YFORM.CGI Sample Form

<HTML>
<HEAD>
  <TITLE>YFORM.CGI Sample Form</TITLE>
</HEAD>
<BODY>

<CENTER>
<H2>YFORM.CGI ver 1.6 Sample Form</H2>

<HR width=40%>

<FORM method="POST" action="http://www.usna.edu/cgi-bin/yform">
<INPUT type=hidden name="required" value="name,email">
<INPUT type=hidden name="sort" value="order:name,email,location,position,comments">
<INPUT type=hidden name="print_blank_fields" value="1">
        <!-- The next fields are for the email to you -->
<INPUT type=hidden name="recipient" value="YOUR EMAIL ADDRESS HERE">
<INPUT type=hidden name="subject" value="Email YFORM Response">
<INPUT type=hidden name="mailtop" value="This text prints above the field list.">
<INPUT type=hidden name="mailbottom" value="This text prints below the field list.">
        <!-- The next fields are for the courtesy reply -->
<INPUT type=hidden name="sendcourtesy" value="yes">
<INPUT type=hidden name="courtext1" value="Thank you for this important  information.">
<INPUT type=hidden name="courfieldlist" value="yes">
<INPUT type=hidden name="courtext2" value="Please contact us with any future concerns.">
<INPUT type=hidden name="courtclose" value="Sincerely,">
<INPUT type=hidden name="myname" value="Domino Computing Services">
<INPUT type=hidden name="myemail" value="somebody@nadn.navy.mil">
<INPUT type=hidden name="mywebsite" value="http://www.usna.edu">
        <!-- The next fields are for the database -->
<INPUT type=hidden name="database" value="sample.dat">
<INPUT type=hidden name="delimiter" value="|">
        <!-- The next fields are for the HTML response page -->
<INPUT type=hidden name="title" value="Thank You">
<INPUT type=hidden name="resptext1" value="We appreciate your time and response.">
<INPUT type=hidden name="respfieldlist" value="yes">
<INPUT type=hidden name="resptext2" value="Please return often.">
<INPUT type=hidden name="return_link_title" value="Click here to return to the main page.">
<INPUT type=hidden name="return_link_url" value="http://www.usna.edu">

<TABLE width=550 Border=0>
<TR>
	<TD>
		<I> Your full name: </I> <BR>
		<INPUT type=text name="name"> <FONT size=1>required</FONT> <BR>
		<BR>
		<I> Email Address: </I> <BR>
		<INPUT type=text name="email"> <FONT size=1>required</FONT> <BR>
		<BR>
		<I>Where are you? <font size=2>[ city, state country] </I></font> <BR>
		<INPUT type=text size=30 name="location"> <BR>  
	</TD>
	<TD>
		<I>Are you a:</I> <BR>
		<INPUT type="checkbox" name="position" value="Student"> Student 
		<INPUT type=checkbox name="position" value="Teacher"> Teacher
 		<INPUT type=checkbox name="position" value="Other"> Other <BR>
		<BR>
		<I>What would you like to tell us?</I> <BR>
		<TEXTAREA wrap=virtual name="comments" rows=5 cols=30></TEXTAREA> <BR>
	</TD>
</TR>
<TR align=center>
	<TD colspan=2>
		<BR>
		<INPUT type=submit value="Submit"> 
		<INPUT type=reset>
	</TD>
</TR>
</TABLE>
</FORM>
</CENTER>

</BODY>
</HTML>