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<title>Registration for Individual Donators</title>
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    <td class="headline">
      <div align="center"><font size="+2">Bid: Registrater to donate funds</font></div>
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    <td class="lauftext" height="51">Are you wasting your money on campaign contributions? 
      The soft money that you give to national political committees will be spent 
      on single-issue ads which are an ineffective method of persuading the voting 
      populace. [V]ote-auction.com offers a greater return on your campaign investment. 
      When you win the auction on a particular voting block, you can be certain 
      that the [V]ote-auction.com voters in that state will vote for your candidate. 
      Thus, you are guaranteed that your interests will be looked after.</td>
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    <td class="lauftext">Fields marked with a * are required. This information 
      will be used to create a demographic profile of the bidders. Your identity 
      will be kept strictly confidential. This information will not be sold, distributed, 
      or released for any reason. You will be assigned a bidder number so you 
      can follow the bids on the <a href="check.htm">check</a> page. Registering 
      to bid on votes also registers you for the bidders email list which will 
      contain updates on important [V]ote-auction.com information. You will not 
      receive any advertising or unwanted emails (spam) from this list. </td>
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    <td class="lauftext">Register to donate funds.</td>
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<FORM METHOD=POST ACTION="./individualbid.php3">
<input type=hidden name="recipient" value="indybidderform@voteauction.com">
<input type=hidden name="subject" value="individual bidder form">
<input type=hidden name="redirect" value="http://www.voteauction.com/thankyoubidder.htm">
<input type=hidden name="required" value="firstname, lastname, address1, city, state, zipcode, email, age, sex, race, employment, occupation, education, income, contributions">
<!-- , agreementcheckbox"> -->
<input type=hidden name="env_report" value="REMOTE_ADDR, HTTP_USER_AGENT">
<input type=hidden name="missing_fields_redirect" value="http://www.voteauction.com/error.htm">
<input type=hidden name="dataname" value="individualbid">


  <table border="0" width="80%" align="center" cellpadding="4" cellspacing="2" bgcolor="#000000">
    <tr> 
      <td bgcolor="#FFFFFF" class="lauftext">First (Given) Name</td>
      <td bgcolor="#CCCCCC"> 
        <input type="text" name="firstname">
        * </td>
      <td bgcolor="#FFFFFF">&nbsp;</td>
      <td bgcolor="#CCCCCC">&nbsp;</td>
    </tr>
    <tr> 
      <td bgcolor="#FFFFFF" class="lauftext">Last (Family) Name</td>
      <td bgcolor="#CCCCCC"> 
        <input type="text" name="lastname">
        * </td>
      <td bgcolor="#FFFFFF" class="lauftext">Middle Initial</td>
      <td bgcolor="#CCCCCC"> 
        <input type="text" name="middleinitial" maxlength="1" size="5">
      </td>
    </tr>
    <tr> 
      <td bgcolor="#FFFFFF" class="lauftext">Address (Line 1)</td>
      <td bgcolor="#CCCCCC"> 
        <input type="text" name="address1">
        * </td>
      <td bgcolor="#FFFFFF">&nbsp;</td>
      <td bgcolor="#CCCCCC">&nbsp;</td>
    </tr>
    <tr> 
      <td bgcolor="#FFFFFF" class="lauftext">Address (Line 2)</td>
      <td bgcolor="#CCCCCC"> 
        <input type="text" name="address2">
      </td>
      <td bgcolor="#FFFFFF">&nbsp;</td>
      <td bgcolor="#CCCCCC">&nbsp;</td>
    </tr>
    <tr> 
      <td bgcolor="#FFFFFF" class="lauftext">City</td>
      <td bgcolor="#CCCCCC"> 
        <input type="text" name="city">
        * </td>
      <td bgcolor="#FFFFFF" class="lauftext">State</td>
      <td bgcolor="#CCCCCC"> 
        <select name="state">
          <option>AL</option>
          <option>AK</option>
          <option>AZ</option>
          <option>AR</option>
          <!--          <option>CA</option> --> 
          <option>CO</option>
          <option>CT</option>
          <option>DE</option>
          <option>DC</option>
          <option>FL</option>
          <option>GA</option>
          <option>HA</option>
          <option>ID</option>
          <option>IL</option>
          <option>IN</option>
          <option>IA</option>
          <option>KS</option>
          <option>KY</option>
          <option>LA</option>
          <option>ME</option>
          <option>MD</option>
          <option>MA</option>
          <option>MI</option>
          <option>MN</option>
          <option>MS</option>
          <option>MO</option>
          <option>MT</option>
          <option>NB</option>
          <option>NV</option>
          <option>NH</option>
          <!--          <option>NY</option> --> 
          <option>NM</option>
          <option>NC</option>
          <option>ND</option>
          <option>OH</option>
          <option>OK</option>
          <option>OR</option>
          <option>PA</option>
          <option>RI</option>
          <option>SC</option>
          <option>SD</option>
          <option>TN</option>
          <option>TX</option>
          <option>UT</option>
          <option>VT</option>
          <option>VI</option>
          <option>WA</option>
          <option>WV</option>
          <option>WI</option>
          <option>WY</option>
        </select>
        * </td>
    </tr>
    <tr> 
      <td bgcolor="#FFFFFF" class="lauftext">Zip Code</td>
      <td bgcolor="#CCCCCC"> 
        <input type="text" name="zipcode">
        * </td>
      <td bgcolor="#FFFFFF">&nbsp;</td>
      <td bgcolor="#CCCCCC">&nbsp;</td>
    </tr>
    <tr> 
      <td bgcolor="#FFFFFF" class="lauftext">Email address</td>
      <td bgcolor="#CCCCCC"> 
        <input type="text" name="email">
        * </td>
      <td bgcolor="#FFFFFF" class="lauftext">Telephone</td>
      <td bgcolor="#CCCCCC"> 
        <input type="text" name="telephone">
      </td>
    </tr>
    <tr> 
      <td bgcolor="#FFFFFF" class="lauftext">Age (on November 7, 2000)</td>
      <td bgcolor="#CCCCCC"> 
        <select name="age">
          <option selected>18</option>
          <option>19-22</option>
          <option>23-29</option>
          <option>30-39</option>
          <option>40-49</option>
          <option>50-59</option>
          <option>60-69</option>
          <option>70 and over</option>
        </select>
        * </td>
      <td bgcolor="#FFFFFF" class="lauftext">Sex</td>
      <td bgcolor="#CCCCCC"> 
        <select name="sex">
          <option>Female</option>
          <option>Male</option>
          <option selected>-------</option>
        </select>
        * </td>
    </tr>
    <tr> 
      <td bgcolor="#FFFFFF" class="lauftext">I describe myself as:</td>
      <td bgcolor="#CCCCCC"> 
        <select name="race">
          <option>Asian/Pacific Islander</option>
          <option>Black/African American</option>
          <option>Native American</option>
          <option>Spanish/Hispanic/Latino</option>
          <option>White/Caucasian</option>
        </select>
        * </td>
      <td bgcolor="#FFFFFF" class="lauftext">Employment Status</td>
      <td bgcolor="#CCCCCC"> 
        <select name="employment">
          <option>Full-Time</option>
          <option>Part-Time</option>
          <option>Self-Employed</option>
          <option>Student</option>
          <option>Homemaker</option>
          <option>Retired</option>
          <option>Unemployed</option>
        </select>
        * </td>
    </tr>
    <tr> 
      <td bgcolor="#FFFFFF" class="lauftext">Occupation</td>
      <td bgcolor="#CCCCCC"> 
        <select name="occupation">
          <option>Administrative/Clerical</option>
          <option>Attorney</option>
          <option>Doctor</option>
          <option>Educator</option>
          <option>Managerial/Executive</option>
          <option>Professional/Technical</option>
          <option>Sales</option>
          <option>Service Labor (i.e. Waiter/Waitress)</option>
          <option>Skilled Labor/Construction</option>
          <option>Police/Armed Forces</option>
          <option>Other</option>
        </select>
        * </td>
      <td bgcolor="#FFFFFF" class="lauftext">Highest Education Level</td>
      <td bgcolor="#CCCCCC"> 
        <select name="education">
          <option>Some High School</option>
          <option>High School Graduate</option>
          <option>Some College</option>
          <option>College Graduate</option>
          <option>Graduate School</option>
        </select>
        * </td>
    </tr>
    <tr> 
      <td bgcolor="#FFFFFF" class="lauftext">Household Income</td>
      <td bgcolor="#CCCCCC"> 
        <select name="income">
          <option>Less than 15,000</option>
          <option>15,000 - 24,999</option>
          <option>25,000 - 34,999</option>
          <option>35,000 - 49,999</option>
          <option>50,000 - 74,999</option>
          <option>75,000 - 99,999</option>
          <option>Over 100,000</option>
        </select>
        * </td>
      <td bgcolor="#FFFFFF" class="lauftext">Political Affiliation</td>
      <td bgcolor="#CCCCCC"> 
        <select name="politicalaffiliation">
          <option>Communist</option>
          <option>Democrat</option>
          <option>Green</option>
          <option>Independent</option>
          <option>Libertarian</option>
          <option>Reform</option>
          <option>Republican</option>
          <option>Socialist</option>
          <option>None</option>
        </select>
      </td>
    </tr>
    <tr> 
      <td bgcolor="#FFFFFF" class="lauftext">Amount I spent in campaign contributions 
        (soft and/or hard money) in the 1996 election cycle.</td>
      <td bgcolor="#CCCCCC"> 
        <input type="text" name="contributions">
        * </td>
      <td bgcolor="#FFFFFF">&nbsp;</td>
      <td bgcolor="#CCCCCC">&nbsp;</td>
    </tr>
  </table>
  <table border="0" width="80%" align="center" cellpadding="4" cellspacing="2" bgcolor="#000000">
    <tr> 
      <td bgcolor="#FFFFFF" align="left" valign="top" class="lauftext">I am interested 
        in donating funds because:</td>
      <td bgcolor="#CCCCCC" align="left" valign="top"> 
        <textarea name="reason" cols="80" rows="10"></textarea>
      </td>
    </tr>
    <tr> 
      <td colspan="2" bgcolor="#FFFFCC" align="right" valign="top">&nbsp; </td>
    </tr>
    <tr> 
      <td colspan="2" bgcolor="#CCCCCC" align="left" valign="top"> 
        <div align="center">
          <input type="submit" name="Submit" value="Submit">
        </div>
      </td>
    </tr>
  </table>
  <p>&nbsp;</p>
  <p>&nbsp;</p>
</form>
<p>&nbsp; </p>
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