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<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<title>Welcome to Orissa Socio-Cultural Association Ahmedabad</title>
<style type="text/css">

body{margin:0px; padding:0px; background:#000;}
#bg{position:fixed; z-index:1; overflow:hidden;}

  @font-face {
	font-family: 'graublauweb-webfont';
	src: url('fonts/graublauweb-webfont.eot');
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@font-face {
	font-family: 'graublauwebbold-webfont';
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.line {
	font-family: Arial, Helvetica, sans-serif;
	font-size: 14px;
	font-style: normal;
	font-weight: bold;
	font-variant: normal;
	color: #2DB9FD;
	text-decoration: none;
}
a:link {
	text-decoration: none;
}
a:visited {
	text-decoration: none;
}
a:hover {
	text-decoration: none;
}
a:active {
	text-decoration: none;
}
</style>
<script type="text/javascript" src="http://ajax.googleapis.com/ajax/libs/jquery/1.4/jquery.min.js"></script>
<script type="text/javascript" src="script/validation.js"></script>
<script type="text/javascript">
window.onload = function () {
FullScreenBackground('#bgimg');
}
$(window).resize(function() {
FullScreenBackground('#bgimg');
});
function FullScreenBackground(theItem){
var winWidth=$(window).width();
var winHeight=$(window).height();
var imageWidth=$(theItem).width();
var imageHeight=$(theItem).height();
var picHeight = imageHeight / imageWidth;
var picWidth = imageWidth / imageHeight;
if ((winHeight / winWidth) < picHeight) {
$(theItem).css("width",winWidth);
$(theItem).css("height",picHeight*winWidth);
} else {
$(theItem).css("height",winHeight);
$(theItem).css("width",picWidth*winHeight);
};
$(theItem).css("margin-left",winWidth / 2 - $(theItem).width() / 2);
$(theItem).css("margin-top",winHeight / 2 - $(theItem).height() / 2);
}
</script>
<script type="text/javascript" src="http://code.jquery.com/jquery-latest.js"></script>
<script type="text/javascript" src="script/menu.js"></script>
<script type="text/javascript" src="script/validation.js"></script>
 <script type="text/javascript">
            $(document).ready(function() {
                $('.menu').tagdrop({tagPaddingTop: '60px',bgColor: '#020202',bgMoverColor: '#00badc',textColor: '#e0e0e0',padding:'5px'});
            });
        </script>
        <link rel="stylesheet" href="css/menu.css" type="text/css" />
        <link rel="stylesheet" href="css/body.css" type="text/css" />
     
</head>
<body>
<div id="bg"><img src="images/membership_osca.jpg" width="1440" height="948" id="bgimg" /></div>


<div style="position:absolute; top:0px; right:10px;  z-index:15; height:300px; width:98%;">
<ul class="menu">
            
       <a href = "about_osca.html">   <li>About us</li></a>
<a href = "osca_association.html"> <li>Association</li></a>
          <li>Events</li>
         <a href = "services_osca.html">    <li>Services</li></a>
			<a href = "membership_osca.php"> <li>Membership</li></a>
<a href = "publications_osca.html"> <li>Smaranika</li></a>
			<a href = "contact_us_osca.html"> <li>Contact Us</li></a>
        </ul>

</div>

<div style="position:absolute; top:0px; left:0px;  z-index:1; height:1500px; width:100%;">
<div class="tf_pattern"></div></div>
<div style="position:absolute; top:30px; left:30px;  z-index:15; height:300px; width:200px;"><a href= "index.html">
<img src="images/Orissaculturalassociationlogo_white.png" /></a>
</div>
<div style="position:absolute; top:300px; left:30px;  z-index:15; height:1160px; width:805px;">
<img src="images/text_bg.png" width="700" height="1100" /></div>
<div style="position:absolute; top:300px; left:30px;  z-index:15; height:100px; width:700px; padding:20px;">
<h1 class="red">  Apply for membership  </h1></div>



<div style="position:absolute; top:380px; left:40px;  z-index:15; height:1000px; width:800px; padding:10px; overflow:auto;">
<span class ="line">-----------------------------------------</span><br /><br />

<form id="form" name="form" method="post" onSubmit="return validate_input()" action="membership_osca_action.php">
<table width="700" border="0" cellspacing="12" id="body">
  <tr>&nbsp;&nbsp;&nbsp;<span class= "smallheadings">Fill the simple form below to apply for membership in OSCA.</span>  
  </tr>
   <tr>
    <td width="200">&nbsp;<span class= "paratex">Name : </span></td>
    <td>&nbsp;<input name="name" type="text" size="30" maxlength="100" value = "<?php echo $_GET['name']; ?>" /></td>
  </tr>
  <tr>
    <td width="200">&nbsp;<span class= "paratex">Company/Organisation:</span></td>
    <td>&nbsp; <input name="company" type="text" size="30" maxlength="100" value = "<?php echo $_GET['company']; ?>" /></td>
  </tr>
  <tr>
    <td width="200">&nbsp;<span class= "paratex">Designation :</span></td>
    <td>&nbsp;<input name="designation" type="text" size="30" maxlength="100" value = "<?php echo $_GET['designation']; ?>" /></td>
  </tr>
  <tr>
    <td width="200">&nbsp;<span class= "paratex">Address Office: </span></td>
    <td>&nbsp;<input name="address_office" type="text" size="30" maxlength="250" value = "<?php echo $_GET['address_office']; ?>" /></td>
  </tr>
    <tr>
    <td width="200">&nbsp;<span class= "paratex">Address Residence: </span></td>
    <td>&nbsp;<input name="address_residence" type="text" size="30" maxlength="250" value = "<?php echo $_GET['address_residence']; ?>" /></td>
  </tr>
  <tr>
    <td width="200">&nbsp;<span class= "paratex">State : </span></td>
    <td>&nbsp;<input name="state" type="text" size="30" maxlength="100" value = "<?php echo $_GET['state']; ?>" /></td>
  </tr>
  <tr>
    <td width="200">&nbsp;<span class= "paratex">Country :</span> </td>
    <td>&nbsp;<select name="country" id="country" class="dropdown" reqman="true" format="Number" >

	<option selected="selected" value="0">-Please Select-</option>

	<option value="Afghanistan">Afghanistan</option>

	<option value="Albania">Albania</option>

	<option value="Algeria">Algeria</option>

	<option value="American Samoa">American Samoa</option>

	<option value="Andorra">Andorra</option>

	<option value="Angola">Angola</option>

	<option value="Anguilla">Anguilla</option>

	<option value="Antarctica">Antarctica</option>

	<option value="Antigua &amp; Barbuda">Antigua &amp; Barbuda</option>

	<option value="Argentina">Argentina</option>

	<option value="Armenia">Armenia</option>

	<option value="Aruba">Aruba</option>

	<option value="Australia">Australia</option>

	<option value="Austria">Austria</option>

	<option value="Azerbaijan">Azerbaijan</option>

	<option value="Bahamas, The">Bahamas, The</option>

	<option value="Bahrain">Bahrain</option>

	<option value="Bangladesh">Bangladesh</option>

	<option value="Barbados">Barbados</option>

	<option value="Belarus">Belarus</option>

	<option value="Belgium">Belgium</option>

	<option value="Belize">Belize</option>

	<option value="Benin">Benin</option>

	<option value="Bermuda">Bermuda</option>

	<option value="Bhutan">Bhutan</option>

	<option value="Bolivia">Bolivia</option>

	<option value="Bosnia &amp; Herzegovina">Bosnia &amp; Herzegovina</option>

	<option value="Botswana">Botswana</option>

	<option value="Bouvet Island">Bouvet Island</option>

	<option value="Brazil">Brazil</option>

	<option value="British Indian Ocean">British Indian Ocean</option>

	<option value="Brunei">Brunei</option>

	<option value="Bulgaria">Bulgaria</option>

	<option value="Burkina Faso">Burkina Faso</option>

	<option value="Burundi">Burundi</option>

	<option value="Cambodia">Cambodia</option>

	<option value="Cameroon">Cameroon</option>

	<option value="Canada">Canada</option>

	<option value="Cape Verde">Cape Verde</option>

	<option value="Cayman Islands">Cayman Islands</option>

	<option value="Central African Rep.">Central African Rep.</option>

	<option value="Chad">Chad</option>

	<option value="Chile">Chile</option>

	<option value="China">China</option>

	<option value="Christmas Island">Christmas Island</option>

	<option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands</option>

	<option value="Colombia">Colombia</option>

	<option value="Comoros">Comoros</option>

	<option value="Congo">Congo</option>

	<option value="Congo, Democractic Rep.">Congo, Democractic Rep.</option>

	<option value="Cook Islands">Cook Islands</option>

	<option value="Costa Rica">Costa Rica</option>

	<option value="Cote D'Ivoire (Ivory Coast)">Cote D'Ivoire (Ivory Coast)</option>

	<option value="Croatia (Hrvatska)">Croatia (Hrvatska)</option>

	<option value="Cuba">Cuba</option>

	<option value="Cyprus">Cyprus</option>

	<option value="Czech Republic">Czech Republic</option>

	<option value="Denmark">Denmark</option>

	<option value="Djibouti">Djibouti</option>

	<option value="Dominica">Dominica</option>

	<option value="Dominican Republic">Dominican Republic</option>

	<option value="East Timor">East Timor</option>

	<option value="Ecuador">Ecuador</option>

	<option value="Egypt">Egypt</option>

	<option value="El Salvador">El Salvador</option>

	<option value="Equatorial Guinea">Equatorial Guinea</option>

	<option value="Eritrea">Eritrea</option>

	<option value="Estonia">Estonia</option>

	<option value="Ethiopia">Ethiopia</option>

	<option value="Falkland Islands">Falkland Islands</option>

	<option value="Faroe Islands">Faroe Islands</option>

	<option value="Fiji Islands">Fiji Islands</option>

	<option value="Finland">Finland</option>

	<option value="France">France</option>

	<option value="French Guiana">French Guiana</option>

	<option value="French Polynesia">French Polynesia</option>

	<option value="French Southern Territ.">French Southern Territ.</option>

	<option value="Gabon">Gabon</option>

	<option value="Gambia, The">Gambia, The</option>

	<option value="Georgia">Georgia</option>

	<option value="Germany">Germany</option>

	<option value="Ghana">Ghana</option>

	<option value="Gibraltar">Gibraltar</option>

	<option value="Greece">Greece</option>

	<option value="Greenland">Greenland</option>

	<option value="Grenada">Grenada</option>

	<option value="Guadeloupe">Guadeloupe</option>

	<option value="Guam">Guam</option>

	<option value="Guatemala">Guatemala</option>

	<option value="Guinea">Guinea</option>

	<option value="Guinea-Bissau">Guinea-Bissau</option>

	<option value="Guyana">Guyana</option>

	<option value="Haiti">Haiti</option>

	<option value="Heard &amp; McDonald Islands">Heard &amp; McDonald Islands</option>

	<option value="Honduras">Honduras</option>

	<option value="Hong Kong S.A.R.">Hong Kong S.A.R.</option>

	<option value="Hungary">Hungary</option>

	<option value="Iceland">Iceland</option>

	<option value="India">India</option>

	<option value="Indonesia">Indonesia</option>

	<option value="Iran">Iran</option>

	<option value="Iraq">Iraq</option>

	<option value="Ireland">Ireland</option>

	<option value="Israel">Israel</option>

	<option value="Italy">Italy</option>

	<option value="Jamaica">Jamaica</option>

	<option value="Japan">Japan</option>

	<option value="Jordan">Jordan</option>

	<option value="Kazakhstan">Kazakhstan</option>

	<option value="Kenya">Kenya</option>

	<option value="Kiribati">Kiribati</option>

	<option value="Korea">Korea</option>

	<option value="Korea, North">Korea, North</option>

	<option value="Kuwait">Kuwait</option>

	<option value="Kyrgyzstan">Kyrgyzstan</option>

	<option value="Laos">Laos</option>

	<option value="Latvia">Latvia</option>

	<option value="Lebanon">Lebanon</option>

	<option value="Lesotho">Lesotho</option>

	<option value="Liberia">Liberia</option>

	<option value="Libya">Libya</option>

	<option value="Liechtenstein">Liechtenstein</option>

	<option value="Lithuania">Lithuania</option>

	<option value="Luxembourg">Luxembourg</option>

	<option value="Macau S.A.R.">Macau S.A.R.</option>

	<option value="Macedonia, Former Yugoslav Rep.">Macedonia, Former Yugoslav Rep.</option>

	<option value="Madagascar">Madagascar</option>

	<option value="Malawi">Malawi</option>

	<option value="Malaysia">Malaysia</option>

	<option value="Maldives">Maldives</option>

	<option value="Mali">Mali</option>

	<option value="Malta">Malta</option>

	<option value="Marshall Islands">Marshall Islands</option>

	<option value="Martinique">Martinique</option>

	<option value="Mauritania">Mauritania</option>


	<option value="Mauritius">Mauritius</option>

	<option value="Mayotte">Mayotte</option>

	<option value="Mexico">Mexico</option>

	<option value="Micronesia">Micronesia</option>

	<option value="Moldova">Moldova</option>

	<option value="Monaco">Monaco</option>

	<option value="Mongolia">Mongolia</option>

	<option value="Montserrat">Montserrat</option>

	<option value="Morocco">Morocco</option>

	<option value="Mozambique">Mozambique</option>

	<option value="Myanmar">Myanmar</option>

	<option value="Namibia">Namibia</option>

	<option value="Nauru">Nauru</option>

	<option value="Nepal">Nepal</option>

	<option value="Netherlands Antilles">Netherlands Antilles</option>

	<option value="Netherlands, The">Netherlands, The</option>

	<option value="New Caledonia">New Caledonia</option>

	<option value="New Zealand">New Zealand</option>

	<option value="Nicaragua">Nicaragua</option>

	<option value="Niger">Niger</option>

	<option value="Nigeria">Nigeria</option>

	<option value="Niue">Niue</option>

	<option value="Norfolk Island">Norfolk Island</option>

	<option value="Northern Mariana Islands">Northern Mariana Islands</option>

	<option value="Norway">Norway</option>

	<option value="Oman">Oman</option>

	<option value="Pakistan">Pakistan</option>

	<option value="Palau">Palau</option>

	<option value="Panama">Panama</option>

	<option value="Papua new Guinea">Papua new Guinea</option>

	<option value="Paraguay">Paraguay</option>

	<option value="Peru">Peru</option>

	<option value="Philippines">Philippines</option>

	<option value="Pitcairn Island">Pitcairn Island</option>

	<option value="Poland">Poland</option>

	<option value="Portugal">Portugal</option>

	<option value="Puerto Rico">Puerto Rico</option>

	<option value="Qatar">Qatar</option>

	<option value="Reunion">Reunion</option>

	<option value="Romania">Romania</option>

	<option value="Russia">Russia</option>

	<option value="Rwanda">Rwanda</option>

	<option value="Saint Helena">Saint Helena</option>

	<option value="Saint Kitts And Nevis">Saint Kitts And Nevis</option>

	<option value="Saint Lucia">Saint Lucia</option>

	<option value="Saint Pierre and Miquelon">Saint Pierre and Miquelon</option>

	<option value="Saint Vincent &amp; The Grenadines">Saint Vincent &amp; The Grenadines</option>

	<option value="Samoa">Samoa</option>

	<option value="San Marino">San Marino</option>

	<option value="Sao Tome and Principe">Sao Tome and Principe</option>

	<option value="Saudi Arabia">Saudi Arabia</option>

	<option value="Senegal">Senegal</option>

	<option value="Seychelles">Seychelles</option>

	<option value="Sierra Leone">Sierra Leone</option>

	<option value="Singapore">Singapore</option>

	<option value="Slovakia">Slovakia</option>

	<option value="Slovenia">Slovenia</option>

	<option value="Solomon Islands">Solomon Islands</option>

	<option value="Somalia">Somalia</option>

	<option value="South Africa">South Africa</option>

	<option value="South Georgia &amp; The South Sandwich Islands">South Georgia &amp; South

                                                Sandwich Islands</option>

	<option value="Spain">Spain</option>

	<option value="Sri Lanka">Sri Lanka</option>

	<option value="Sudan">Sudan</option>

	<option value="Suriname">Suriname</option>

	<option value="Svalbard &amp; Jan Mayen Islands">Svalbard &amp; Jan Mayen Islands</option>

	<option value="Swaziland">Swaziland</option>

	<option value="Sweden">Sweden</option>

	<option value="Switzerland">Switzerland</option>

	<option value="Syria">Syria</option>

	<option value="Taiwan">Taiwan</option>

	<option value="Tajikistan">Tajikistan</option>

	<option value="Tanzania">Tanzania</option>

	<option value="Thailand">Thailand</option>

	<option value="Togo">Togo</option>

	<option value="Tokelau">Tokelau</option>

	<option value="Tonga">Tonga</option>

	<option value="Trinidad And Tobago">Trinidad And Tobago</option>

	<option value="Tunisia">Tunisia</option>

	<option value="Turkey">Turkey</option>

	<option value="Turkmenistan">Turkmenistan</option>

	<option value="Turks And Caicos Islands">Turks And Caicos Islands</option>

	<option value="Tuvalu">Tuvalu</option>

	<option value="Uganda">Uganda</option>

	<option value="Ukraine">Ukraine</option>

	<option value="United Arab Emirates">United Arab Emirates</option>

	<option value="United Kingdom">United Kingdom</option>

	<option value="United States">United States</option>

	<option value="United States Minor Outlying Islands">United States Minor Outlying Islands</option>

	<option value="Uruguay">Uruguay</option>

	<option value="Uzbekistan">Uzbekistan</option>

	<option value="Vanuatu">Vanuatu</option>

	<option value="Vatican City State">Vatican City State</option>

	<option value="Venezuela">Venezuela</option>

	<option value="Vietnam">Vietnam</option>

	<option value="Virgin Islands (British)">Virgin Islands (British)</option>

	<option value="Virgin Islands (US)">Virgin Islands (US)</option>

	<option value="Wallis And Futuna Islands">Wallis And Futuna Islands</option>

	<option value="Yemen">Yemen</option>

	<option value="Yugoslavia">Yugoslavia</option>

	<option value="Zambia">Zambia</option>

	<option value="Zimbabwe">Zimbabwe</option>

</select>
</td>
  </tr>
  <tr>
    <td width="200">&nbsp;<span class= "paratex">Postal Code :</span></td>
    <td>&nbsp;<input name="pincode" type="text" size="30" maxlength="6" value = "<?php echo $_GET['pincode']; ?>" /></td>
  </tr>
  <tr>
    <td width="200">&nbsp;<span class= "paratex">Phone :</span></td>
    <td>&nbsp;<input name="phone" type="text" size="30" maxlength="100" value = "<?php echo $_GET['phone']; ?>" /></td>
  </tr>
 
  <tr>
    <td width="200">&nbsp;<span class= "paratex">Email :</span></td>
    <td>&nbsp;<input name="email" type="text" size="30" maxlength="100" value = "<?php echo $_GET['email']; ?>" /></td>
  </tr>
  
  <tr>
    <td width="200">&nbsp;<span class= "paratex">Inquiry Brief : </span></td>
    <td>&nbsp;
      <textarea name="inquiry" cols="40" rows="6" ><?php echo $_GET['inquiry']; ?></textarea></td>
  </tr>
  <tr>
    <td width="200">&nbsp;<span class= "paratex">Verification Code : </span></td>
    <td>&nbsp;
		<?php
				require_once('recaptchalib.php');           
				$publickey = "6LfJGb4SAAAAANY7cMGo1H3P9ywtq8cZHfZIB9lN"; // you got this from the signup page           
				echo recaptcha_get_html($publickey);   
		?>
		</td>
  </tr>
  
  <tr>
    <td width="200">&nbsp;</td>
    <td>&nbsp;</td>
  </tr>
   <tr>
    <td width="200">&nbsp;</td>
    <td>&nbsp;<input name="newsletters" type="checkbox" value="" checked /><span class= "paratex">Subscribe to our monthly newsletters.</span></td>
  </tr>
       <td width="200">&nbsp; <input name="newsletter" type="hidden" value="0" /></td>
    <td>&nbsp;</td>
  </tr>
  <tr>
    <td width="200">&nbsp;</td>
    <td>&nbsp;<input name="Submit" type="submit" class="submit" value="Submit" /></td>
  </tr>
  <tr>
    <td width="200">&nbsp;</td>
    <td>&nbsp;</td>
  </tr>
  <td width="200">
</table>
</form>
</div>



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