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<!DOCTYPE HTML PUBLIC "-//IETF//DTD HTML//EN">
<html>
<head>
<title>Comments to NYISE</title>
</head>
<body bgcolor="#336666" text="#FFFFFF" link="#FCFFDA" vlink="#FFFF00">
<H1><b>Please complete this form and tell us <BR>
how NYISE can be of service to you:</b> </H1>
<B><font size=4>If you prefer not to use a form, </font></B><a href="mailto:112213.2114@compuserve.com" target=""><B><font size=4><b>contact
us by e-mail</b></font></b></a><BR>
<BR>
<hr size=5 noshade width=40% align=left>
<form action="/cgi-bin/IBS_FormMail.cgi" method="post">
<dl>
<dd> <font size=5>
<p><b>Mark all that apply.</b><br>
<input type="checkbox" name="report" value="Send an Annual Report">Send me an Annual Report or current newsletter<br>
<input type="checkbox" name="inst" value="Send info about admissions">Send me additional information about admissions<br>
<input type="checkbox" name="clearing" value="Send info about employment">Send me information about employment opportunities<br>
<input type="checkbox" name="trust" value="Email updates">Email me about updates to the website.<br>
<input type="checkbox" name="mutual" value="Add to donor list">Add me to donor and fund raising appeals mailing list.<br>
</p>
<font size=4>
<b>Name: <input type=text size=38 maxlength=256 name="name"></b></font>
<p><font size=4><b>Title: <input type=text size=40 maxlength=256 name="Title_name"></b></font> </p>
<p><font size=4><b>Company: <input type=text size=35 maxlength=256 name="company"></b></font></p>
<p><font size=4><b>Email Address: <input type=text size=30 maxlength=256 name="email"></b></font> </p>
<p><font size=4><b>Street Address: <input type=text size=30 maxlength=256 name="street"></b></font> </p>
<p><font size=4><b>City, State, Zip: <input type=text size=30 maxlength=256 name="city"></b></font> </p>
<p><font size=4><b>Phone: <input type=text size=16 maxlength=256 name="phone"></b><b> Fax: <input type=text size=15 maxlength=256 name="fax"></b></font> <FONT SIZE=2>(optional)</FONT></p>
<p><font size=4><b>Comments:<br>
<textarea name="comments" rows=7 cols=50></textarea></b></font> </p>
<p><font size=4><b>Thank you for taking the time to contact us.</b><br>
<input type=submit value="Submit Your Information"><input type=reset></font> </p>
</font></dd>
</dl><font size=5>
<input type=hidden name="recipient" value="112213.2114@compuserve.com">
<input type=hidden name="return_link_url" value="http://www.nyise.org/">
<input type=hidden name="return_link_title" value="Back to our home page">
<input type=hidden name="subject" value="NYISE feed back">
<input type=hidden name="bgcolor" value="#FFFFFF">
<input type=hidden name="print_config" value="email">
<input type=hidden name="required" value="name,Title_name,company,email,street,city">
<input type=hidden name="sort" value="order:name,Title_name,company,email,street,city,phone,fax,comments,report,inst,clearing,trust,mutual">
<input type=hidden name="text_color" value="#FFFFFF">
<input type=hidden name="bgcolor" value="#336666">
<input type=hidden name="vlink_color" value="#FFFF00">
<input type=hidden name="link_color" value="#FCFFDA">
</font></form><font size=5>
<p><font size=4><br>
<b>For additional information contact:</b><br></font></p>
<address><font size=4><b>The New York Institute for Special Education<br>
attn: </b></font><font size=4><b> <a href="mailto:112213.2114@compuserve.com" target="">Kim
Benisatto, Operations Manager</a><br>
999 Pelham Parkway Bronx, New York 10469 USA<br>
Phone: (718) 519-7000 Ext. 315 Fax: (718) 231-9314</b><br>
</font></address>
<p><font size=3>Comments and/or suggestions on improving this site <br>
or reporting dead links can be addressed to:<br>
</font><a href="mailto:ilumin@earthlink.net"><font size=3>John Hernandez, Media
Coordinator-NYISE</font></a><font size=3> <br>
Copyright &#169; 1998 </font></p>
</font></body></html>