suggestions, comments and questions
for sam's page
******THIS IS NOT CURRENTLY WORKING******
please enter the following information. fields marked with
!!!
are required for the form to submit.
first name
!!!
last name
!!!
city
state
-Select State-
not everybody lives in u.s.
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Mars
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
NeverNeverLand
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Wisconsin
Wyoming
lalalala
lalala
Shock!
Stoned?
email address:
!!!
ex:
[email protected]
gender:
male
female
other
suggestions, comments or questions:
or
after you click "submit", you will be taken to a page that asks you to verify the information you have just entered. you will then be required to click another submit button for the form to be submitted completely. sorry :(
