ÿþ <!--This page is a template for an email chit system. Written by Justin Martin. Licensed under the GPL.--> <!--Page designed for usage by the University of Minnesota Naval ROTC Unit--> <!--Only edit the info on this page. The email_chit.php file need not be changed--> <html> <head> <title>Spring 2012 Special Request Chits</title> </head> <body> <center><h2>Special Request Chit Form</h2> <form name="chit" action="email_chit.php" method="post"> <table> <tr> <td>NAME:<input type="text" name="name" value="DOE, JOHN, J."></td> <td>RANK:<input type="text" name="rank" size=8 value="MIDN X/C"></td> <td>DATE OF REQUEST:<input type="text" name="reqdate" size=11 value="17-JAN-2012"></td> <td>EMAIL:<input type="text" name="email" value="doex1234@umn.edu"></td> </tr> </table> <table> <tr> <textarea rows="30" cols="100" name="request">Respectfully request to be excused from Drill for 0800 class for Spring semester 2012. Explain...</textarea> </tr> <tr> <td>NO DAYS REQUESTED:<input type="text" name="reqdays" value="180"></td> <td>FROM:<input type="text" name="fromdate" value="0800 17-JAN-2012"></td> <td>TO:<input type="text" name="todate" value="0900 18-JAN-2012"></td> </tr> <tr> <td>DISTANCE:<input type="text" name="distance" value="N/A"></td> <td>MODE OF TRAVEL:<input type="text" name="travelmode" value="N/A"></td> </tr> <tr> <td>LEAVE ADDRESS:<input type="text" name="address" value="N/A"></td> <td>TELEPHONE NUMBER:<input type="text" name="phonenumber" value="N/A"></td> </tr> </table> <br> <table> <tr> <td>Squad Leader: <select name="SQD"> <option value="hasse162@umn.edu"> A - 1</option> <option value="cris8126@stthomas.edu"> A - 2</option> <option value="keil9259@stthomas.edu"> A - 3</option> <option value="blaz0100@umn.edu"> C - 1</option> <option value="schu2672@stthomas.edu"> C - 2</option> <option value="brook491@umn.edu"> C - 3</option> <option value="asmus049@umn.edu"> A Co</option> <option value="starr157@umn.edu"> C Co</option> <option value="mskelton37@yahoo.com"> Staff</option> </select> </td> </tr> </table> <hr> <br> <input type="submit" value="Submit Chit"> </form> </center> </body>