Become a member

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=100 BGCOLOR="#CCCCFF" TEXT="#080000" bgproperties="fixed" background="07400640egdysm.jpg"> <div> <FONT SIZE="5" COLOR="#000066" FACE="Arial" ><B>Christian Aid to Romania and Elsewhere (CARE)</B></FONT><FONT SIZE="5" COLOR="#000099" FACE="Arial" ><B> </B></FONT><B>    |     </B><A HREF="index.htm" TARGET="_top" TITLE="Christian Aid to Romania and Elsewhere ("><U><B>home</B></U></A></div> <div> <A HREF="current_news.htm" TARGET="_top" TITLE="Current News"><U>Current News</U></A>   |   <A HREF="missionstatement.htm" TARGET="_top" TITLE="Mission Statement"><U>Mission Statement</U></A>   |   <A HREF="currentprojects.htm" TARGET="_top" TITLE="Current Projects"><U>Current Projects</U></A>   |   <A HREF="fre.htm" TARGET="_top" TITLE="Fundraising Events"><U>Fund-raising Events</U></A>   |   <A HREF="donations.htm" TARGET="_top" 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action="http://csbmail.globalscape.com/cgi-bin/csbmail/csbmail.pl" method="POST" enctype="application/x-www-form-urlencoded"><input type="hidden" name="tlx_SortOrder" value="FirstName,LastName,Email,Company,Address1,Address2,City,State,Zip,Phone,Comments"><input type="hidden" name="tlx_FormIndex" value="2"><input type="hidden" name="tlx_OKMessage" value="Thank you for your request for information, we will be in touch shortly."><input type="hidden" name="tlx_SendMode" value="1"><input type="hidden" name="tlx_Subject" value="Become a Member of CARE"><input type="hidden" name="tlx_EmailTo" value="paulwilson@uk2.net"> <table cellpadding="0" cellspacing="1" border="0" align="center"> <tr> <td align="left">First Name:<br> <input type="text" name="FirstName" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Last Name:<br> <input type="text" name="LastName" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Email:<br> <input type="text" name="Email" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Company:<br> <input type="text" name="Company" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Address Line 1:<br> <input type="text" name="Address1" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Address Line 2:<br> <input type="text" name="Address2" size="30" maxlength="100"></td> </tr> <tr> <td align="left">City:<br> <input type="text" name="City" size="30" maxlength="100"></td> </tr> <tr> <td align="left">State:<br> <input type="text" name="State" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Post Code ro Zip:<br> <input type="text" name="Zip" size="10" maxlength="10"></td> </tr> <tr> <td align="left">Phone Number:<br> <input type="text" name="Phone" size="14" maxlength="14"></td> </tr> <tr> <td align="left">Comments:<br> <textarea name="Comments" rows="5" cols="30"></textarea></td> </tr> <tr> <td align="right"><input type="reset"> <input type="submit" value="Send" name="tlx_send"></td> </tr> </table> </form>  </div> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 75 WIDTH="487"><div>  <script src="http://www.google-analytics.com/urchin.js" type="text/javascript"> </script> <script type="text/javascript"> _uacct = "UA-262624-3"; urchinTracker(); </script>  </div> </tD> </tR> </TABLE></div> <bR> <bR> <bR> <bR> <bR> </td> </tr></table></body>