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<title>Module M1R3</title> 
 
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            </td>
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<tr ><td width="500" colspan="2" align="center" class="black"  ><b><div align="center"><U> Please Enter the Name and Email Address</div></U></b>
</td>
</tr>
<tr border=0>
<td width="200"  class="black"><b>
 &nbsp;&nbsp;&nbsp Name:
</td>
<td  width="300" >
<input type = "text" name="name" maxlength="60" size="45"  >
</td>
</tr>
<tr border=0 >
<td  class="black" width="200" ><b>
&nbsp;&nbsp;&nbsp Email- Id:
</td>
<td  width="300">
<input type = "text" name="email" size="45">
</td>
</tr border=0>
<tr border=no>
<td></td><td width="500" colspan="2" align="center">
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</td></tr>
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</table>
</td>
</tr>

</form>
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