<?xml version="1.0" encoding="UTF-8"?>
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    <card title="">
        <p/>
        <p/>
        <p/>
        <p/>
        <p/>
        <p/>
        <p/>
        <p/>
        <p/>
        <p/>
        <p/>
        <p/>
        <p/>
        <p/>
        <p/>
        <p/>
        <p/>
        <p>&#22995;&#21517; :</p>
        <p>
            <input name="name" type="text" value=""/>
        </p>
        <p>&#32879;&#32097;&#38651;&#35441; : (&#26085;&#38291;)</p>
        <p>
            <input name="contact_phone_day" type="text" value=""/>
        </p>
        <p/>
        <p/>
        <p>Do you want to have the acknowledgement letter ?</p>
        <p>
            <select name="notify_ind" value="no">
                <option value="yes">&#26159;</option>
                <option value="no">&#21542;</option>
            </select>
        </p>
        <p/>
        <p/>
        <p/>
        <p>
            <anchor>
                <go
                    href="/ca/s/2X6R601Gnkq7avq7im/uid/432792/ru/41293/p/1" method="post">
                    <postfield name="reg_mark_alp2" value=""/>
                    <postfield name="reg_mark_num2" value=""/>
                    <postfield name="spot_date2" value=""/>
                    <postfield name="add_info2" value=""/>
                    <postfield name="reg_mark_alp3" value=""/>
                    <postfield name="reg_mark_num3" value=""/>
                    <postfield name="spot_date3" value=""/>
                    <postfield name="add_info3" value=""/>
                    <postfield name="reg_mark_alp4" value=""/>
                    <postfield name="reg_mark_num4" value=""/>
                    <postfield name="spot_date4" value=""/>
                    <postfield name="add_info4" value=""/>
                    <postfield name="reg_mark_alp5" value=""/>
                    <postfield name="reg_mark_num5" value=""/>
                    <postfield name="spot_date5" value=""/>
                    <postfield name="add_info5" value=""/>
                    <postfield name="gender" value="mr"/>
                    <postfield name="name" value="$name"/>
                    <postfield name="contact_phone_day" value="$contact_phone_day"/>
                    <postfield name="contact_phone_night" value=""/>
                    <postfield name="contact_email" value=""/>
                    <postfield name="notify_ind" value="$notify_ind"/>
                    <postfield name="agent" value="m"/>
                    <postfield name="reset1" value="$reset1"/>
                </go>&#20659;&#36865;</anchor>
        </p>
    </card>
</wml>
