<table><tr><td>
Full Name: <INPUT NAME="Full Name" TYPE="text" SIZE=20><BR>
Gender Of Choice: <INPUT NAME="Gender Of Choice" TYPE="text" SIZE=20><BR>
Usual Orientation: <INPUT NAME="Usual Orientation" TYPE="text" SIZE=20><BR>
Global Location: <INPUT NAME="Global Location" TYPE="text" SIZE=20><BR>
Email: <INPUT NAME="Email" TYPE="text" SIZE=20><BR>
Home Page: <INPUT NAME="Home Page" TYPE="text" SIZE=20><BR>
<TEXTAREA NAME="Additional Information" ROWS=10 COLS=45></TEXTAREA><BR>
</td></tr>
<tr><td align=center>
<INPUT TYPE="submit" value="I'm An Ally!" style="color: #ffffff; background-color: #000000">
</td></tr></table>
</FORM>