<form method="post" action="https://register.sendreach.com/forms/?listid=32795" name="optin" id="optin" onsubmit="return required();"> <table> <tr><td colspan=2><center></center></td></tr> <tr><td>Name:</td><td><input type="text" name="name" value="" size="20"></td></tr> <tr><td>Email:</td><td><input type="text" name="email" value="" size="20"></td></tr> <tr><td colspan=2><center></center></td></tr> <tr><td align="center" colspan="2"><input type="submit" value="Subscribe"><input type="hidden" name="lid" value="32795"></td></tr> </table> </form>