<!-- BOF: ./personal-templates/show.body -->
<!-- BOF: ./personal-templates/simple/generic/show -->
<!-- BOF: ./personal-templates/rtl.html -->
<!-- Locale=en_US_ISO8859_1 -->
<!-- EOF: ./personal-templates/rtl.html -->


<!-- BOF: ./personal-templates/simple/generic/functions -->
<!-- BOF: ./personal-templates/simple/generic/navbar --><!-- EOF: ./personal-templates/simple/generic/navbar -->


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

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<!-- BOF: ./personal-templates/simple/personal/other/l21.settings.init -->


<!-- EOF: ./personal-templates/simple/personal/other/l21.settings.init -->


  <!-- BOF: ./personal-templates/simple/personal/layout/l22.wait -->


<!-- EOF: ./personal-templates/simple/personal/layout/l22.wait -->


<HTML>

<HEAD>


<META NAME="description" CONTENT="">
<META NAME="Keywords"    CONTENT="">


<!-- personal -->


<META HTTP-EQUIV="Content-Type" CONTENT="text/html; charset=UTF-8">
<META NAME="Generator" content="">
<!-- BOF: ./personal-templates/simple/themes.show -->


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


<!--<BASE HREF="http://d12626998.u83.c4.ixwebhosting.com/form.html">-->
<TITLE>Contact Us</TITLE></head>
<BODY  BGCOLOR="#FFFFFF"
 TEXT="#333333"

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

 onLoad=""
 
 LINK="#000000"
 VLINK="#000000"
 ALINK="#000000"
>

  
      <!-- BOF: ./personal-templates/simple/personal/layout/l22.layout --> 
<!-- html -->
<TABLE WIDTH="100%" HEIGHT="100%" BORDER="0" CELLPADDING="0" CELLSPACING="0" VALIGN="top">
<TR>
    <TD WIDTH="50%" HEIGHT="100%" BGCOLOR="#ADB291" VALIGN="top"><img src="widgets/spacer.gif" height=16 width=6 alt=""></TD>
    <TD WIDTH=775 HEIGHT="100%">
    <TABLE WIDTH=775 HEIGHT="100%" BORDER="0" CELLPADDING="0" CELLSPACING="0" VALIGN="top">
    <TR><TD COLSPAN="5" WIDTH=775 HEIGHT=10 BGCOLOR="#ADB291"><img src="widgets/spacer.gif" height=10 width=775 alt=""></TD></TR>
    <TR><TD COLSPAN="5" WIDTH=775 HEIGHT=1><img src="widgets/spacer.gif" height=1 width=775 alt=""></TD></TR>
    <TR>
        <TD WIDTH=1 HEIGHT=1><img src="widgets/spacer.gif" height=1 width=1 alt=""></TD>
        <TD COLSPAN="3" WIDTH=773 HEIGHT=1 BGCOLOR="#ADB291"><img src="widgets/spacer.gif" height=1 width=773 alt=""></TD>
        <TD WIDTH=1 HEIGHT=1><img src="widgets/spacer.gif" height=1 width=1 alt=""></TD>
    </TR>
    <TR>
        <TD WIDTH=1 HEIGHT="100%"><img src="widgets/spacer.gif" height=1 width=1 alt=""></TD>
        <TD WIDTH=1 HEIGHT="100%" BGCOLOR="#ADB291"><img src="widgets/spacer.gif" height=1 width=1 alt=""></TD>
        <TD WIDTH=771 HEIGHT="100%">
        <TABLE WIDTH=771 HEIGHT="100%" BORDER="0" CELLPADDING="0" CELLSPACING="0" VALIGN="top">
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            <TD WIDTH=15 HEIGHT=15><img src="widgets/spacer.gif" height=15 width=15 alt=""></TD>
            <TD WIDTH=741 HEIGHT=15><img src="widgets/spacer.gif" height=15 width=741 alt=""></TD>
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        </TR>
        <TR>
            <TD WIDTH=15 HEIGHT="100%"><img src="widgets/spacer.gif" height=15 width=15 alt=""></TD>
            <TD WIDTH=741 HEIGHT="100%" VALIGN="top">
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                <TD WIDTH=741 HEIGHT="100%" VALIGN="top">
                <TABLE WIDTH=741 HEIGHT="100%" BORDER="0" CELLPADDING="0" CELLSPACING="0" VALIGN="top">
                <TR>
                    <TD WIDTH=219 VALIGN="top"> 
                    <TABLE WIDTH=219 HEIGHT="100%" BORDER="0" CELLPADDING="0" CELLSPACING="0" VALIGN="top">
                    <TR><TD WIDTH=219 HEIGHT=71><img src="widgets/gen_44.1.gif" border=0 width=219 height=71 alt=""></TD></TR>
                    <TR><TD WIDTH=10 HEIGHT=10><img src="widgets/spacer.gif" height=10 width=10 alt=""></TD></TR>
                    <TR><TD WIDTH=219 HEIGHT=36><img src="widgets/gen_51.1.gif" border=0 width=219 height=36 alt=""></TD></TR>
                    <TR>
                        <TD WIDTH=219 VALIGN="top">
                        
                        <a href="index.html" onMouseOver="document.images['img6'].src='widgets/gen_31.1.gif'" onMouseOut="document.images['img6'].src='widgets/gen_30.1.gif'"><img src="widgets/gen_30.1.gif" alt="Home" name="img6" border="0"></a><br>
                        <a href="gpage2.html" onMouseOver="document.images['img33'].src='widgets/gen_120.1.gif'" onMouseOut="document.images['img33'].src='widgets/gen_119.1.gif'"><img src="widgets/gen_119.1.gif" alt="I Struggle with SSA" name="img33" border="0"></a><br>
                        <a href="gpage3.html" onMouseOver="document.images['img35'].src='widgets/gen_138.1.gif'" onMouseOut="document.images['img35'].src='widgets/gen_137.1.gif'"><img src="widgets/gen_137.1.gif" alt="My Husband Struggles" name="img35" border="0"></a><br>
                        <a href="gpage4.html" onMouseOver="document.images['img37'].src='widgets/gen_140.1.gif'" onMouseOut="document.images['img37'].src='widgets/gen_139.1.gif'"><img src="widgets/gen_139.1.gif" alt="My Child Struggles" name="img37" border="0"></a><br>
                        <a href="gpage1.html" onMouseOver="document.images['img30'].src='widgets/gen_104.1.gif'" onMouseOut="document.images['img30'].src='widgets/gen_103.1.gif'"><img src="widgets/gen_103.1.gif" alt="Recommended Reading" name="img30" border="0"></a><br>
                        <a href="Links.html" onMouseOver="document.images['img26'].src='widgets/gen_98.1.gif'" onMouseOut="document.images['img26'].src='widgets/gen_97.1.gif'"><img src="widgets/gen_97.1.gif" alt="Links" name="img26" border="0"></a><br>
                        <a href="external1.html" onMouseOver="document.images['img18'].src='widgets/gen_46.1.gif'" onMouseOut="document.images['img18'].src='widgets/gen_45.1.gif'"><img src="widgets/gen_45.1.gif" alt="Calendar" name="img18" border="0"></a><br>
                        <a href="external2.html" onMouseOver="document.images['img19'].src='widgets/gen_48.1.gif'" onMouseOut="document.images['img19'].src='widgets/gen_47.1.gif'"><img src="widgets/gen_47.1.gif" alt="Daily Humor" name="img19" border="0"></a><br>
                        <a href="external3.html" onMouseOver="document.images['img32'].src='widgets/gen_50.1.gif'" onMouseOut="document.images['img32'].src='widgets/gen_49.1.gif'"><img src="widgets/gen_49.1.gif" alt="Private Message Board" name="img32" border="0"></a><br>
                        <a href="form.html" onMouseOver="document.images['img20'].src='widgets/gen_54.1.gif'" onMouseOut="document.images['img20'].src='widgets/gen_53.1.gif'"><img src="widgets/gen_53.1.gif" alt="Contact Us" name="img20" border="0"></a><br>
                        
                        </TD> 
                    </TR>
                    <TR><TD WIDTH=219 HEIGHT=5><img src="widgets/gen_6.1.gif" border=0 width=219 height=5 alt=""></TD></TR>
                    <TR><TD WIDTH=10 HEIGHT=10><img src="widgets/spacer.gif" height=10 width=10 alt=""></TD></TR>
                    <TR><TD WIDTH=219 HEIGHT=71><img src="widgets/gen_7.1.gif" border=0 width=219 height=71 alt=""></TD></TR>
                    <TR><TD WIDTH=10 HEIGHT="100%"><img src="widgets/spacer.gif" height=10 width=10 alt=""></TD></TR>
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                    </TD>
                    <TD WIDTH=10 HEIGHT="100%"><img src="widgets/spacer.gif" height=10 width=10 alt=""></TD>
                    <TD WIDTH=509 HEIGHT="100%" VALIGN="top" ALIGN="center">
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                    <TR><TD WIDTH=509 HEIGHT=31><img src="widgets/gen_114.1.gif" border=0 width=509 height=31 alt=""></TD></TR>
                    <TR><TD WIDTH=10 HEIGHT=10><img src="widgets/spacer.gif" height=10 width=10 alt=""></TD></TR>
                    <TR>
                        <TD>
                        <TABLE WIDTH=509 HEIGHT="100%" BORDER="0" CELLPADDING="0" CELLSPACING="0" VALIGN="top">
                        <TR>
                            <TD><img src="widgets/gen_55.1.gif" border=0 width=247 height=117 alt=""></TD>
                            <TD WIDTH=10 HEIGHT=10><img src="widgets/spacer.gif" height=10 width=10 alt=""></TD>
                            <TD><img src="widgets/gen_56.1.gif" border=0 width=247 height=117 alt=""></TD>
                        </TR>
                        </TABLE>
                        </TD>
                    </TR>
                    <TR><TD WIDTH=10 HEIGHT=10><img src="widgets/spacer.gif" height=10 width=10 alt=""></TD></TR>
                    <TR>
                        <TD WIDTH="100%" HEIGHT="100%" VALIGN="top">
                        <TABLE DIR="LTR" WIDTH="100%" HEIGHT="100%" BORDER="0" CELLPADDING="0" CELLSPACING="0" VALIGN="top">
                        <TR>
                            <TD><img src="widgets/gen_8.1.gif" border=0 width=22 height=15 alt=""></TD>
                            <TD WIDTH="100%" BACKGROUND="widgets/gen_9.1.gif"><img src="widgets/spacer.gif" height=10 width=10 alt=""></TD>
                            <TD><img src="widgets/gen_10.1.gif" border=0 width=22 height=15 alt=""></TD>
                        </TR>
                        <TR>
                            <TD><img src="widgets/gen_14.1.gif" border=0 width=22 height=29 alt=""></TD>
                            <TD WIDTH="100%" BACKGROUND="widgets/gen_17.1.gif"><img src="widgets/gen_52.1.gif" border=0 width=465 height=29 alt=""></TD>
                            <TD><img src="widgets/gen_15.1.gif" border=0 width=22 height=29 alt=""></TD>
                        </TR>
                        <TR>
                            <TD BACKGROUND="widgets/gen_11.1.gif"><img src="widgets/spacer.gif" height=9 width=22 alt=""></TD>
                            <TD BACKGROUND="widgets/gen_13.1.gif" WIDTH="100%" HEIGHT="100%" VALIGN="top"><div align="justify" style="margin-top:10px;margin-left:10px;margin-bottom:10px;">
                            <!-- BOF: ./personal-templates/simple/personal/form/html -->


<center><table border=0>
<tr><td>


<font face='Arial' size='+1' color='#465D06'>

Contact Us

</font>


<br>
<SCRIPT LANGUAGE="JavaScript">
var BUILDER = '/studio/servlet/psoft.masonry.Builder';
function validate(frm){
var i = 0;

if (frm.field_24.value=="") return error(frm.field_24);

if (frm.field_25.value=="") return error(frm.field_25);

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://71.18.216.15:8080/studio/servlet/psoft.customform.CustomForm" method="post">
<input type="hidden" name="domain" value="">
<input type="hidden" name="title" value="Contact Us">
<input type="hidden" name="esubj" value="SSA Website Form">
<input type="hidden" name="name" value="=GghoWXsbVRbLl=b">
<input type="hidden" name="submit_url" value="onsubmit.html">
<input type="hidden" name="error_url"  value="onerror.html">
<input type="hidden" name="order" value="24 25 ">
<table border=0 cellpedding=5 cellspacing=5>

<input type="hidden" name="name_24" value="Your email address">
<tr><td>


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

Your email address

</font>


 <font color="red" size="-1">*</font></td><td>


<input type="text" name="field_24" size="">
<input type="hidden" name="rcpt" value="field_24">


</td></tr>

<input type="hidden" name="name_25" value="Comment or Question">
<tr><td>


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

Comment or Question

</font>


 <font color="red" size="-1">*</font></td><td>


<textarea name="field_25" rows="5" cols="40"></textarea>

</td></tr>

<tr><td colspan=2 align=center>
    <input onClick="return validate(form)" type="submit" value="Submit">
    <input type="reset"  value="Reset">
    </td>
</tr>
</table>
</form>
</td></tr></table></center>
<!-- EOF: ./personal-templates/simple/personal/form/html -->
<br>

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

<nobr>|<a href="gpage2.html">I Struggle with SSA</A>|</nobr>

<nobr>|<a href="gpage3.html">My Husband Struggles</A>|</nobr>

<nobr>|<a href="gpage4.html">My Child Struggles</A>|</nobr>

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

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

<nobr>|<a href="external1.html">Calendar</A>|</nobr>

<nobr>|<a href="external2.html">Daily Humor</A>|</nobr>

<nobr>|<a href="external3.html">Private Message Board</A>|</nobr>

<nobr>|Contact Us|</nobr>
</center>
</font>

</div></TD>
                            <TD BACKGROUND="widgets/gen_12.1.gif"><img src="widgets/spacer.gif" height=9 width=22 alt=""></TD>
                        </TR>
                        <TR>
                            <TD><img src="widgets/gen_21.1.gif" border=0 width=22 height=29 alt=""></TD>
                            <TD WIDTH="100%" BACKGROUND="widgets/gen_23.1.gif"><img src="widgets/spacer.gif" height=29 width=10 alt=""></TD>
                            <TD><img src="widgets/gen_22.1.gif" border=0 width=22 height=29 alt=""></TD>
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                        <TR>
                            <TD><img src="widgets/gen_18.1.gif" border=0 width=22 height=15 alt=""></TD>
                            <TD WIDTH="100%" BACKGROUND="widgets/gen_20.1.gif"><img src="widgets/spacer.gif" height=10 width=10 alt=""></TD>
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                        </TABLE>
                        </TD>
                    </TR>
                    </TABLE>
                    </TD>
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                </TABLE>
                </TD>
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            </TABLE>
            </TD>
            <TD WIDTH=15 HEIGHT="100%"><img src="widgets/spacer.gif" height=15 width=15 alt=""></TD>
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        <TD WIDTH=1 HEIGHT="100%" BGCOLOR="#ADB291"><img src="widgets/spacer.gif" height=1 width=1 alt=""></TD>
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    <TR>
        <TD WIDTH=1 HEIGHT=1><img src="widgets/spacer.gif" height=1 width=1 alt=""></TD>
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        <TD WIDTH=1 HEIGHT=1><img src="widgets/spacer.gif" height=1 width=1 alt=""></TD>
    </TR>
    <TR><TD COLSPAN="5" WIDTH="100%" HEIGHT=1><img src="widgets/spacer.gif" height=1 width=775 alt=""></TD></TR>
    <TR><TD COLSPAN="5" WIDTH="100%" HEIGHT=10 BGCOLOR="#ADB291"><img src="widgets/spacer.gif" height=5 width=775 alt=""><br>
<center><table border="0" cellpadding="0" cellspacing="3"><tr><td align="center">
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</td></tr></table></center>
<br><img src="widgets/spacer.gif" height=5 width=775 alt=""></TD></TR>
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    <TD WIDTH="50%" HEIGHT="100%" BGCOLOR="#ADB291" VALIGN="top"><img src="widgets/spacer.gif" height=16 width=6 alt=""></TD>
</TR>
</TABLE>
<!-- end html -->
<!-- EOF: ./personal-templates/simple/personal/layout/l22.layout -->

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


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

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


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


</html>


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