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<center>

<font size="2" face="Arial, Helvetica"><a href="mailto:contact@labana.net">contact@labana.net</a></font><br><br><br>


<form  action="http://www.labana.net/php/newsletter.php" method="post" target="_self">
<table border="0" align="center" cellspacing="0" cellpadding="5">

<tr><td colspan="2"><font size="2" face="Arial, Helvetica,">Fill out your e-mail address<br />to receive our newsletter!</font></td></tr>

<tr><td valign="top"><font size="2" face="Arial, Helvetica,">E-mail adress:</font></td><td valign="top"><input type="text" name="name_php" size="20" /></td></tr>

<tr><td valign="top"><font size="2" face="Arial, Helvetica,">Name:</font></td><td valign="top"><input type="text" name="mail_php" size="20" /></td></tr>

<tr><td colspan="2"><input type="submit" /></td></tr>
</table>
</form>

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