To add a message to the Guestbook, enter your name, email address, and message below. Please note that any information submitted to the guestbook will be viewable on this website. Entries intended to be private should be submitted directly to the family or to the funeral home.</P>
<FORM METHOD="POST" ACTION="registryGuestbookCheck.php" ENCTYPE="application/x-www-form-urlencoded">
<INPUT TYPE=HIDDEN NAME="PHPSESSID" VALUE="">
<INPUT TYPE=HIDDEN NAME="i_memorialid" VALUE="1264787301">
<INPUT TYPE=HIDDEN NAME="override" VALUE="">
<TABLE> 
	<TR>
		<TD width="100"><FONT FACE="Helvetica, Arial" SIZE=2>Your Name</FONT></TD>
		<TD><FONT FACE="Helvetica, Arial" SIZE=2><INPUT TYPE=TEXT NAME="c_name" VALUE=""></FONT></TD>
	</TR>
	<TR>
		<TD><FONT FACE="Helvetica, Arial" SIZE=2>Email Address</FONT></TD>
		<TD><FONT FACE="Helvetica, Arial" SIZE=2><INPUT TYPE=TEXT SIZE=20 NAME="c_email" MAXLENGTH=64 VALUE=""></FONT></TD>
	</TR>
	<TR>
		<TD VALIGN=TOP><FONT FACE="Helvetica, Arial" SIZE=2>Message</FONT></TD>
		<TD><FONT FACE="Helvetica, Arial" SIZE=2><TEXTAREA NAME="t_message" ROWS=5 COLS=21></TEXTAREA></FONT></TD>
	</TR>
	<TR>
		<TD><FONT FACE="Helvetica, Arial" SIZE=2><input type="checkbox" name="mail_visible"></font></TD>
		<td><FONT FACE="Helvetica, Arial" SIZE=2>Check this box if you want your email made available in the online guestbook tribute. Adding your email allows friends and relatives to contact you by simply clicking on your message</font></td>
	</TR>
	<TR>
		<TD VALIGN=TOP><FONT FACE="Helvetica, Arial" SIZE=2>Validation</FONT></TD>
		<TD><img src="randomimage.php?key=797bcf"></TD>
	</TR>
	<TR>
		<TD VALIGN=TOP><FONT FACE="Helvetica, Arial" SIZE=2>Enter the code</FONT></TD>
		<TD><FONT FACE="Helvetica, Arial" SIZE=2><INPUT TYPE=TEXT SIZE=20 NAME="validate" MAXLENGTH=64 VALUE=""></FONT></TD>
	</TR>
<TR><TD ALIGn=CENTER COLSPAN=2>&nbsp;<BR><INPUT TYPE=SUBMIT VALUE="Submit">&nbsp;<INPUT TYPE=RESET VALUE="Reset"></TD></TR>
</TABLE>
</FORM>