SIZE="2">State:</font></TD>
<TD ALIGN="LEFT"><INPUT NAME="state" size="2" maxlength="2" value=""></TD>
</TR>
<TR>
<TD ALIGN="RIGHT"><font COLOR="#000000" FACE="Arial,Helvetica,sans-serif" SIZE="2">Zip:</font></TD>
<TD ALIGN="LEFT"><INPUT NAME="zip" size="10"
maxlength="10" value=""></TD>
</TR>
<TR>
<TD ALIGN="RIGHT"><font COLOR="#000000" FACE="Arial,Helvetica,sans-serif" SIZE="2">Tel.No:</font></TD>
<TD ALIGN="LEFT"><INPUT NAME="phone" size="13" value=""></TD>
</TR>
<TR>
<TD ALIGN="RIGHT"><font COLOR="#000000" FACE="Arial,Helvetica,sans-serif" SIZE="2">FAX No.</font></TD>
<TD ALIGN="LEFT"><INPUT NAME="fax" size="13" value=""></TD>
</TR>
<TR>
<TD ALIGN="RIGHT"><font COLOR="#000000" FACE="Arial,Helvetica,sans-serif" SIZE="2">e-mail:</font></TD>
<TD ALIGN="LEFT"><INPUT NAME="email" size="30" value="">
<BR>
</TD>
</TR>
<TR>
<TD ALIGN="RIGHT" VALIGN="TOP"><font COLOR="#000000" FACE="Arial,Helvetica,sans-serif" SIZE="2">What can you do?</font></TD>
<TD ALIGN="LEFT"><font COLOR="#000000" FACE="Arial,Helvetica,sans-serif" SIZE="2">I am willing to provide pro bono services in the following areas:</font>
</TD>
</TR>
<TR>
<TD ALIGN="RIGHT" VALIGN="TOP"> </TD>
<TD><font COLOR="#000000" FACE="Arial,Helvetica,sans-serif" SIZE="2"><input name="CKgrants" type=checkbox value="1" > Grant Writing <input name="CKfundraise" type=checkbox value="2" > Fund Raising</font>
</TD>
</TR>
<TR>
<TD ALIGN="RIGHT" VALIGN="TOP"> </TD>
<TD><font COLOR="#000000" FACE="Arial,Helvetica,sans-serif" SIZE="2"><input name="CKvolunteer" type=checkbox value="3" > Volunteer as Board Commissioner
<P>
<input name="CKfinancial" type=checkbox value="4" > Financial Donations
<P>
<input name="CKother" type=checkbox value="5" > Other </font><INPUT NAME="othertext" size="30" value="">
</TD>
</TR>
<TR>
<TD ALIGN="RIGHT" VALIGN="TOP"><font COLOR="#000000" FACE="Arial,Helvetica,sans-serif" SIZE="2">Other comment:</font></TD>
<TD ALIGN="LEFT"><TEXTAREA NAME="comment" cols=32 rows=4></textarea>
</TD>
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<TD ALIGN="RIGHT"> </TD>
<TD ALIGN="LEFT"><input type="submit" value="SEND FORM" >
<input type="reset" value="START OVER" >
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<DIV ALIGN="CENTER"><font size="1" face="Arial, Helvetica, sans-serif" color="#000000">Copyright (C) 2002. Newton Childcare Commission and Fund. All Rights Reserved</font></DIV>
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