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<br>
<p>
<b>PublishPDF Registration</b>
</p>

              <p>Please complete the following form to register 
                PublishPDF and receive your Registration Number for unlocking 
                the program.</font></p>
              <form method="post" action="http://www.manac.com.au/cgi-bin/ppdfform.cgi" name="">
                <input type="hidden" name="data_order" value="gender,f_name,l_name,address_1,address_2,address_3,address_4,submit_by,WEBCODE,product">
                <!-- end of form configuration (could add Required fields, cc_to field) --> 
                Please fill out the following information boxes. 
                If you make a mistake, use the &quot;Reset&quot; button (bottom 
                left of this page) and start over...</font></p> 
                <hr>
		<b>Personal Details </b>
                <hr>
		<p><font color="#000000">Company: </font> 
                  <input type="text" name="company" size="30" maxlength="40">
                  </font>
                    <p> Gender: 
                      </font> 
                      <input type="radio" name="gender" value="Mr." checked>
                      Mr. 
                      <input type="radio" name="gender" value="Mrs.">
                      Mrs. 
                      <input type="radio" name="gender" value="Ms.">
                      Ms.</font> </p>

                <table border="0" cellspacing="0" cellpadding="2" class="main">
                  <tr> 
                    <td><font color="#000000">First Name: </font></font></td>
                    <td> 
                      <input type="text" name="f_name" value="" size="20" maxlength="20">
                      <font color="#FF0000">*</font></font></td>
                  </tr>
                  <tr> 
                    <td>Surname: </font></td>
                    <td> 
                      <input type="text" name="l_name" value="" size="20" maxlength="20">
                      <font color="#FF0000">*</font></font> </td>
                  </tr>
                </table>
                </p>
		<hr>
                <b>Address Details</b>
                <hr><p>
		<table width="90%" border="0" cellspacing="0" cellpadding="0" class="main">
                  <tr> 
                    <td> 
                      <div align="right">Street Address&nbsp;</div>
                    </td>
                    <td> 
                      <input type="text" name="address_1" size="30" maxlength="90">
                      <font color="#FF0000">*</font></font> </td>
                  </tr>
                  <tr> 
                    <td> 
                      <div align="right">Suburb&nbsp;</div>
                    </td>
                    <td> 
                      <input type="text" name="address_2" value="" size="20" maxlength="30">
                      <font color="#FF0000">*</font></font> </td>
                  </tr>
                  <tr> 
                    <td> 
                      <div align="right">Postcode&nbsp;</div>
                    </td>
                    <td> 
                      <input type="text" name="address_3" value="" size="8" maxlength="8">
                      <font color="#FF0000">*</font></font> </td>
                  </tr>
                  <tr> 
                    <td> 
                      <div align="right">Country&nbsp;</div>
                    </td>
                    <td> 
                      <input type="text" name="address_4" value="Australia" size="20" maxlength="20">
                      <font color="#FF0000">*</font></font> </td>
                  </tr>
                  <tr> 
                    <td> 
                      <div align="right">Email Address&nbsp;</div>
                    </td>
                    <td> 
		      <input type=text name="submit_by" size=40 maxlength="50">
                      <font color="#FF0000">*</font></font> </td>
                  </tr>
                </table>
		</p>
                <hr>
                <b>About YOUR PublishPDF</b>
		<hr>
                <p>What Type of PublishPDF do you have?</font><br>
                  <input type="radio" name="product" value="basic" checked>
                  PublishPDF 
                  <input type="radio" name="product" value="pro">
                  PublishPDF Professional</font></p>
                <p>Please Enter your PublishPDF Web Password: </font></font><br> 
                  <input type="text"name="WEBCODE" value="" size="30" maxlength="12">
                  <font color="#FF0000">*</font></font> </p>
                <p> 
		<hr>
                  <input type="reset" name="Reset" value="Reset">
                  &nbsp;&nbsp; or &nbsp;&nbsp;  
                  <input type="submit" value="Register Now!" name="submit">
                <hr>
		</p>
                <p><b><font color="#660000"> </font><font color="#FF0000">*&nbsp;</font></font>Red 
                  asterisks</b> mark fields that are required. </p>
                <p> <b>Privacy: </b>This information will not be made available 
                  to anyone else.<br>
                  We may e-mail special offers from time to time and you will 
                  always be given the option to unsubscribe from future e-mails. 
                </p>
                <p align="right"><a href="http://www.publishpdf.com">Return to 
                  Home</a>
                <p>&nbsp; 
              </form>
              <p>&nbsp;</p>


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