<TD HEIGHT="528" VALIGN="TOP"> <TABLE WIDTH="100%" BORDER="0" CELLPADDING="6" CELLSPACING="0">
<TR>
<TD WIDTH="121"><A HREF="http://www.kirbykangaroo.com/index.php?cuid=53325116" TARGET="_blank" onClick="return confirmAction()"><IMG SRC="images/graphics/kirby_kangaroo.gif" WIDTH="121" HEIGHT="76" BORDER="0"></A></TD>
<TD VALIGN="MIDDLE">
<P><STRONG><IMG SRC="images/kk_member_app.gif" WIDTH="277" HEIGHT="54"></STRONG></P>
</TD>
</TR>
</TABLE>
<BR>
<TABLE WIDTH="100%" BORDER="0" CELLPADDING="5" CELLSPACING="0" CLASS="maintext">
<TR> 
<TD ALIGN="LEFT" VALIGN="TOP"> <FORM METHOD="post" NAME="form" ACTION="http://scripts.ilinkadv.com/mailformurl.cgi">
<INPUT TYPE="hidden" NAME="recipient"  VALUE="marketing@sccu.net">
<INPUT TYPE="hidden" NAME="subject" VALUE="Kirby Kangaroo Membership App">
<INPUT TYPE="hidden" NAME="redirect" VALUE="http://www.sccu.net/content.php?id=113">
<TABLE WIDTH="100%" BORDER="0" CELLPADDING="2" CELLSPACING="0" CLASS="maintext">
<TR> 
<TD WIDTH="146" ALIGN="LEFT" VALIGN="TOP">&nbsp;</TD>
</TR>
<TR> 
<TD ALIGN="LEFT" VALIGN="TOP"><TABLE WIDTH="100%" BORDER="0" CELLSPACING="0" CELLPADDING="2">
<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 NAME="First Name" TYPE="text" ID="First Name"></TD>
<TD><INPUT NAME="Middle Initial" TYPE="text" ID="Middle Initial" SIZE="5"></TD>
<TD><INPUT NAME="Last Name" TYPE="text" ID="Last Name"></TD>
</TR>
</TABLE></TD>
</TR>
<TR> 
<TD ALIGN="LEFT" VALIGN="TOP"><TABLE WIDTH="100%" BORDER="0" CELLSPACING="0" CELLPADDING="2">
<TR> 
<TD CLASS="maintext">Address</TD>
</TR>
<TR> 
<TD><INPUT NAME="Address - line1" TYPE="text" ID="Address - line1" SIZE="35"></TD>
</TR>
<TR> 
<TD><INPUT NAME="Address - line2" TYPE="text" ID="Address - line2" SIZE="35"></TD>
</TR>
</TABLE></TD>
</TR>
<TR> 
<TD ALIGN="LEFT" VALIGN="TOP"><TABLE WIDTH="100%" BORDER="0" CELLSPACING="0" CELLPADDING="2">
<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 NAME="City" TYPE="text" ID="City"></TD>
<TD><INPUT NAME="State" TYPE="text" ID="State" SIZE="5"></TD>
<TD><INPUT NAME="Zip Code" TYPE="text" ID="Zip Code" SIZE="8"></TD>
</TR>
</TABLE></TD>
</TR>
<TR> 
<TD ALIGN="LEFT" VALIGN="TOP"><TABLE WIDTH="100%" BORDER="0" CELLSPACING="0" CELLPADDING="2">
<TR>
<TD CLASS="maintext">Birthday</TD>
<TD CLASS="maintext">Favorite 
Color </TD>
</TR>
<TR>
<TD CLASS="maintext"><INPUT NAME="Birthday" TYPE="text" ID="Birthday"></TD>
<TD CLASS="maintext"><INPUT NAME="Favorite Color" TYPE="text" ID="Favorite Color"></TD>
</TR>
<TR>
<TD CLASS="maintext">Favorite 
Sport / Hobby</TD>
<TD CLASS="maintext">Favorite 
Snack </TD>
</TR>
<TR>
<TD CLASS="maintext"><INPUT NAME="Favorite Sport / Hobby" TYPE="text" ID="Favorite Sport / Hobby"></TD>
<TD CLASS="maintext"><INPUT NAME="Favorite Snack" TYPE="text" ID="Favorite Snack"></TD>
</TR>
<TR> 
<TD WIDTH="40%" CLASS="maintext">Favorite 
Cartoon</TD>
<TD WIDTH="60%" CLASS="maintext">&nbsp;</TD>
</TR>
<TR> 
<TD>
<INPUT NAME="Favorite Cartoon" TYPE="text" ID="Favorite Cartoon"></TD>
<TD>&nbsp; </TD>
</TR>
</TABLE></TD>
</TR>
<TR> 
<TD ALIGN="LEFT" VALIGN="TOP">&nbsp;</TD>
</TR>
<TR> 
<TD ALIGN="LEFT" VALIGN="TOP"><INPUT NAME="Thanks!" TYPE=SUBMIT ID="Thanks!" onClick="verify();" VALUE="Submit"> 
<INPUT NAME="Clear" TYPE="reset" VALUE="Clear Form">	
</TD>
</TR>
</TABLE>
</FORM></TD>
</TR>
</TABLE>