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<HTML>

<HEAD>


<META NAME="description" CONTENT="Business Development
Business Education
Health Education
Health Training">
<META NAME="Keywords"    CONTENT="business development,business training,health education,hepatitis education and testing,business formation">


<!-- business -->


<META HTTP-EQUIV="Content-Type" CONTENT="text/html; charset=UTF-8">
<META NAME="Generator" content="">
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<!--<BASE HREF="http://daphne.meccahosting.com/~a000402b/form.html">-->
<TITLE>Bus Training Registration</TITLE></head>
<BODY  BGCOLOR="#D0DEED"
 TEXT="#333333"

LEFTMARGIN="0" TOPMARGIN="0" RIGHTMARGIN="0" BOTTOMMARGIN="0"

 onLoad=""
 
 LINK="#000000"
 VLINK="#333333"
 ALINK="#58BEF8"
>

  
      <!-- BOF: ./personal-templates/simple/business/layout/l50.layout --> 


<!-- html -->
<TABLE WIDTH="100%" HEIGHT="100%" BORDER="0" CELLPADDING="0" CELLSPACING="0" VALIGN="top">
    <TR>
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       <TD WIDTH="100%" HEIGHT=88>
                 <TABLE WIDTH="100%" HEIGHT=88 BORDER="0" CELLPADDING="0" CELLSPACING="0" VALIGN="top">
                     <TR>
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                                <IMG SRC="widgets/gen_3181.1.gif" WIDTH=670 HEIGHT=88 ALT=""></TD>
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      <TD VALIGN="top" HEIGHT=100%>
                   
                 <TABLE WIDTH=100% HEIGHT="100%" BORDER="0" CELLPADDING="0" CELLSPACING="0" VALIGN="top">
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                  <TD WIDTH=174 BACKGROUND="widgets/gen_2648.1.gif" style="background-repeat: no-repeat;" VALIGN="top">
                      <IMG SRC="widgets/spacer.gif" WIDTH=1 HEIGHT=20>
                      
                      <a href="index.html" onMouseOver="document.images['img16'].src='widgets/gen_2672.1.gif'" onMouseOut="document.images['img16'].src='widgets/gen_2671.1.gif'"><img src="widgets/gen_2671.1.gif" alt="Home" name="img16" border="0"></a><br>
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                      <a href="resources1.html" onMouseOver="document.images['img91'].src='widgets/gen_3312.1.gif'" onMouseOut="document.images['img91'].src='widgets/gen_3331.1.gif'"><img src="widgets/gen_3331.1.gif" alt="Business Resources" name="img91" border="0"></a><br>
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                      <a href="AAHEI.html" onMouseOver="document.images['img17'].src='widgets/gen_3250.1.gif'" onMouseOut="document.images['img17'].src='widgets/gen_3249.1.gif'"><img src="widgets/gen_3249.1.gif" alt="AAHEI" name="img17" border="0"></a><br>
                      <a href="hepatitis.html" onMouseOver="document.images['img54'].src='widgets/gen_2684.1.gif'" onMouseOut="document.images['img54'].src='widgets/gen_3132.1.gif'"><img src="widgets/gen_3132.1.gif" alt="Hepatitis" name="img54" border="0"></a><br>
                      <a href="cardio.html" onMouseOver="document.images['img57'].src='widgets/gen_3118.1.gif'" onMouseOut="document.images['img57'].src='widgets/gen_3186.1.gif'"><img src="widgets/gen_3186.1.gif" alt="Cardiometabolic Dis" name="img57" border="0"></a><br>
                      <a href="survey.html" onMouseOver="document.images['img236'].src='widgets/gen_3364.1.gif'" onMouseOut="document.images['img236'].src='widgets/gen_3363.1.gif'"><img src="widgets/gen_3363.1.gif" alt="CMD Survey" name="img236" border="0"></a><br>
                      <a href="women.html" onMouseOver="document.images['img129'].src='widgets/gen_3569.1.gif'" onMouseOut="document.images['img129'].src='widgets/gen_3568.1.gif'"><img src="widgets/gen_3568.1.gif" alt="10/3 Event Details" name="img129" border="0"></a><br>
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                      <a href="gpage1.html" onMouseOver="document.images['img254'].src='widgets/gen_3606.1.gif'" onMouseOut="document.images['img254'].src='widgets/gen_3605.1.gif'"><img src="widgets/gen_3605.1.gif" alt="Sponsor" name="img254" border="0"></a><br>
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                      <a href="Consumer.html" onMouseOver="document.images['img70'].src='widgets/gen_2694.1.gif'" onMouseOut="document.images['img70'].src='widgets/gen_2693.1.gif'"><img src="widgets/gen_2693.1.gif" alt="Consumer Events" name="img70" border="0"></a><br>
                      <a href="Faith.html" onMouseOver="document.images['img83'].src='widgets/gen_3200.1.gif'" onMouseOut="document.images['img83'].src='widgets/gen_2695.1.gif'"><img src="widgets/gen_2695.1.gif" alt="Faith Based Events" name="img83" border="0"></a><br>
                      <a href="Appeal.html" onMouseOver="document.images['img251'].src='widgets/gen_3504.1.gif'" onMouseOut="document.images['img251'].src='widgets/gen_3503.1.gif'"><img src="widgets/gen_3503.1.gif" alt="An Appeal For Help" name="img251" border="0"></a><br>
                      <a href="donate.html" onMouseOver="document.images['img139'].src='widgets/gen_3100.1.gif'" onMouseOut="document.images['img139'].src='widgets/gen_3122.1.gif'"><img src="widgets/gen_3122.1.gif" alt="Program Donations" name="img139" border="0"></a><br>
                      <a href="about.html" onMouseOver="document.images['img20'].src='widgets/gen_2700.1.gif'" onMouseOut="document.images['img20'].src='widgets/gen_2699.1.gif'"><img src="widgets/gen_2699.1.gif" alt="ABOUT US" name="img20" border="0"></a><br>
                      <a href="contact.html" onMouseOver="document.images['img22'].src='widgets/gen_3184.1.gif'" onMouseOut="document.images['img22'].src='widgets/gen_3198.1.gif'"><img src="widgets/gen_3198.1.gif" alt="CONTACT US" name="img22" border="0"></a><br>
                      
                      <a href="mailto:info@blackexpocommdev.org" onMouseOver="document.images['img_email'].src='widgets/gen_2706.1.gif'" onMouseOut="document.images['img_email'].src='widgets/gen_3212.1.gif'"><img src="widgets/gen_3212.1.gif" alt="Email Me" name="img_email" border="0"></a><br><br></TD>
                  </TD>
                  <TD WIDTH=13>
                       <TABLE WIDTH="100%" HEIGHT="100%" BORDER="0" CELLPADDING="0" CELLSPACING="0" VALIGN="top">
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                             <TD WIDTH=13 HEIGHT=342 VALIGN="top"><IMG SRC="widgets/gen_3219.1.gif" WIDTH=13 HEIGHT=342 ALT=""></TD>
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                          <TR>
                             <TD BACKGROUND="widgets/gen_2650.1.gif"></TD>
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                          <TR>
                            <TD WIDTH=13 HEIGHT=7 VALIGN="bottom"><IMG SRC="widgets/gen_2656.1.gif" WIDTH=13 HEIGHT=7 ALT=""></TD>
                          </TR>
                       </TABLE>
                  </TD>
                                    
                  <TD WIDTH=100% BACKGROUND="widgets/gen_2645.1.gif" style="background-repeat: no-repeat;" VALIGN="top">
                                        

                           <TABLE WIDTH="100%" HEIGHT="100%" BORDER="0" CELLPADDING="0" CELLSPACING="0" VALIGN="top">
                                   <TR>  
                                     <TD WIDTH="100%" HEIGHT="100%" VALIGN="top"><!-- BOF: ./personal-templates/simple/businessnew/form/style_l40.html -->


<TABLE  WIDTH=100% BORDER=0 CELLPADDING=0 CELLSPACING=0 VALIGN="top">
                                                        <TR>
                                                                <TD WIDTH=400 HEIGHT=50><IMG SRC="widgets/gen_3373.1.gif" WIDTH=400 HEIGHT=50></TD>
                                                                
                                                           
                                                        </TR>        
                                                </TABLE>

<TABLE WIDTH=100% BORDER=0 CELLPADDING=0 CELLSPACING=0 VALIGN="top">
<TR><TD COLSPAN="2"></TD></TR>
<TR>
    <TD WIDTH=100% COLSPAN="2" VALIGN="top">
    <TABLE WIDTH=90% BORDER=0 CELLPADDING=5 CELLSPACING=0 VALIGN="top">
    <TR>
<SCRIPT LANGUAGE="JavaScript">
var BUILDER = '/servlet/psoft.masonry.Builder';
function validate(frm){
var i = 0;

if (frm.field_124.value=="") return error(frm.field_124);
if (frm.field_y_125.value=="") return error(frm.field_y_125);

if (frm.field_126.value=="") return error(frm.field_126);

var url = document.URL;
if (url.indexOf(BUILDER) == -1 && url.charAt(url.length)!='/') {
 url = url.substring(0, url.lastIndexOf('/')+1);
}
frm.domain.value=url;
return true;

}
function error(field){ alert('You did not fill all required fields!'); field.focus(); return false; }
</SCRIPT>
<form name="questionary" action="http://76.74.155.84:8080/servlet/psoft.customform.CustomForm" method="post">
<input type="hidden" name="domain" value="">
<input type="hidden" name="title" value="Bus Training Registration">
<input type="hidden" name="esubj" value="Submitted Form Report">
<input type="hidden" name="name" value="=GCh0WGxbU1bal4b">
<input type="hidden" name="submit_url" value="onsubmit1.html">
<input type="hidden" name="error_url" value="onerror1.html">

<input type="hidden" name="order" value="124 d125 126 ">

        <TD VALIGN="top">
        <TABLE border="0" cellpadding="5" cellspacing="5" width="95%">
        <TR><TD colspan=2>&nbsp;</td></TR>
        <input type="hidden" name="name_124" value="Your Name/Address/City/Phone">
        <TR><TD>


<font face='Arial' size='2' color='#333333'>

Your Name/Address/City/Phone

</font>


<font color="red" size="-1">*</font></td>
            <TD><textarea name="field_124" rows="5" cols="30"></textarea>
            
            </TD>
        </TR>
        <input type="hidden" name="name_125" value="Today's Date">
        <TR><TD>


<font face='Arial' size='2' color='#333333'>

Today's Date

</font>


<font color="red" size="-1">*</font></td>
            <TD><select name="field_m_125" size="1">
            <option>Jan<option>Feb<option>Mar
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<font face='Arial' size='2' color='#333333'>

Provide Your Email Address

</font>


<font color="red" size="-1">*</font></td>
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</form>
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</TR>
</TABLE>
<!-- EOF: ./personal-templates/simple/businessnew/form/style_l40.html -->

                                                </TD>
                                   </TR>
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                                     <TD>
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                                                                             <TD BACKGROUND="widgets/gen_2667.1.gif">
<center><table border="0" cellpadding="0" cellspacing="3"><tr><td align="center">

<br><font face="helvetica,verdana, arial" size="1">&nbsp;</font>

</td></tr></table></center>
</TD>
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                  <TD HEIGHT=19 BGCOLOR="#8DA7C2"><IMG SRC="widgets/spacer.gif" WIDTH=1 HEIGHT=19></TD>
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 </TR>
 <TR>
     <TD HEIGHT=51 BACKGROUND="widgets/gen_2644.1.gif" style="background-position: bottom left; background-repeat: repeat-x;" VALIGN="bottom" BGCOLOR="#8DA7C2">

<br>
<FONT FACE="verdana, arial, helvetica" SIZE="1">
<center>
<nobr>|<a href="index.html">Home</A>|</nobr>

<nobr>|<a href="businessservices.html">BUSINESS SERVICES</A>|</nobr>

<nobr>|<a href="incorporation.html">Form A Corporation</A>|</nobr>

<nobr>|<a href="bustraining.html">Bus Training Program </A>|</nobr>

<nobr>|Bus Training Registration |</nobr>

<nobr>|<a href="resources1.html">Business Resources</A>|</nobr>

<nobr>|<a href="ad.html">HEALTH EDUCATION</A>|</nobr>

<nobr>|<a href="AAHEI.html">AAHEI</A>|</nobr>

<nobr>|<a href="hepatitis.html">Hepatitis</A>|</nobr>

<nobr>|<a href="cardio.html">Cardiometabolic Dis</A>|</nobr>

<nobr>|<a href="survey.html">CMD Survey</A>|</nobr>

<nobr>|<a href="women.html">10/3 Event Details</A>|</nobr>

<nobr>|<a href="gpage.html">10/3 Event Schedule</A>|</nobr>

<nobr>|<a href="speakers.html">10/3 Speakers</A>|</nobr>

<nobr>|<a href="womenreg.html">10/3 Registration Form</A>|</nobr>

<nobr>|<a href="registrations.html">10/3 Registrants</A>|</nobr>

<nobr>|<a href="gpage1.html">Sponsor</A>|</nobr>

<nobr>|<a href="comments.html">Guests Feedback</A>|</nobr>

<nobr>|<a href="Consumer.html">Consumer Events</A>|</nobr>

<nobr>|<a href="Faith.html">Faith Based Events</A>|</nobr>

<nobr>|<a href="Appeal.html">An Appeal For Help</A>|</nobr>

<nobr>|<a href="donate.html">Program Donations</A>|</nobr>

<nobr>|<a href="about.html">ABOUT US</A>|</nobr>

<nobr>|<a href="contact.html">CONTACT US</A>|</nobr>
</center>
</font>

<br></TD>
 </TR>
</TABLE> 

<!-- end html -->
                
<!-- EOF: ./personal-templates/simple/business/layout/l50.layout -->

    
<!-- BOF: ./personal-templates/simple/themes.show.body -->


<!-- EOF: ./personal-templates/simple/themes.show.body -->

</body>
<!-- BOF: ./personal-templates/simple/themes.show.end -->


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</html>


<!-- EOF: ./personal-templates/show.body -->