<h2>News Idea and Request Form</h2>
<br />* required fields
<table cellpadding="20">
<tr>
<td>*<strong>Select a category:</strong> <br /> <input name="category" type="radio" value="News Idea" /> News Idea<br /> <input name="category" type="radio" value="Request Information" /> Request Information<br /> <input name="category" type="radio" value="Other" /> Other</td>
<td>*<strong>Select an association:</strong> <br /> <input name="association" type="radio" value="Media" /> Media<br /> <input name="association" type="radio" value="SIUE Affiliate" /> SIUE Affiliate<br /> <input name="association" type="radio" value="Other" /> Other</td>
</tr>
</table>
*<strong>Enter your information, comment or question in the space provided:</strong>
<p><textarea name="comments" rows="10" cols="50"></textarea></p>
<p><br /> <strong>Provide contact information below:</strong></p>
<p>*Name:<br /> <input name="realname" size="35" type="text" /><br /> *E-mail:<br /> <input name="email" size="35" type="text" /><br /> Telephone:<br /> <input name="phone" size="35" type="text" /><br /> FAX:<br /> <input name="fax" size="35" type="text" /></p>
<p><br /> <input name="Submit" type="submit" value="Submit" /> <input name="Clear" type="reset" value="Clear Form" id="Clear" /></p>