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<HTML>

<HEAD>


<META NAME="description" CONTENT="Come and join us as we seek God together to be his hands and feet on Earth.">
<META NAME="Keywords"    CONTENT="mennonite, mennonite brethren, MB, Wichita, Bible, God, Jesus, FMBC, First Mennonite Brethren Church">


<!-- business -->


<META HTTP-EQUIV="Content-Type" CONTENT="text/html; charset=ISO-8859-1">
<META NAME="Generator" content="">
<!-- BOF: ./personal-templates/simple/themes.show -->


<!-- EOF: ./personal-templates/simple/themes.show -->


<!--<BASE HREF="http://firstmbchurch.com/churchcampreg.html">-->
<TITLE>Church Camp Registration</TITLE></head>
<BODY  BGCOLOR="#cc99ff"
 TEXT="#000000"

LEFTMARGIN="0" TOPMARGIN="0" RIGHTMARGIN="0" BOTTOMMARGIN="0"

 onLoad=""
 
 LINK="#000000"
 VLINK="#000000"
 ALINK="#000000"
>

  
      <!-- BOF: ./personal-templates/simple/business/layout/l17.layout -->


<DIV ALIGN="center">
<TABLE WIDTH=750 BORDER=0 CELLPADDING=0 CELLSPACING=0 BGCOLOR="#FFFFFF">
        <TR>
                <TD COLSPAN=2 BGCOLOR="#FFFFFF" VALIGN="bottom">
                        <IMG SRC="widgets/gen_6816.1.gif" WIDTH=566 HEIGHT=59 border=0></TD>
                <TD WIDTH=184 HEIGHT=259 ROWSPAN=3 BGCOLOR="#FFFFFF" background="widgets/gen_3515.1.gif" VALIGN="top">
                        <IMG SRC="widgets/gen_6855.1.gif" WIDTH=150 HEIGHT=211>
                        <FONT FACE="Arial" SIZE="-1"><I></I></FONT>
                </TD>
        </TR>
        <TR>
                <TD WIDTH=181 HEIGHT=211 VALIGN="top" BACKGROUND="widgets/gen_3514.1.gif">
                        <table border="0" BACKGROUND="widgets/gen_6812.1.gif" CELLPADDING=0 CELLSPACING=0>
                        <tr><td align="right" WIDTH=181>
                        &nbsp;&nbsp;
                                
                                        <a href="index.html"><IMG SRC="widgets/gen_6787.1.gif" WIDTH="181" HEIGHT="30" border="0" alt="Welcome"></a>
                                
                        
                                        <a href="visitors.html"><IMG SRC="widgets/gen_6788.1.gif" WIDTH="181" HEIGHT="30" border="0" alt="I'm New to FMBC"></a>
                                
                        
                                        <a href="calendar.html"><IMG SRC="widgets/gen_6789.1.gif" WIDTH="181" HEIGHT="30" border="0" alt="Calendar"></a>
                                
                        
                                        <a href="news.html"><IMG SRC="widgets/gen_6790.1.gif" WIDTH="181" HEIGHT="30" border="0" alt="News"></a>
                                
                        
                                        <a href="opportunities.html"><IMG SRC="widgets/gen_6791.1.gif" WIDTH="181" HEIGHT="30" border="0" alt="Opportunities"></a>
                                
                        
                                        <a href="events.html"><IMG SRC="widgets/gen_6792.1.gif" WIDTH="181" HEIGHT="30" border="0" alt="Events"></a>
                                
                        
                                        <a href="faq.html"><IMG SRC="widgets/gen_6793.1.gif" WIDTH="181" HEIGHT="30" border="0" alt="FAQ"></a>
                                
                        
                                        <a href="about.html"><IMG SRC="widgets/gen_6794.1.gif" WIDTH="181" HEIGHT="30" border="0" alt="About Us"></a>
                                
                        
                                        <a href="contact.html"><IMG SRC="widgets/gen_6795.1.gif" WIDTH="181" HEIGHT="30" border="0" alt="Contact Us"></a>
                                
                        
                                        <a href="ministries.html"><IMG SRC="widgets/gen_6796.1.gif" WIDTH="181" HEIGHT="30" border="0" alt="Ministries"></a>
                                
                        
                                        <a href="missions.html"><IMG SRC="widgets/gen_6798.1.gif" WIDTH="181" HEIGHT="30" border="0" alt="Missions"></a>
                                
                        
                                        <a href="campaign.html"><IMG SRC="widgets/gen_6864.1.gif" WIDTH="181" HEIGHT="30" border="0" alt="Harvest Project"></a>
                                
                        
                                        <a href="partner.html1.html"><IMG SRC="widgets/gen_6871.1.gif" WIDTH="181" HEIGHT="30" border="0" alt="Partnering with FMBC"></a>
                                
                        
                                        <a href="audio.html"><IMG SRC="widgets/gen_6800.1.gif" WIDTH="181" HEIGHT="30" border="0" alt="Audio"></a>
                                
                        
                                        <a href="firstword.html"><IMG SRC="widgets/gen_6801.1.gif" WIDTH="181" HEIGHT="30" border="0" alt="First Word"></a>
                                
                        
                                        <a href="llpreschool.html"><IMG SRC="widgets/gen_6802.1.gif" WIDTH="181" HEIGHT="30" border="0" alt="LL Preschool"></a>
                                
                        
                                        <a href="marketplace.html"><IMG SRC="widgets/gen_6803.1.gif" WIDTH="181" HEIGHT="30" border="0" alt="Marketplace"></a>
                                
                        
                  <a href="mailto:welcome@firstmbchurch.com"><img src="widgets/gen_6805.1.gif" width="181" height="30" border="0" alt="e-mail me"></a>
                

                        </td></tr>
                        </table>
                </TD>
                <TD ROWSPAN=2 WIDTH=385 BGCOLOR="#FFFFFF" VALIGN="top">
                
                <!-- BOF: ./personal-templates/simple/businessnew/form/style_l17.html -->


        <TABLE WIDTH=100% BORDER=0 CELLPADDING=15 CELLSPACING=5>

        <TR>
                <TD ALIGN=left VALIGN=bottom>&nbsp;


<font face='Arial' size='+1' color='#000000'>

Church Camp Registration

</font>


<br><img src="widgets/gen_3512.1.gif"></TD>
        </TR>


         <SCRIPT LANGUAGE="JavaScript">
function validate(){
	var valid;
        valid=true;
    	var valueExists;


if (document.forms[0].field_833.value==""){ valid=false; };


if (document.forms[0].field_834.value==""){ valid=false; };


if (document.forms[0].field_835.value==""){ valid=false; };


if (document.forms[0].field_836.value==""){ valid=false; };


if (document.forms[0].field_837.value==""){ valid=false; };


if (valid==false) { 
		alert('You did not fill all required fields!'); 
	    }

return valid;
}
</SCRIPT>

<form name="questionary" action="http://204.142.85.9:8080/servlet/psoft.customform.CustomForm" method="post">
<input type="hidden" name="form_id" value="829">
<input type="hidden" name="user_id" value="95">
<input type="hidden" name="title" value="Church Camp Registration">

<input type="hidden" name="name" value="email3.html">


<input type="hidden" name="order" value="833 834 835 836 837 838 ">
<input type="hidden" name="submit_url" value="http://firstmbchurch.com/onsubmit3.html">
<input type="hidden" name="error_url" value="http://firstmbchurch.com/onerror3.html">

<input type="hidden" name="name_833" value="Names of Adults:">
<tr>	
	<td nowrap>


<font face='Arial' size='2' color='#000000'>

Names of Adults:

</font>


<font color="red" size="-1">*</font><br><br>	


<textarea name="field_833" rows="5" cols="30"></textarea>


</td>
</tr> 

<input type="hidden" name="name_834" value="Names of Children & Ages: (If this does not apply, please type NONE)">
<tr>	
	<td nowrap>


<font face='Arial' size='2' color='#000000'>

Names of Children & Ages: (If this does not apply, please type NONE)

</font>


<font color="red" size="-1">*</font><br><br>	


<textarea name="field_834" rows="5" cols="30"></textarea>


</td>
</tr> 

<input type="hidden" name="name_835" value="Address:">
<tr>	
	<td nowrap>


<font face='Arial' size='2' color='#000000'>

Address:

</font>


<font color="red" size="-1">*</font><br><br>	


<input type="text" name="field_835" size="35">


</td>
</tr> 

<input type="hidden" name="name_836" value="City, State, Zip:">
<tr>	
	<td nowrap>


<font face='Arial' size='2' color='#000000'>

City, State, Zip:

</font>


<font color="red" size="-1">*</font><br><br>	


<input type="text" name="field_836" size="35">


</td>
</tr> 

<input type="hidden" name="name_837" value="Phone:">
<tr>	
	<td nowrap>


<font face='Arial' size='2' color='#000000'>

Phone:

</font>


<font color="red" size="-1">*</font><br><br>	


<input type="text" name="field_837" size="35">


</td>
</tr> 

<input type="hidden" name="name_838" value="Email:">
<tr>	
	<td nowrap>


<font face='Arial' size='2' color='#000000'>

Email:

</font>


<br><br>	


<input type="text" name="field_838" size="35">


</td>
</tr> 

<tr>
	
	<td>
	 
	<input type="submit" onClick="return validate()"><input type="reset">
	</td>
</tr>

</form>


</table>


<!-- EOF: ./personal-templates/simple/businessnew/form/style_l17.html -->

                
                <br>

<br>
<FONT FACE="verdana, arial, helvetica" SIZE="1">
<center>
<nobr>|<a href="index.html">Welcome</A>|</nobr>

<nobr>|<a href="visitors.html">I'm New to FMBC</A>|</nobr>

<nobr>|<a href="calendar.html">Calendar</A>|</nobr>

<nobr>|<a href="news.html">News</A>|</nobr>

<nobr>|<a href="opportunities.html">Opportunities</A>|</nobr>

<nobr>|<a href="events.html">Events</A>|</nobr>

<nobr>|<a href="faq.html">FAQ</A>|</nobr>

<nobr>|<a href="about.html">About Us</A>|</nobr>

<nobr>|<a href="contact.html">Contact Us</A>|</nobr>

<nobr>|<a href="ministries.html">Ministries</A>|</nobr>

<nobr>|<a href="missions.html">Missions</A>|</nobr>

<nobr>|<a href="campaign.html">Harvest Project</A>|</nobr>

<nobr>|<a href="partner.html1.html">Partnering with FMBC</A>|</nobr>

<nobr>|<a href="audio.html">Audio</A>|</nobr>

<nobr>|<a href="firstword.html">First Word</A>|</nobr>

<nobr>|<a href="llpreschool.html">LL Preschool</A>|</nobr>

<nobr>|<a href="marketplace.html">Marketplace</A>|</nobr>
</center>
</font>

<br>
                
                </TD>
        </TR>
        <tr>
                <td height="50" background="widgets/gen_3514.1.gif">&nbsp;</td>
        </tr>
        <TR>
                <TD WIDTH=181 BGCOLOR="#FFFFFF" VALIGN="bottom">
                        <IMG SRC="widgets/gen_3519.1.gif" WIDTH=181 HEIGHT=46></TD>
                <TD WIDTH=385 BGCOLOR="#FFFFFF" VALIGN="bottom" align="center">
                <IMG SRC="widgets/spacer.gif" WIDTH=385 HEIGHT=1><br>
                        
<center><table border="0" cellpadding="0" cellspacing="3"><tr><td align="center">

<br><font face="helvetica,verdana, arial" size="1"><a href="http://impacthosting.com">Powered by http://impacthosting.com</a></font>

</td></tr></table></center>
</TD>
                <TD WIDTH=184 BGCOLOR="#FFFFFF" VALIGN="bottom">
                        <IMG SRC="widgets/gen_3519.1.gif" WIDTH=184 HEIGHT=46></TD>
        </TR>
</TABLE>
</DIV>
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</body>
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</html>


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