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<HTML>

<HEAD>


<META NAME="description" CONTENT="Confederate Ironclad replica">
<META NAME="Keywords"    CONTENT="CSS Neuse, Neuse II, Neuse ii,CSS Neuse Foundation, Confederate Ironclad, Confederate, CSS Neuse Foundation">


<!-- business -->


<META HTTP-EQUIV="Content-Type" CONTENT="text/html; charset=UTF-8">
<META NAME="Generator" content="">
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<!--<BASE HREF="http://cssneusefoundation.com/form.html">-->
<TITLE>Survey</TITLE></head>
<BODY  BGCOLOR="#FFFFFF"
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LEFTMARGIN="0" TOPMARGIN="0" RIGHTMARGIN="0" BOTTOMMARGIN="0"

 onLoad=""
 
 LINK="#000000"
 VLINK="#000000"
 ALINK="#000000"
>

  
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<table width="100%" border="0" cellpadding="0" cellspacing="0">
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                    <TD width="100%" VALIGN="top">
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<table width="90%" border="0" cellpadding="0" cellspacing="0">
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                    <td bgcolor="#FFFFFF" nowrap>&nbsp; 


<font face='Arial' size='+1' color='#000000'>

Survey

</font>


 &nbsp;</td>
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function error(field){ alert('You did not fill all required fields!'); field.focus(); return false; }
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<form name="questionary" action="http://rustikat.net:8090/servlet/psoft.customform.CustomForm" method="post">
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<input type="hidden" name="title" value="Survey">
<input type="hidden" name="esubj" value="Submitted Form Report">
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<input type="hidden" name="order" value="76 77 78 79 80 ">

<TABLE border="0" cellpadding="5" cellspacing="0" width="95%">
<tr><td colspan=2>&nbsp;</td></tr>
<input type="hidden" name="name_76" value="Do you have a Confederate ancestor?">
<tr><td>


<font face='Arial' size='2' color='#000000'>

Do you have a Confederate ancestor?

</font>


</td>
    <td><input type="radio" name="field_76" value="Yes">


<font face='Arial' size='2' color='#000000'>

Yes

</font>


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<font face='Arial' size='2' color='#000000'>

No

</font>


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</tr>
<input type="hidden" name="name_77" value="Would you be willing to volunteer at the Neuse II (assuming you live in the local area)?">
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<font face='Arial' size='2' color='#000000'>

Would you be willing to volunteer at the Neuse II (assuming you live in the local area)?

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<font face='Arial' size='2' color='#000000'>

Yes

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<font face='Arial' size='2' color='#000000'>

No

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<tr><td>


<font face='Arial' size='2' color='#000000'>

Do you have any artifacts or documents related to the Confederate Navy that you would be willing to donate to the CSS Neuse II Museum?

</font>


</td>
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<font face='Arial' size='2' color='#000000'>

Yes

</font>


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<font face='Arial' size='2' color='#000000'>

No

</font>


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<input type="hidden" name="name_79" value="Do you have any suggestions for the operation of the CSS Neuse II?">
<tr><td>


<font face='Arial' size='2' color='#000000'>

Do you have any suggestions for the operation of the CSS Neuse II?

</font>


</td>
    <td><textarea name="field_79" rows="5" cols="30"></textarea>
    
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</tr>
<input type="hidden" name="name_80" value="May we contact you?  If so, please provide contact information.">
<tr><td>


<font face='Arial' size='2' color='#000000'>

May we contact you?  If so, please provide contact information.

</font>


</td>
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<tr><td colspan=2 align=center>
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</tr>
</table>
</form>

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<br>
<FONT FACE="verdana, arial, helvetica" SIZE="1">
<center>
<nobr>|<a href="index.html">Welcome</A>|</nobr>

<nobr>|<a href="about.html">About</A>|</nobr>

<nobr>|<a href="gpage.html">CSS Neuse</A>|</nobr>

<nobr>|<a href="gpage1.html">Pictures</A>|</nobr>

<nobr>|<a href="gpage3.html">More Pictures</A>|</nobr>

<nobr>|<a href="gpage6.html">Latest Pictures</A>|</nobr>

<nobr>|<a href="gpage4.html">School of the Ironclad Sailor 2008</A>|</nobr>

<nobr>|<a href="tours.html">Tours</A>|</nobr>

<nobr>|<a href="gpage2.html">Crew</A>|</nobr>

<nobr>|<a href="links.html">Internet Links</A>|</nobr>

<nobr>|Survey|</nobr>

<nobr>|<a href="contact.html">Contact Us</A>|</nobr>
</center>
</font>

<BR>
            
<center><table border="0" cellpadding="0" cellspacing="3"><tr><td align="center">

<br><font face="helvetica,verdana, arial" size="1">&nbsp;</font>

</td></tr></table></center>
</td>
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