<form action=”mailto:[email protected]” method=”post” enctype=”text/plain”>
<fieldset>
<legend>Personal Information</legend>
<label for=”name”>Full Name:</label><br>
<input type=”text” id=”name” name=”name” required><br><br>
<label for=”address”>Address:</label><br>
<textarea id=”address” name=”address” rows=”4″ cols=”40″ required></textarea><br><br>
<label for=”callsign”>Callsign:</label><br>
<input type=”text” id=”callsign” name=”callsign” required><br><br>
</fieldset>
<fieldset>
<legend>Membership Details</legend>
<label><input type=”checkbox” name=”ares_member” value=”Yes”> ARES Member</label><br>
<label><input type=”checkbox” name=”arrl_member” value=”Yes”> ARRL Member</label><br>
<label><input type=”checkbox” name=”cert” value=”Yes”> CERT</label><br>
<label><input type=”checkbox” name=”ics100″ value=”Yes”> ICS100</label><br>
<label><input type=”checkbox” name=”ics200″ value=”Yes”> ICS200</label><br>
<label><input type=”checkbox” name=”ics700″ value=”Yes”> ICS700</label><br>
<label><input type=”checkbox” name=”ics800″ value=”Yes”> ICS800</label><br>
</fieldset>
<fieldset>
<legend>Additional Information</legend>
<label><input type=”checkbox” name=”willing_to_deploy” value=”Yes”> Willing to Deploy?</label><br>
<label><input type=”checkbox” name=”act_as_ncs” value=”Yes”> Act as NCS?</label><br>
</fieldset>
<button type=”submit”>Submit Application</button>
</form>