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By: a guest | Mar 21st, 2010 | Syntax: None | Size: 7.06 KB | Hits: 106 | Expires: Never
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  1. <!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01//EN" "http://www.w3.org/TR/html4/strict.dtd"><html><head><link rel="shortcut icon" href="https://spreadsheet.google.com/images/forms/favicon.ico" type="image/x-icon">
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  3. <title>Ask Laura McGonigle a South East Ward constituency question</title>
  4. <link href='//spreadsheets.google.com/client/css/3386678453-published_form_compiled.css' type='text/css' rel='stylesheet'><link href='//spreadsheets.google.com/client/css/3386678453-published_form_compiled.css' type='text/css' rel='stylesheet'>
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  6. <body class="ss-base-body" dir="ltr"><div class="ss-form-container">
  7. <div class="ss-form-heading"><h1 class="ss-form-title">Ask Laura McGonigle a South East Ward constituency question</h1>
  8. <p></p>
  9. <div class="ss-form-desc">If you fill in all sections of this form, I&#39;ll be able to address your issue faster. Thank you.</div>
  10. <p></p>
  11.  
  12. <hr class="ss-email-break" style="display:none;">
  13. <div class="ss-required-asterisk">* Required</div></div>
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  79.  
  80. <br>
  81. <div class="errorbox-good">
  82. <div class="ss-item ss-item-required ss-text"><div class="ss-form-entry"><label class="ss-q-title" for="entry_1">What is your name?
  83. <span class="ss-required-asterisk">*</span></label>
  84. <label class="ss-q-help" for="entry_1"></label>
  85. <input type="text" name="entry.1.single" value="" class="ss-q-short" id="entry_1"></div></div></div>
  86. <br> <div class="errorbox-good">
  87. <div class="ss-item ss-item-required ss-select"><div class="ss-form-entry"><label class="ss-q-title" for="entry_0">Which part of the South East Ward are you living in?
  88. <span class="ss-required-asterisk">*</span></label>
  89. <label class="ss-q-help" for="entry_0"></label>
  90. <select name="entry.0.single" id="entry_0"><option value="Ballinlough">Ballinlough</option> <option value="Blackrock">Blackrock</option> <option value="Ballintemple">Ballintemple</option> <option value="Douglas">Douglas</option> <option value="Mahon">Mahon</option> <option value="Boreenmanna Road">Boreenmanna Road</option> <option value="Not from South East Ward">Not from South East Ward</option></select></div></div></div>
  91. <br> <div class="errorbox-good">
  92. <div class="ss-item ss-item-required ss-text"><div class="ss-form-entry"><label class="ss-q-title" for="entry_2">Email Address
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  95. <input type="text" name="entry.2.single" value="" class="ss-q-short" id="entry_2"></div></div></div>
  96. <br> <div class="errorbox-good">
  97. <div class="ss-item ss-item-required ss-text"><div class="ss-form-entry"><label class="ss-q-title" for="entry_4">Phone / Mobile Number
  98. <span class="ss-required-asterisk">*</span></label>
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  100. <input type="text" name="entry.4.single" value="" class="ss-q-short" id="entry_4"></div></div></div>
  101. <br> <div class="errorbox-good">
  102. <div class="ss-item  ss-checkbox"><div class="ss-form-entry"><label class="ss-q-title" for="entry_5">Check this box to get regular updates from me on constituency matters  
  103. </label>
  104. <label class="ss-q-help" for="entry_5"></label>
  105. <ul class="ss-choices"><li class="ss-choice-item"><input type="checkbox" name="entry.5.group" value="Opt in" class="ss-q-checkbox" id="group_5_1">
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  108. <br> <div class="errorbox-good">
  109. <div class="ss-item ss-item-required ss-paragraph-text"><div class="ss-form-entry"><label class="ss-q-title" for="entry_6">Details of your issue / concern. (All matters will be dealt with in the strictest confidence)
  110. <span class="ss-required-asterisk">*</span></label>
  111. <label class="ss-q-help" for="entry_6"></label>
  112. <textarea name="entry.6.single" rows="8" cols="75" class="ss-q-long" id="entry_6"></textarea></div></div></div>
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  144. <span class="ss-terms"><small><a href="https://spreadsheets.google.com/reportabuse?formkey=dFJOdlhQNW9LdWVHbEloalNLSEhsMHc6MA&amp;source=https%253A%252F%252Fspreadsheets.google.com%252Fviewform%253Fformkey%253DdFJOdlhQNW9LdWVHbEloalNLSEhsMHc6MA">Report Abuse</a>
  145. -
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  148. <a href="http://www.google.com/google-d-s/terms.html">Additional Terms</a></small></span></div></div></div></body></html>
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