<%@ Control Language="c#" AutoEventWireup="false" Codebehind="BrochureRequest.ascx.cs" Inherits="Xpdt.Portal.DesktopModules.BrochureRequest" TargetSchema="http://schemas.microsoft.com/intellisense/ie3-2nav3-0" %>
<table cellSpacing="0" cellPadding="3" width="500" border="0">
	<tr>
		<td width="128">First Name:</td>
		<td width="360"><input class="info" id="firstName" type="text" name="firstName" runat="server"></td>
	</tr>
	<tr>
		<td>Last Name:</td>
		<td><input class="info" id="lastName" type="text" name="lastName" runat="server"></td>
	</tr>
	<tr>
		<td>Mailing Address:</td>
		<td><input class="info" id="address" type="text" size="20" name="address" runat="server"></td>
	</tr>
	<tr>
		<td>City:</td>
		<td><input class="info" id="city" type="text" name="city" runat="server"></td>
	</tr>
	<tr>
		<td>State:</td>
		<td><input class="info" id="state" type="text" name="state" runat="server"></td>
	</tr>
	<tr>
		<td>Zip Code:</td>
		<td><input class="info" id="zip" type="text" name="zip" runat="server"></td>
	</tr>
	<tr>
		<td>Country:</td>
		<td><input class="info" id="country" type="text" name="country" runat="server"></td>
	</tr>
	<tr>
		<td>Phone (Day):</td>
		<td><input class="info" id="phoneDay" type="text" name="phoneDay" runat="server"></td>
	</tr>
	<tr>
		<td>Phone (Evening):</td>
		<td><input class="info" id="phoneNite" type="text" name="phoneNite" runat="server"></td>
	</tr>
	<tr>
		<td>Email:</td>
		<td><input class="info" id="email" type="text" name="email" runat="server">
			<asp:requiredfieldvalidator id="EmailValidator1" runat="server" ErrorMessage="RequiredFieldValidator" ControlToValidate="email" Display="Dynamic">Required</asp:requiredfieldvalidator><asp:regularexpressionvalidator id="EmailValidator2" runat="server" ErrorMessage="RegularExpressionValidator" Display="Dynamic">Invalid e-mail</asp:regularexpressionvalidator></td>
	</tr>
	<tr>
		<td>Confirm Email:</td>
		<td><input class="info" id="emailConfirm" type="text" name="emailConfirm" runat="server">
			<asp:comparevalidator id="EmailValidator3" runat="server" ErrorMessage="CompareValidator" ControlToValidate="emailConfirm" Display="Dynamic" ControlToCompare="email">E-mail addresses should be the same</asp:comparevalidator></td>
	</tr>
	<tr>
		<td colSpan="2">I am a:</td>
	</tr>
	<tr>
		<td colSpan="2"><input id="donor" type="checkbox" value="checkbox" name="donor" runat="server">
			Donor<br>
			<input id="subscriber" type="checkbox" value="checkbox" name="subscriber" runat="server">
			Subscriber<br>
			<input id="singleTicket" type="checkbox" value="checkbox" name="singleTicket" runat="server">
			Single Ticke Purchaser</td>
	</tr>
	<tr>
		<td colSpan="2"><br>
			Do you listen to classical radio, and if so, which station ?</td>
	</tr>
	<tr>
		<td colSpan="2"><input class="info" id="radioListen" type="text" maxLength="0" size="0" name="radioListen" runat="server"></td>
	</tr>
	<tr>
		<td colSpan="2"><br>
			How did you hear about San Diego Opera? (i.e. radio, newspaper, magazine, movie 
			theatre ads -- please be specific as to which publication or station. Thanks.)</td>
	</tr>
	<tr>
		<td colSpan="2"><input class="info" id="hearFromUs" type="text" maxLength="0" size="0" name="hearFromUs" runat="server"></td>
	</tr>
	<tr>
		<td><br>
			Comments:</td>
		<td>&nbsp;</td>
	</tr>
	<tr>
		<td colSpan="2">
			<p><textarea class="msg" id="comments" name="comments" rows="10" cols="50" runat="server"></textarea>
			</p>
			<p>&nbsp;</p>
		</td>
	</tr>
	<tr>
		<td colSpan="2">
			<p><asp:button id="SendBrochureButton" runat="server" Text="Send me a free brochure" CssClass="NewsletterButton" CausesValidation="False"></asp:button></p>
			<p></p>
		</td>
	</tr>
</table>
