<!---START OF ADD FORM-->
For more information please fill out this form:<br><br>
<form action="http://freeautobot.com/cgi-bin/autores/autores.cgi">
<input type=hidden name="do" value="add_lead_external">
<input type=hidden name="Username" value="USERNAME">
<input type=hidden name="Stop_Status" value="Active">
<input type=hidden name="Cycle_Number" value="0">
<input type=hidden name="Success_URL" value="http://freeautobot.com">
<input type=hidden name="Failure_URL" value="http://freeautobot.com/Failure.html">
<input type=hidden name="Notes" value="Added from opt-in form">
Name: <input type=text name="Name" value=""><br>
Email Address: <input type=text name="Email" value=""><br>
<input type=submit value="Submit">
</form>
<!---END OF ADD FORM-->