<br><table width="100%" cellspacing="0" cellpadding="6" border="0">
    <tbody>
        <tr>
            <td width="94" height="93"><a target="_blank" href="http://www.cusucceed.net/index.php?cuid=53325116"><img width="94" height="88" border="0" src="upload_content/images/cu_succeed.gif" alt="" /></a></td>
            <td valign="MIDDLE">
            <p><img width="257" height="47" src="upload_content/images/cu_member_app.gif" alt="" /></p>
            </td>
        </tr>
    </tbody>
</table>
<p>&nbsp;</p>
<table width="100%" cellspacing="0" cellpadding="5" border="0" class="maintext">
    <tbody>
        <tr>
            <td valign="TOP" align="LEFT">
            <form action="http://scripts.ilinkadv.com/mailformurl.cgi" name="form" method="post">
                <input type="hidden" value="marketing@sccu.net" name="recipient" /> <input type="hidden" value="CU Succeed Membership App" name="subject" /> <input type="hidden" value="http://www.sccu.net/content.php?id=114" name="redirect" />
                <table width="100%" cellspacing="0" cellpadding="2" border="0" class="maintext">
                    <tbody>
                        <tr>
                            <td width="146" valign="TOP" align="LEFT">&nbsp;</td>
                        </tr>
                        <tr>
                            <td valign="TOP" align="LEFT">
                            <table width="100%" cellspacing="0" cellpadding="2" border="0">
                                <tbody>
                                    <tr>
                                        <td width="40%" height="24" class="maintext">First  Name</td>
                                        <td width="20%" class="maintext">Middle  Initial</td>
                                        <td width="40%" class="maintext">Last  Name</td>
                                    </tr>
                                    <tr>
                                        <td><input type="text" id="First Name" name="First Name" /></td>
                                        <td><input type="text" size="5" id="Middle Initial" name="Middle Initial" /></td>
                                        <td><input type="text" id="Last Name" name="Last Name" /></td>
                                    </tr>
                                </tbody>
                            </table>
                            </td>
                        </tr>
                        <tr>
                            <td valign="TOP" align="LEFT">
                            <table width="100%" cellspacing="0" cellpadding="2" border="0">
                                <tbody>
                                    <tr>
                                        <td class="maintext">Address</td>
                                    </tr>
                                    <tr>
                                        <td><input type="text" size="35" id="Address - line1" name="Address - line1" /></td>
                                    </tr>
                                    <tr>
                                        <td><input type="text" size="35" id="Address - line2" name="Address - line2" /></td>
                                    </tr>
                                </tbody>
                            </table>
                            </td>
                        </tr>
                        <tr>
                            <td valign="TOP" align="LEFT">
                            <table width="100%" cellspacing="0" cellpadding="2" border="0">
                                <tbody>
                                    <tr>
                                        <td width="40%" height="24" class="maintext">City</td>
                                        <td width="20%" class="maintext">State</td>
                                        <td width="40%" class="maintext">Zip  Code</td>
                                    </tr>
                                    <tr>
                                        <td><input type="text" id="City" name="City" /></td>
                                        <td><input type="text" size="5" id="State" name="State" /></td>
                                        <td><input type="text" size="8" id="Zip Code" name="Zip Code" /></td>
                                    </tr>
                                </tbody>
                            </table>
                            </td>
                        </tr>
                        <tr>
                            <td valign="TOP" align="LEFT">
                            <table width="100%" cellspacing="0" cellpadding="2" border="0">
                                <tbody>
                                    <tr>
                                        <td width="40%" class="maintext">Birthday</td>
                                        <td width="60%" class="maintext">Grade</td>
                                    </tr>
                                    <tr>
                                        <td class="maintext"><input type="text" id="Birthday" name="Birthday" /></td>
                                        <td class="maintext"><input type="text" id="Grade" name="Grade" /></td>
                                    </tr>
                                    <tr>
                                        <td class="maintext">Sports  / Hobbies / Clubs</td>
                                        <td class="maintext">School</td>
                                    </tr>
                                    <tr>
                                        <td class="maintext"><input type="text" id="Sports" name="Sports" /></td>
                                        <td class="maintext"><input type="text" id="School" name="School" /></td>
                                    </tr>
                                </tbody>
                            </table>
                            </td>
                        </tr>
                        <tr>
                            <td valign="TOP" align="LEFT">&nbsp;</td>
                        </tr>
                        <tr>
                            <td valign="TOP" align="LEFT"><input type="SUBMIT" value="Submit" onClick="verify();" id="Thanks!" name="Thanks!" />  <input type="reset" value="Clear Form" name="Clear" /></td>
                        </tr>
                    </tbody>
                </table>
            </form>
            </td>
        </tr>
    </tbody>
</table>