<!-- BOF: ./personal-templates/show.body -->
<!-- BOF: ./personal-templates/simple/generic/show -->
<!-- BOF: ./personal-templates/rtl.html -->
<!-- Locale=en_US -->
<!-- EOF: ./personal-templates/rtl.html -->


<!-- BOF: ./personal-templates/simple/generic/functions -->
<!-- BOF: ./personal-templates/simple/generic/navbar --><!-- EOF: ./personal-templates/simple/generic/navbar -->


<!-- EOF: ./personal-templates/simple/generic/functions -->


<!-- EOF: ./personal-templates/simple/generic/show -->

<!-- BOF: ./personal-templates/simple/generic/images -->

<!-- EOF: ./personal-templates/simple/generic/images -->


<!-- BOF: ./personal-templates/simple/personal/other/l75.settings.init -->


<!-- EOF: ./personal-templates/simple/personal/other/l75.settings.init -->


<!-- EOF: ./personal-templates/simple/business/layout/l75.wait -->


<HTML>

<HEAD>


<META NAME="description" CONTENT="TBI survivors network for eastern washington spokane area ">
<META NAME="Keywords"    CONTENT="tbi doctors Washington, spokane tbi, spokane brain injury, spokane tbi doctors, spokane brain health, spokane brain injury help, spokane wa tbi help,tbi network spokane wa, brain injury network spokane wa, tbi support region 1 washington, tbi help line spokane wa, tbi information spokane washington, tramatic Brain Injury spokane washington, tbi survivors, brain injury survivors, brain injury support groups, tbi education, tbi videos, tbi news spokane wa, tbi facts, tbi history, tbi counseling, tbi eye doctors, tbi ear doctors, tbi rehab">


<!-- business -->


<META HTTP-EQUIV="Content-Type" CONTENT="text/html; charset=UTF-8">
<META NAME="Generator" content="">
<!-- BOF: ./personal-templates/simple/themes.show -->


<!-- EOF: ./personal-templates/simple/themes.show -->


<!--<BASE HREF="http://www.tbiwa.org/form.html">-->
<TITLE>Survey</TITLE></head>
<BODY  BGCOLOR="#FFFFFF"
 TEXT="#333333"

LEFTMARGIN="0" TOPMARGIN="0" RIGHTMARGIN="0" BOTTOMMARGIN="0"

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

  
      <!-- BOF: ./personal-templates/simple/business/layout/l75.layout -->
<table width="100%" height="100%" border="0" cellpadding="0" cellspacing="0" valign="top">
   <tr>
      <td colspan="2" height="168" width="100%" valign="top">
           <table height="168" cellpadding="0" cellspacing="0" border="0" width="100%">
             <tr>
                <td rowspan="2" width="266" height="168"><img src="widgets/gen_568.1.gif" border=0 width=266 height=168 alt=""></td>
                <td height="100" width="100%" background="widgets/gen_581.1.gif"><img src="widgets/gen_571.1.gif" border=0 width=381 height=100 alt=""></td>
             </tr>
             <tr>
                <td height="68" background="widgets/gen_573.1.gif"><img src="widgets/gen_651.1.gif" border=0 width=474 height=68 alt=""></td>
             </tr>
           </table>
      </td>
   </tr>
   <tr>
      <td width="266" height="100%">
          <table height="100%" width="266" border="0" cellspacing="0" cellpadding="0">
             <tr>
                <td width="12" height="28"><img src="widgets/gen_570.1.gif" border=0 width=12 height=28 alt=""></td>
                <td width="254" height="28"><img src="widgets/gen_569.1.gif" border=0 width=254 height=28 alt=""></td>
             </tr>
             <tr>
                <td background="widgets/gen_574.1.gif"></td>
                <td height="100%" bgcolor="#82AED6" valign="top">
                <a href="index.html" onMouseOver="document.images['img6'].src='widgets/gen_584.1.gif'" onMouseOut="document.images['img6'].src='widgets/gen_583.1.gif'"><img src="widgets/gen_583.1.gif" alt="Home" name="img6" border="0"></a><br><a href="supportgroups.html" onMouseOver="document.images['img28'].src='widgets/gen_586.1.gif'" onMouseOut="document.images['img28'].src='widgets/gen_585.1.gif'"><img src="widgets/gen_585.1.gif" alt="Support Groups" name="img28" border="0"></a><br><a href="external12.html" onMouseOver="document.images['img49'].src='widgets/gen_588.1.gif'" onMouseOut="document.images['img49'].src='widgets/gen_587.1.gif'"><img src="widgets/gen_587.1.gif" alt="2010 WA TBI Conference" name="img49" border="0"></a><br><a href="advocacy.html" onMouseOver="document.images['img25'].src='widgets/gen_606.1.gif'" onMouseOut="document.images['img25'].src='widgets/gen_605.1.gif'"><img src="widgets/gen_605.1.gif" alt="Advocacy" name="img25" border="0"></a><br><a href="Neuropsychologists.html" onMouseOver="document.images['img30'].src='widgets/gen_594.1.gif'" onMouseOut="document.images['img30'].src='widgets/gen_593.1.gif'"><img src="widgets/gen_593.1.gif" alt="Neuropsychologists" name="img30" border="0"></a><br><a href="Library Info.html" onMouseOver="document.images['img40'].src='widgets/gen_592.1.gif'" onMouseOut="document.images['img40'].src='widgets/gen_591.1.gif'"><img src="widgets/gen_591.1.gif" alt="Library Info" name="img40" border="0"></a><br><a href="Rehabilitation Doctors.html" onMouseOver="document.images['img27'].src='widgets/gen_596.1.gif'" onMouseOut="document.images['img27'].src='widgets/gen_595.1.gif'"><img src="widgets/gen_595.1.gif" alt="Rehabilitation Doctors" name="img27" border="0"></a><br><a href="Personal Injury Lawyers.html" onMouseOver="document.images['img47'].src='widgets/gen_590.1.gif'" onMouseOut="document.images['img47'].src='widgets/gen_589.1.gif'"><img src="widgets/gen_589.1.gif" alt="Personal Injury Lawyers" name="img47" border="0"></a><br><a href="Optometry .html" onMouseOver="document.images['img39'].src='widgets/gen_598.1.gif'" onMouseOut="document.images['img39'].src='widgets/gen_597.1.gif'"><img src="widgets/gen_597.1.gif" alt="Optometry " name="img39" border="0"></a><br><a href="Glorias Doctor List.html" onMouseOver="document.images['img38'].src='widgets/gen_600.1.gif'" onMouseOut="document.images['img38'].src='widgets/gen_599.1.gif'"><img src="widgets/gen_599.1.gif" alt="Glorias Doctor List" name="img38" border="0"></a><br><a href="Hospitals.html" onMouseOver="document.images['img32'].src='widgets/gen_602.1.gif'" onMouseOut="document.images['img32'].src='widgets/gen_601.1.gif'"><img src="widgets/gen_601.1.gif" alt="Hospitals" name="img32" border="0"></a><br><a href="Survivor Events.html" onMouseOver="document.images['img36'].src='widgets/gen_604.1.gif'" onMouseOut="document.images['img36'].src='widgets/gen_603.1.gif'"><img src="widgets/gen_603.1.gif" alt="Survivor Events" name="img36" border="0"></a><br><a href="Survivor Stories.html" onMouseOver="document.images['img35'].src='widgets/gen_608.1.gif'" onMouseOut="document.images['img35'].src='widgets/gen_607.1.gif'"><img src="widgets/gen_607.1.gif" alt="Survivor Stories" name="img35" border="0"></a><br><a href="form.html" onMouseOver="document.images['img7'].src='widgets/gen_610.1.gif'" onMouseOut="document.images['img7'].src='widgets/gen_609.1.gif'"><img src="widgets/gen_609.1.gif" alt="Survey" name="img7" border="0"></a><br><a href="alternate therapies.html" onMouseOver="document.images['img14'].src='widgets/gen_612.1.gif'" onMouseOut="document.images['img14'].src='widgets/gen_611.1.gif'"><img src="widgets/gen_611.1.gif" alt="Alternate Therapies" name="img14" border="0"></a><br><a href="external6.html" onMouseOver="document.images['img23'].src='widgets/gen_614.1.gif'" onMouseOut="document.images['img23'].src='widgets/gen_613.1.gif'"><img src="widgets/gen_613.1.gif" alt="Social Security Online" name="img23" border="0"></a><br><a href="external7.html" onMouseOver="document.images['img24'].src='widgets/gen_616.1.gif'" onMouseOut="document.images['img24'].src='widgets/gen_615.1.gif'"><img src="widgets/gen_615.1.gif" alt="Dept of Social Health Services" name="img24" border="0"></a><br><a href="external10.html" onMouseOver="document.images['img33'].src='widgets/gen_618.1.gif'" onMouseOut="document.images['img33'].src='widgets/gen_617.1.gif'"><img src="widgets/gen_617.1.gif" alt="Centers for Disease Control TBI" name="img33" border="0"></a><br><a href="external.html" onMouseOver="document.images['img16'].src='widgets/gen_620.1.gif'" onMouseOut="document.images['img16'].src='widgets/gen_619.1.gif'"><img src="widgets/gen_619.1.gif" alt="Defense and Veterans" name="img16" border="0"></a><br><a href="external1.html" onMouseOver="document.images['img17'].src='widgets/gen_622.1.gif'" onMouseOut="document.images['img17'].src='widgets/gen_621.1.gif'"><img src="widgets/gen_621.1.gif" alt="TBI washington" name="img17" border="0"></a><br><a href="external2.html" onMouseOver="document.images['img18'].src='widgets/gen_624.1.gif'" onMouseOut="document.images['img18'].src='widgets/gen_623.1.gif'"><img src="widgets/gen_623.1.gif" alt="BIA WA Spokane" name="img18" border="0"></a><br><a href="external3.html" onMouseOver="document.images['img20'].src='widgets/gen_626.1.gif'" onMouseOut="document.images['img20'].src='widgets/gen_625.1.gif'"><img src="widgets/gen_625.1.gif" alt="BIA Washington" name="img20" border="0"></a><br><a href="external4.html" onMouseOver="document.images['img21'].src='widgets/gen_628.1.gif'" onMouseOut="document.images['img21'].src='widgets/gen_627.1.gif'"><img src="widgets/gen_627.1.gif" alt="BIA Idaho" name="img21" border="0"></a><br><a href="external5.html" onMouseOver="document.images['img22'].src='widgets/gen_630.1.gif'" onMouseOut="document.images['img22'].src='widgets/gen_629.1.gif'"><img src="widgets/gen_629.1.gif" alt="BIA Oregon" name="img22" border="0"></a><br><a href="external8.html" onMouseOver="document.images['img29'].src='widgets/gen_632.1.gif'" onMouseOut="document.images['img29'].src='widgets/gen_631.1.gif'"><img src="widgets/gen_631.1.gif" alt="Idaho TBI Program" name="img29" border="0"></a><br><a href="external9.html" onMouseOver="document.images['img31'].src='widgets/gen_634.1.gif'" onMouseOut="document.images['img31'].src='widgets/gen_633.1.gif'"><img src="widgets/gen_633.1.gif" alt="WA State Medical Association" name="img31" border="0"></a><br><a href="donate.html" onMouseOver="document.images['img34'].src='widgets/gen_636.1.gif'" onMouseOut="document.images['img34'].src='widgets/gen_635.1.gif'"><img src="widgets/gen_635.1.gif" alt="Please Donate" name="img34" border="0"></a><br><a href="Depression Comics.html" onMouseOver="document.images['img37'].src='widgets/gen_638.1.gif'" onMouseOut="document.images['img37'].src='widgets/gen_637.1.gif'"><img src="widgets/gen_637.1.gif" alt="Depression Comics" name="img37" border="0"></a><br><a href="Home ownership.html" onMouseOver="document.images['img42'].src='widgets/gen_640.1.gif'" onMouseOut="document.images['img42'].src='widgets/gen_639.1.gif'"><img src="widgets/gen_639.1.gif" alt="Home ownership" name="img42" border="0"></a><br><a href="tbicampout.html" onMouseOver="document.images['img43'].src='widgets/gen_642.1.gif'" onMouseOut="document.images['img43'].src='widgets/gen_641.1.gif'"><img src="widgets/gen_641.1.gif" alt="TBI Campout" name="img43" border="0"></a><br><a href="custom.html" onMouseOver="document.images['img45'].src='widgets/gen_644.1.gif'" onMouseOut="document.images['img45'].src='widgets/gen_643.1.gif'"><img src="widgets/gen_643.1.gif" alt="Custom" name="img45" border="0"></a><br><a href="external11.html" onMouseOver="document.images['img46'].src='widgets/gen_646.1.gif'" onMouseOut="document.images['img46'].src='widgets/gen_645.1.gif'"><img src="widgets/gen_645.1.gif" alt="BIA WA Spokane News Letter 2009" name="img46" border="0"></a><br><a href="Lost Self.html" onMouseOver="document.images['img48'].src='widgets/gen_648.1.gif'" onMouseOut="document.images['img48'].src='widgets/gen_647.1.gif'"><img src="widgets/gen_647.1.gif" alt="Lost Self" name="img48" border="0"></a><br><a href="mailto:Craig@tbiwa.org" onMouseOver="document.images['img_email'].src='widgets/gen_650.1.gif'" onMouseOut="document.images['img_email'].src='widgets/gen_649.1.gif'"><img src="widgets/gen_649.1.gif" alt="e-mail me" name="img_email" border="0"></a><br>
                  
                </td>
             </tr>
          </table>
      </td>
      <td width="100%" valign="top">
                <table width="100%" height="100%" border="0" cellspacing="0" cellpadding="0" valign="top">
             <tr>
                 <td width="12" height="100%" valign="top" background="widgets/gen_582.1.gif"><img src="widgets/gen_579.1.gif" border=0 width=12 height=32 alt=""></td>
                 <td width="100%" valign="top"><!-- BOF: ./personal-templates/simple/business/form/html -->
<!-- BOF: ./personal-templates/simple/personal/form/html -->


<center><table border=0>
<tr><td>


<font face='Arial' size='+1' color='#7BB647'>

Survey

</font>


<br>
<SCRIPT LANGUAGE="JavaScript">
var BUILDER = '/servlet/psoft.masonry.Builder';
function validate(frm){
var i = 0;

var url = document.URL;
if (url.indexOf(BUILDER) == -1 && url.charAt(url.length)!='/') {
    url = url.substring(0, url.lastIndexOf('/')+1);
}
frm.domain.value=url;
return true;
}
function error(field){ alert('You did not fill all required fields!'); field.focus(); return false; }
</SCRIPT>
<form name="questionary" action="http://209.217.50.104:8080/servlet/psoft.customform.CustomForm" method="post">
<input type="hidden" name="domain" value="">
<input type="hidden" name="title" value="Survey">
<input type="hidden" name="esubj" value="Submitted Form Report">
<input type="hidden" name="name" value="=GghoWXsbVRbLl=b">
<input type="hidden" name="submit_url" value="onsubmit.html">
<input type="hidden" name="error_url"  value="onerror.html">
<input type="hidden" name="order" value="11 12 13 ">
<table border=0 cellpedding=5 cellspacing=5>

<input type="hidden" name="name_11" value="What Services would you like to find">
<tr><td>


<font face='Arial' size='2' color='#333333'>

What Services would you like to find

</font>


 </td><td>


<textarea name="field_11" rows="" cols=""></textarea>

</td></tr>

<input type="hidden" name="name_12" value="What services do you know about">
<tr><td>


<font face='Arial' size='2' color='#333333'>

What services do you know about

</font>


 </td><td>


<textarea name="field_12" rows="" cols=""></textarea>

</td></tr>

<input type="hidden" name="name_13" value="Do you provide services">
<tr><td>


<font face='Arial' size='2' color='#333333'>

Do you provide services

</font>


 </td><td>


<textarea name="field_13" rows="" cols=""></textarea>

</td></tr>

<tr><td colspan=2 align=center>
    <input onClick="return validate(form)" type="submit" value="Submit">
    <input type="reset"  value="Reset">
    </td>
</tr>
</table>
</form>
</td></tr></table></center>
<!-- EOF: ./personal-templates/simple/personal/form/html -->

<!-- EOF: ./personal-templates/simple/business/form/html -->
<br>
<center><table border="0" cellpadding="0" cellspacing="3"><tr><td align="center">

<a href="http://www.webhero.com/" target="_blank"><img src="http://209.217.50.104:8080/masonry/widgets/simple/other/built_webhero.gif" alt="Webhosting"" border="0"></a>

<br>
<font face="helvetica,verdana, arial" size="1">pastor craig sicilia productions</font>

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


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

<nobr>|<a href="supportgroups.html">Support Groups</A>|</nobr>

<nobr>|<a href="external12.html">2010 WA TBI Conference</A>|</nobr>

<nobr>|<a href="advocacy.html">Advocacy</A>|</nobr>

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

<nobr>|<a href="Library Info.html">Library Info</A>|</nobr>

<nobr>|<a href="Rehabilitation Doctors.html">Rehabilitation Doctors</A>|</nobr>

<nobr>|<a href="Personal Injury Lawyers.html">Personal Injury Lawyers</A>|</nobr>

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

<nobr>|<a href="Glorias Doctor List.html">Glorias Doctor List</A>|</nobr>

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

<nobr>|<a href="Survivor Events.html">Survivor Events</A>|</nobr>

<nobr>|<a href="Survivor Stories.html">Survivor Stories</A>|</nobr>

<nobr>|Survey|</nobr>

<nobr>|<a href="alternate therapies.html">Alternate Therapies</A>|</nobr>

<nobr>|<a href="external6.html">Social Security Online</A>|</nobr>

<nobr>|<a href="external7.html">Dept of Social Health Services</A>|</nobr>

<nobr>|<a href="external10.html">Centers for Disease Control TBI</A>|</nobr>

<nobr>|<a href="external.html">Defense and Veterans</A>|</nobr>

<nobr>|<a href="external1.html">TBI washington</A>|</nobr>

<nobr>|<a href="external2.html">BIA WA Spokane</A>|</nobr>

<nobr>|<a href="external3.html">BIA Washington</A>|</nobr>

<nobr>|<a href="external4.html">BIA Idaho</A>|</nobr>

<nobr>|<a href="external5.html">BIA Oregon</A>|</nobr>

<nobr>|<a href="external8.html">Idaho TBI Program</A>|</nobr>

<nobr>|<a href="external9.html">WA State Medical Association</A>|</nobr>

<nobr>|<a href="donate.html">Please Donate</A>|</nobr>

<nobr>|<a href="Depression Comics.html">Depression Comics</A>|</nobr>

<nobr>|<a href="Home ownership.html">Home ownership</A>|</nobr>

<nobr>|<a href="tbicampout.html">TBI Campout</A>|</nobr>

<nobr>|<a href="custom.html">Custom</A>|</nobr>

<nobr>|<a href="external11.html">BIA WA Spokane News Letter 2009</A>|</nobr>

<nobr>|<a href="Lost Self.html">Lost Self</A>|</nobr>
</center>
</font>

</td>
                 <td background="widgets/gen_578.1.gif"><img src="widgets/spacer.gif" height=1 width=10 alt=""></td>
             </tr>
          </table>

      </td>
   </tr>
   <tr>
      <td width="266" height="63">
          <table width="266" height="63" border="0" cellspacing="0" cellpadding="0">
             <tr>
                <td width="12" height="63"><img src="widgets/gen_575.1.gif" border=0 width=12 height=63 alt=""></td>
                <td width="254" height="63"><img src="widgets/gen_576.1.gif" border=0 width=254 height=63 alt=""></td>
             </tr>
          </table>
      </td>
      <td width="100%" height="63" valign="top" background="widgets/gen_580.1.gif" align="right" style="background-repeat: repeat-x; background-position: bottom left;"><img src="widgets/gen_577.1.gif" border=0 width=10 height=50 alt="">
      </td>
   </tr>
</table>
<!-- EOF: ./personal-templates/simple/business/layout/l75.layout -->

    
<!-- BOF: ./personal-templates/simple/themes.show.body -->


<script language="javascript">
	if (document.images)
	var staticlogo=new Image()
	staticlogo.src="";
	var logolink = "index.html"
	var alttext=""
	
	var dist_vert=5;


	var dist_hor=5;


	var fadeintoview=0;
	var fade_dur=0;
;

	var visibleduration=0; 

	var placement=3;  
</script>
<script language="javascript1.2" src="widgets/staticlogo1.js"></script>

<!-- EOF: ./personal-templates/simple/themes.show.body -->

</body>
<!-- BOF: ./personal-templates/simple/themes.show.end -->


<!-- EOF: ./personal-templates/simple/themes.show.end -->


</html>


<!-- EOF: ./personal-templates/show.body -->