<html>
<head>
<title>Peer Rating Form</title>
</head>
<BODY BGCOLOR="#ffffff" TEXT="#000000" LINK="#0000ff" VLINK="#0000ff">

<FORM ACTION="http://www.ncat.edu/~lindm/virtual/mis.cgi"
METHOD=POST>
<body background="/~lindm/page/piratebk.jpg">  
<center>
<h2>MIS Information Request Form</h2>
</center>
<h4>
<br>
</h4>


<li><b>Your name? </b>
        <INPUT SIZE=40 MAXLENGTH=40 NAME="category1">
        </ul>
<li><b>Current school, job? </b>
        <INPUT SIZE=40 MAXLENGTH=40 NAME="category2">
        </ul>

<li><b>Email Address? </b>
        <INPUT SIZE=40 MAXLENGTH=40 NAME="category3">
        </ul>
<li><b>Street Address? </b>
        <INPUT SIZE=40 MAXLENGTH=40 NAME="category4">
        </ul>

<li><b>City, State, zip code? </b>
        <INPUT SIZE=40 MAXLENGTH=40 NAME="category5">
        </ul>
<li><b>Please indicate any questions that you have in the box below.</b>
        <textarea rows=10 cols=60 SIZE=60 MAXLENGTH=400 NAME="category6">
</textarea>
        </ul>

<center>
        <INPUT TYPE="reset" VALUE="Clear Form"> or
        <INPUT TYPE="submit" VALUE="Submit Form">
        </center>
<br>
<br>
</FORM>
</body> </html>

