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<title>CCNA工程師國際認證班</title>
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<p><div align="center" class="style13">請詳細填寫您的聯絡資料，我們會儘快與您聯絡!</div>
<FORM name=form1
action=http://www.bsnet.com.tw/cgi-bin/bsNET/Html/onLine.crt
method=post><INPUT type=hidden value=EDM資料
name=fld9>
<TABLE borderColor=#FFFFFF cellPadding=1 width="86%"
align=center border=1>
<TBODY>
<TR bgColor=#003366>
<TD width=100>
<DIV align=center ><FONT color=#FFFFFF size=2>姓名</FONT>
</DIV>
</TD>
<TD width=260> <DIV align=left> <INPUT name=fld2> </DIV>
</TD>
<TD width=100>
<DIV align=center>
<FONT color=#FFFFFF size=2>目前身分</FONT>
</DIV>
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<TD width=275>
<DIV align=left> <SELECT name=fld19>
<OPTION selected>一般身份</OPTION> <OPTION>學生</OPTION>
<OPTION>在職者</OPTION>
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<TD rowSpan=2>
<DIV align=center><FONT color=#FFFFFF
size=2>聯絡電話</FONT></DIV></TD>
<TD rowSpan=2>
<DIV align=left><FONT color=#ffffff size=2><INPUT
id=聯絡電話(日):2 name=fld3> <FONT color=#FFFFFF>(日)
<BR><INPUT id=聯絡電話(夜):2 name=fld4> (夜)
</FONT></FONT></DIV></TD>
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<DIV align=center><FONT color=#FFFFFF
size=2>聯絡時段</FONT></DIV></TD>
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<DIV align=left><FONT color=#ffffff size=2><FONT
color=#FFFFFF><INPUT id=聯絡時段上午 type=checkbox value=上午
name=fld30> 上午</FONT></FONT> <FONT color=#FFFFFF
size=2><INPUT id=聯絡時段下午 type=checkbox value=下午
name=fld31> 下午</FONT> <FONT color=#FFFFFF size=2><INPUT
id=聯絡時段夜間 type=checkbox value=夜間 name=fld32> 夜間</FONT>
<FONT color=#FFFFFF><INPUT id=聯絡時段皆可 type=checkbox
value=皆可 name=fld33> <FONT size=2>皆可</FONT></FONT>
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<DIV align=center><FONT color=#FFFFFF
size=2>諮詢地點</FONT></DIV></TD>
<TD bgColor=#003366>
<DIV align=left> <FONT color=#ffffff size=2>
<SELECT id=select4 name=fld0>
<OPTION value=318 selected>高雄地區中山育成中心</OPTION>
</SELECT>
</FONT>
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<div align=center><FONT color=#FFFFFF
size=2>電子郵件</FONT></div>
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<INPUT id=電子郵件2 name=fld5>
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<TD>
<DIV align=center><FONT color=#FFFFFF
size=2>
諮詢課程</DIV></TD>
<TD>
<DIV align=left><FONT color=#ffffff size=2>
<select id=select3 name=fld7>
<option value=CCNA工程師國際認證班 selected >
CCNA工程師國際認證班
</option>
</select>
</DIV>
</TD>
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<INPUT id=取消填寫4 style="BORDER-RIGHT: #9a0404 2px solid; BORDER-TOP: #9a0404 2px solid; BORDER-LEFT: #9a0404 2px solid; COLOR: #000066; BORDER-BOTTOM: #9a0404 2px solid; HEIGHT: 25px; BACKGROUND-COLOR: #f5f5f5" type=reset value=取消填寫 name=取消填寫>
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