E:12/02 Qube Shoes and Tigi Products

<form action="./bedhead_pop_up.php" method="post" id="competition"> <input name="my_form" value="form" type="hidden"> <table style="margin: 0pt auto; width: 800px;" border="0" cellpadding="0" cellspacing="0"> <tbody><tr> <td colspan="2">
</td> </tr> <tr> <td colspan="2">

</td> </tr> <tr> <td colspan="2"> Your Details
</td> </tr> <tr> <td> <label for="first_name">FIRST NAME</label>
<input name="first_name" id="first_name" value="" style="height: 20px; width: 80%; background-color: rgb(255, 255, 160);" type="text">
</td> <td> <label for="last_name">LAST NAME</label>
<input name="last_name" id="last_name" value="" style="height: 20px; width: 80%; background-color: rgb(255, 255, 160);" type="text">
</td> </tr> <tr> <td> <label for="email">EMAIL ADDRESS</label>
<input name="email" id="email" value="" style="height: 20px; width: 80%; background-color: rgb(255, 255, 160);" type="text">
</td> <td> <label for="confirm_email">CONFIRM EMAIL ADDRESS</label>
<input name="confirm_email" id="confirm_email" value="" style="height: 20px; width: 80%; background-color: rgb(255, 255, 160);" type="text">
</td> </tr> <tr> <td colspan="2" valign="top"> <label for="subscribe">Yes, I would like to receive the Qube Newsletter</label><input name="subscribe" id="subscribe" value="1" type="checkbox">
</td> </tr> <tr> <td colspan="2"> Your Friends Details
</td> </tr> <tr> <td> <label for="friend_first_name">FIRST NAME</label>
<input name="friend_first_name" id="friend_first_name" value="" style="height: 20px; width: 80%; background-color: rgb(255, 255, 160);" type="text">
</td> <td> <label for="friend_last_name">LAST NAME</label>
<input name="friend_last_name" id="friend_last_name" value="" style="height: 20px; width: 80%; background-color: rgb(255, 255, 160);" type="text">
</td> </tr> <tr> <td> <label for="friend_email">EMAIL ADDRESS</label>
<input name="friend_email" id="friend_email" value="" style="height: 20px; width: 80%; background-color: rgb(255, 255, 160);" type="text">
</td> <td> <label for="friend_confirm_email">CONFIRM EMAIL ADDRESS</label>
<input name="friend_confirm_email" id="friend_confirm_email" value="" style="height: 20px; width: 80%; background-color: rgb(255, 255, 160);" type="text">
</td> </tr> <tr> <td>
</td> </tr> <tr> <td colspan="2"></td> </tr> <tr> <td>
</td> </tr> <tr> <td colspan="2"> * Terms and Conditions: Competition closes February 12th 2008. Winners will be notified by email. Open to UK mainland residents only. No purchase necessary. No cash alternative. Colour and delivery subject to availability.
</td> </tr> </tbody></table> </form> <script src="https://ssl.google-analytics.com/urchin.js&quot; type="text/javascript"> </script> <script type="text/javascript"> _uacct = "UA-324197-1"; urchinTracker(); </script>