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<html>
<head>
<title>New Page 1</title>
</head>
<body bgcolor="#000000">
<form method="POST" action="_vti_bin/shtml.dll/surprise.htm" webbot-action="--WEBBOT-SELF--">
<!--webbot bot="SaveResults" S-Email-Format="TEXT/PRE" S-Email-Address="trak@compunet.co.il" startspan --><input TYPE="hidden" NAME="VTI-GROUP" VALUE="0"><!--webbot bot="SaveResults" endspan i-checksum="43374" --><div align="left"><table border="0" cellspacing="0" cellpadding="0" width="450">
<tr>
<td width="578" align="center"><div align="left"><p><img src="images/topsurp.gif" WIDTH="461" HEIGHT="31"><br>
</td>
</tr>
</table>
</div><table border="0" cellspacing="0" cellpadding="0" width="400">
<tr>
<td width="17%"></td>
<td width="83%">&nbsp;<div align="right"><table border="0" width="306" cellspacing="4" cellpadding="2" height="86">
<tr>
<td width="180" colspan="2" align="right"><input type="text" name="FULL_NAME" size="20"></td>
<td width="110"><font color="#00FF00">: àìî íù</font></td>
</tr>
<tr>
<td width="180" colspan="2" align="right"><input type="text" name="ADRESS" size="20"></td>
<td width="110"><font color="#00FF00">: úáåúë</font></td>
</tr>
<tr>
<td width="180" colspan="2" align="right"><input type="text" name="CITY" size="20"></td>
<td width="110"><font color="#00FF00">: ãå÷éîå øéò</font></td>
</tr>
<tr>
<td width="180" colspan="2" align="right"><input type="text" name="PHONE" size="20"></td>
<td width="110"><font color="#00FF00">: ïåôìè</font></td>
</tr>
<tr>
<td width="180" colspan="2" align="right"><input type="text" name="AGE" size="20"></td>
<td width="110"><font color="#00FF00">: ìéâ</font></td>
</tr>
<tr>
<td width="96"><div align="right"><p><input type="radio" value="FEMALE" name="SEX"><font color="#00FF00">:äá÷ð</font></td>
<td width="76"><div align="right"><p><input type="radio" value="MALE" name="SEX"><font color="#00FF00">:øëæ</font></td>
<td width="110"><font color="#00FF00">:ïéî</font></td>
</tr>
</table>
</div></td>
</tr>
</table>
<table border="0" width="420" cellspacing="0" cellpadding="0">
<tr>
<td width="100%" height="40" valign="middle"></td>
</tr>
</table>
<div align="left"><table border="0" width="450">
<tr>
<td width="596" colspan="6" valign="bottom"><div align="center"><center><p><strong><font color="#FFFFFF"><u>?íééìòð âåæ úåð÷ì øçåá äúà íéðåéøèéø÷
åìéà éôì<br>
</u></font></strong></td>
</tr>
<tr align="center">
<td height="17" width="80" align="center"><font color="#00FF00">úåôéãò<br>
úéùéîç </font></td>
<td height="17" width="80" align="center"><font color="#00FF00">úåôéãò<br>
úéòéáø </font></td>
<td height="17" width="80"><div align="center"><center><p><font color="#00FF00">úåôéãò<br>
úéùéìù </font></td>
<td height="17" width="80" align="center"><div align="center"><center><p><font color="#00FF00">úåôéãò<br>
äééðù </font></td>
<td height="17" width="80" align="center"><div align="center"><center><p><font color="#00FF00">úåôéãò<br>
äðåùàø</font></td>
<td width="119" align="center"></td>
</tr>
<tr align="center">
<td width="80" height="17" align="center"><input type="radio" name="ofna" value="fifth"></td>
<td width="80" height="17" align="center"><input type="radio" name="ofna" value="fourth"></td>
<td width="80" height="17" align="center"><input type="radio" name="ofna" value="third"></td>
<td width="80" height="17" align="center"><input type="radio" name="ofna" value="second"></td>
<td width="80" height="17" align="center"><input type="radio" name="ofna" value="first" checked></td>
<td width="119"><font color="#00FF00">äðôåà</font></td>
</tr>
<tr align="center">
<td width="80" height="17" align="center"><input type="radio" name="nohout" value="fifth"></td>
<td width="80" height="17" align="center"><input type="radio" name="nohout" value="fourth"></td>
<td width="80" height="17" align="center"><input type="radio" name="nohout" value="third"></td>
<td width="80" height="17" align="center"><input type="radio" name="nohout" value="second"></td>
<td width="80" height="17" align="center"><input type="radio" name="nohout" value="first" checked></td>
<td width="119"><font color="#00FF00">úåçåð</font></td>
</tr>
<tr align="center">
<td width="80" height="17" align="center"><input type="radio" name="gimour" value="fifth"></td>
<td width="80" height="17" align="center"><input type="radio" name="gimour" value="fourth"></td>
<td width="80" height="17" align="center"><input type="radio" name="gimour" value="third"></td>
<td width="80" height="17" align="center"><input type="radio" name="gimour" value="second"></td>
<td width="80" height="17" align="center"><input type="radio" name="gimour" value="first" checked></td>
<td width="119"><font color="#00FF00">øåîéâ</font></td>
</tr>
<tr align="center">
<td width="80" height="17" align="center"><input type="radio" name="hamlatsa" value="fifth"></td>
<td width="80" height="17" align="center"><input type="radio" name="hamlatsa" value="fourth"></td>
<td width="80" height="17" align="center"><input type="radio" name="hamlatsa" value="third"></td>
<td width="80" height="17" align="center"><input type="radio" name="hamlatsa" value="second"></td>
<td width="80" height="17" align="center"><input type="radio" name="hamlatsa" value="first" checked></td>
<td width="119"><font color="#00FF00">äöìîä</font></td>
</tr>
<tr align="center">
<td width="80" height="17" align="center"><input type="radio" name="mehir" value="fifth"></td>
<td width="80" height="17" align="center"><input type="radio" name="mehir" value="fourth"></td>
<td width="80" height="17" align="center"><input type="radio" name="mehir" value="third"></td>
<td width="80" height="17" align="center"><input type="radio" name="mehir" value="second"></td>
<td width="80" height="17" align="center"><input type="radio" name="mehir" value="first" checked></td>
<td width="119"><font color="#00FF00">øéçî</font></td>
</tr>
</table>
</div><div align="center"><center><table border="0" cellspacing="0" cellpadding="0" width="400">
<tr>
<td width="600" valign="middle" height="60"><div align="center"><center><p>&nbsp; </p>
</center></div><div align="left"><p><input type="submit" value="Submit" name="B1">&nbsp;<input type="reset" value="Reset" name="B2"></td>
</tr>
</table>
</center></div>
</form>
</body>
</html>