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centersuggest.php
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centersuggest.php
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<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Strict//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-strict.dtd">
<html xmlns="http://www.w3.org/1999/xhtml" dir="ltr" lang="en" xml:lang="en">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<link rel="stylesheet" type="text/css" href="http://bais.islamiconlineuniversity.com/bais/theme/standard/styles.php" />
<link rel="stylesheet" type="text/css" href="http://bais.islamiconlineuniversity.com/bais/theme/ingenuous/styles.php" />
<meta name="description" content="" />
<meta name="keywords" content="moodle, Islamic Online University - BAIS " />
<title>Islamic Online University - BAIS</title>
<link rel="shortcut icon" href="http://bais.islamiconlineuniversity.com/bais/theme/ingenuous/favicon.ico" />
<!--<style type="text/css">/*<![CDATA[*/ body{behavior:url(http://bais.islamiconlineuniversity.com/bais/lib/csshover.htc);} /*]]>*/</style>-->
<style type="text/css">
<!--
body {
font-family: Arial;
font-size: 10pt;
line-height: normal;
}
table {
font-family: Arial;
font-size: 10pt;
line-height: normal;
}
.verdana_10px {
font-family: Verdana;
font-size: 11px;
line-height: normal;
}
.td_data td {
padding: 4px
}
.td_data td span {
color:#FFFFFF;
text-decoration:none;
cursor:pointer;}
.arial_10pt {
font-family: Arial;
font-size: 10pt;
line-height: normal;
}
.verdana_10px {
font-family: Verdana;
font-size: 10px;
}
.tahoma_10pt {
font-family: Tahoma;
font-size: 10pt;
}
-->
</style>
<table width= "100%" border="0">
<tr width= "100%" bgcolor="#000000" class="td_data">
<td width= "100%" align= "center"><span><strong>Exam Center Suggestion page</strong></span></td>
</tr>
</table>
</head>
<body>
<p>Suggest a Center</p>
<form id="form1" name="form1" method="post" action="suggest.php">
<p>
<label for="CenterName">Center Name:* </label>
<input type="text" name="CenterName" id="CenterName" />
</p>
<p>
<label for="Country">Country Name</label>
*
<select name="Country" id="Country">
</select>
</p>
<p>
<label for="stateID"> State/County *</label>
<input type="text" name="state" id="state" />
</p>
<p>
<label for="CityID">City Name *</label>
<input type="text" name="CityName" id="CityName" />
</p>
<p>
<label for="Address1">Address*</label>
<textarea name="Address1" id="Address1" cols="45" rows="5"></textarea>
</p>
<p>Contact Information</p>
<p>
<label for="PrimaryPhone">Phone*</label>
<input type="text" name="PrimaryPhone" id="PrimaryPhone" />
<label for="Email">Email*</label>
<input type="text" name="Email" id="Email" />
</p>
<p>
<label for="Website">Website</label>
<input type="text" name="Website" id="Website" />
</p>
<p>
<input type="submit" name="Submit" id="Submit" value="Submit" />
</p>
</form>
<p> </p>
</body>
</html>