<!-- NOTICE - this template MUST be in a table format to function properly -->
{START_FORM}
{INSTRUCTION}<br /><br />
<table cellpadding="5" cellspacing="0" width="50%">
<tr class="bg_dark"><td colspan="2">{ADDITEM}<hr /></td></tr>
<tr class="bg_medium"><td width="80%">{TITLE_LABEL}</td><td width="20%" align="center">{ADD_LABEL}</td></tr>
{CURRENT_ITEMS}
</table>
<br />
{SUBMIT}
{END_FORM}
