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<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=90 BGCOLOR="#006699" TEXT="#080000" background="06efd5a3.jpg"> <div> <FONT SIZE="5" COLOR="#000000" FACE="Arial" ><B>OKLAHOMA PARTNERS IN MISSION</B></FONT><B>    </B><B> |     </B><A HREF="index.htm" TARGET="_top" TITLE="OKLAHOMA PARTNERS IN MISSION"><U><B>home</B></U></A></div> <div> <A HREF="id19.htm" TARGET="_top" TITLE="Newsletters"><U>Newsletters</U></A>   |   <B>Sign Up Online</B>   |   <A HREF="id20.htm" TARGET="_top" TITLE="Contact Us"><U>Contact Us</U></A></div> <div> </div> </td> </tr><tr> <td valign="top" width=210 BGCOLOR="#FFCC66" TEXT="#080000" background="06fd2043.jpg"> <div> <IMG SRC="069a27d0.jpg" border=0 width="162" height="125" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> </td> <td valign="top" height=390 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <I>Sign Up Online</I></div> <div> You can become a Partner In Mission right now.  Just fill out the info below and we'll get you onboard as a Partner.</div> <bR> <bR> <div>  <form action="http://csbmail.globalscape.com/cgi-bin/csbmail/csbmail.pl" method="POST" enctype="application/x-www-form-urlencoded"><input type="hidden" name="tlx_SortOrder" value="Name,Street Address,City,State,Zip,Phone,Email,Church,Shares,Comments"><input type="hidden" name="tlx_FormIndex" value="1"><input type="hidden" name="tlx_OKMessage" value="Thanks for becoming a Partner In Mission. Your contributions will make a lasting difference in the lives of many."><input type="hidden" name="tlx_SendMode" value="1"><input type="hidden" name="tlx_Subject" value="PIM Signup"><input type="hidden" name="tlx_EmailTo" value="tdyke@okpim.org"> <table cellpadding="0" cellspacing="1" border="0" align="center"> <tr> <td align="left">Name:<br> <input type="text" name="Name" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Street Address:<br> <input type="text" name="Street Address" size="30" maxlength="100"></td> </tr> <tr> <td align="left">City:<br> <input type="text" name="City" size="30" maxlength="100"></td> </tr> <tr> <td align="left">State:<br> <input type="text" name="State" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Zip:<br> <input type="text" name="Zip" size="10" maxlength="10"></td> </tr> <tr> <td align="left">Phone Number:<br> <input type="text" name="Phone" size="14" maxlength="14"></td> </tr> <tr> <td align="left">Email:<br> <input type="text" name="Email" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Your Local Church:<br> <input type="text" name="Church" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Number of Shares X $100 annually:<br> <input type="text" name="Shares" size="5" maxlength="5"></td> </tr> <tr> <td align="left">Comments:<br> <textarea name="Comments" rows="5" cols="30"></textarea></td> </tr> <tr> <td align="right"><input type="reset"> <input type="submit" value="Send" name="tlx_send"></td> </tr> </table> </form>  </div> <bR> <bR> <bR> <bR> <bR> </td> </tr></table></body>