Copy the entire text BELOW THIS STATEMENT. Then replace the text in pink with your own text, while leaving the blue text intact. Save the document as "documentname.html" (e.g., appointment_survey.html), and you are ready to post it on your server!

<html>
<head>
<title>survey form</title>
</head>
<body bgcolor=#ffffff>

<h3>Appointment Survey</h3>

<form method="post" action="mailto:raizen@mail.utexas.edu?subject=Appointment Survey" enctype="text/plain">

Select your options from the pull-down menus, and click on the "Send Form" button to submit the information.

<P>Course:<BR>
<SELECT NAME="course">
<OPTION VALUE="FR 506">FR 506
<OPTION VALUE="FR 507">FR 507
<OPTION VALUE="FR 312K">FR 312K
<OPTION VALUE="FR 312L">FR 312L
<OPTION VALUE="FR 508">FR 508
</SELECT>

<P>Instructor:<BR>
<SELECT NAME="instructor">
<OPTION VALUE="Potter">Potter
<OPTION VALUE="Moreau">Moreau
<OPTION VALUE="Bonaparte">Bonaparte
<OPTION VALUE="Dupont">Dupont
<OPTION VALUE="Brown">Brown
</SELECT>

<P>Preferred Appointment Time:<BR>
<SELECT NAME="preferred appointment time">
<OPTION VALUE="Tuesday at 8:00">Tuesday at 8:00
<OPTION VALUE="Tuesday at 12:00">Tuesday at 12:00
<OPTION VALUE="Wednesday at 8:00">Wednesday at 8:00
<OPTION VALUE="Wednesday at 3:00">Wednesday at 3:00
<OPTION VALUE="Friday at 12:00">Friday at 12:00
</SELECT>

<br>
<br>
<br>
<br>
<input type="submit" value="Send Form">
<input type="reset" value="Clear Form">
</form>
</body>
</html>