REQUEST INFO

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cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=3 height=85 BGCOLOR="#FFFFFF" TEXT="#080000" bgproperties="fixed" background="04b00d20egerdp.jpg"> <div> <B>MISS KANSAS COED 2002 </b></div> <div> <A HREF="links.htm" TARGET="_top" TITLE="LINKS"><U><IMG SRC="03c070e0.gif" border=0 width="7" height="14" ALT="previous" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></U></A>     <A HREF="application.htm" TARGET="_top" TITLE="APPLICATION"><U><IMG SRC="03d070e0.gif" border=0 width="7" height="14" ALT="next" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></U></A>      <IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" WIDTH="14">  <A HREF="index.htm" TARGET="_top" TITLE="Miss Kansas Coed 2002"><U><IMG SRC="03f0e0e0.gif" border=0 width="14" height="14" ALT="up" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></U></A></div> </td> </tr><tr> <td valign="top" rowspan="2" width=210 BGCOLOR="#FFFFFF" TEXT="#080000" background="1d20a0a3.gif"> <div> <IMG SRC="3a34b2e0.gif" border=0 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FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" BGCOLOR=#993300 > <tR> <tD VALIGN=TOP HEIGHT= 23 ><NOBR><div> <B>AMERICAN COED APPLICATION</b></div> </NOBR></tD> </tR> </TABLE></div> <div> <A HREF="http://www.gocoed.com/app.shtm" TARGET="_top" TITLE="http://www.gocoed.com/app.shtm"><U>PRINT APPLICATION</U></A></div> <div> <TABLE BORDER="4" CELLPADDING="2" CELLSPACING="1" WIDTH="226" BORDERCOLORLIGHT="#666633" BORDERCOLORDARK="#663300" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" BGCOLOR=#FFCC33 > <tR> <tD VALIGN=TOP HEIGHT= 65 ><NOBR><div>  <FORM METHOD="POST" ACTION="mailto:nationals@gocoed.com?subject=National Website Request"> <font face="times new roman" size="2">First Name    <input type="text" name="first" size="20" maxlength="40">   Last Name <input type="text" name="last" size="30" maxlength="40"> <br> <br> Address    <input type="text" name="address1" size="60" maxlength="60"> <br> <br> Apartment Number    <input type="text" name="address2" size="52" maxlength="60"> <br> <br> City    <input type="text" name="city" size="20" maxlength="40">    State    <input type="text" name="state" size="3" maxlength="5">    Zip Code    <input type="text" name="zip" size="10" maxlength="20"> <br> <br> Date of Birth    <input type="text" name="date of birth" size="10" maxlength="10"> <br> <br> Phone    <input type="text" name="phone" size="20" maxlength="20">    E-Mail    <input type="text" name="email" size="20" maxlength="40">       <br> <br> <b><font size="3">What age group are you interested in?</font></b><font size="3"><br> <br> <input type="CHECKBOX" name="category" value="coed"> <font face="arial" color="#ff2ca3">C</font></font></font><font face="arial" color="#ff2ca3" size="3">oed</font><font face="times new roman" size="2"> </font><font color="#ff2ca3" size="3"><font face="times new roman">18-20</font><font face="arial"> </font></font><font face="arial" color="#ff2ca3" size="2">                                </font><font face="times new roman" size="2"> <input type="checkbox" name="catagory" value="juniorteen"> </font><font face="arial" color="#ff2ca3" size="3">Preteen 10-12</font> <p> <font face="arial" size="2" color="#ff2ca3"> <input type="CHECKBOX" name="category" value="teen"> </font><font face="arial" color="#ff2ca3" size="3">Teen</font><font face="times new roman" size="2" color="#ff2ca3"> </font><font color="#ff2ca3" size="3"><font face="times new roman">16-17</font><font face="arial">  </font></font><font face="arial" color="#ff2ca3" size="2">                                  </font><font face="arial" color="#ff2ca3"><font face="times new roman" size="2"> <input type="CHECKBOX" name="category1" value="sweetheart"> </font><font size="3">Sweetheart 7-9</font></font></p> <p> <font face="arial" size="2" color="#ff2ca3"> <input type="CHECKBOX" name="category" value="preteen"> </font><font face="arial" color="#ff2ca3" size="3">Junior Teen</font><font face="arial" color="#ff2ca3" size="2"> </font><font face="arial" color="#ff2ca3" size="3">13-15 </font><font face="arial" color="#ff2ca3" size="2">                      </font><font face="arial" color="#ff2ca3"> <input type="CHECKBOX" name="category2" value="princess"> <font size="3">Princess 3-6</font> </font> <p><b><font size="3" face="Times New Roman">How did you hear about American Coed Pageants?</font></b> <p> <font face="arial" color="#ff2ca3"> <select name="Referred" size="1"> <option selected>Miss Kansas Coed 2002</option> <option>Friend</option> <option>Relative</option> <option>Link</option> <option>Search Engine</option> <option>Pageantry Magazine</option> <option>Patsy's Magazine</option> <option>Seventeen Magazine</option> <option>Other Magazine</option> <option>I received information in the mail</option> </select> <p><font face="times new roman" size="3" color="black"><b>Additional Comments:</b><br> <br> <textarea name="comments" cols="40" rows="10"> </textarea> <br> <br> <center> <input type="submit" value="submit">     <input type="reset" value="reset"> </center> </font></p> </font> </form>  </div> </NOBR></tD> </tR> </TABLE></div> <div> <A HREF="http://www.gocoed.com/" TARGET="_top" TITLE="http://www.gocoed.com/"><U>http://www.gocoed.com/</U></A></div> <bR> <div> <B> <A HREF = "http://www.pageantrymagazine.com/merchant2/merchant.mv?Screen=SFNT&Store_Code=PMOS&Affiliate=kansascoed"><IMG SRC = "http://www.pageantrymagazine.com/merchant2/graphics/00000001/pag234x60mmallbanner.jpg" ALT = "Shop Online at the Pageantry Mall!" 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