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<form action="http://sanders.enews.senate.gov/mail/util.cfm?mailaction=profile" method="POST" onsubmit="return checkSubmit();" name="form1"> 
 
<div id="primary"> 
	<h1>BERNIE BUZZ SUBSCRIPTION</h1> 
    
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	<div id="contact-content"> 
   Please fill out the following form and we will send you an email for confirmation.

<p><strong>Subscribe To:</strong></p> 
				
                
                	<div>
					<input type="checkbox" id="447" class="checkbox" name="custom_attribs" value="447">
					<label for="447">The Bernie Buzz</label>: Updates on issues facing our nation<br>
				</div>
				<div>
					<input type="checkbox" id="448" class="checkbox" name="custom_attribs" value="448">
					<label for="448">The Vermont Bernie Buzz</label>: Updates on issues important to Vermonters<br>
				</div>
			<br>
         
          <p><strong> 
            <label for="leg e-mail updates"> </label> 
            </strong>Please check the issue updates below 
            that you would like to receive.</p> 
<input type="hidden" id="listids" name="listids" value="430,15,449,274,431,450,272,432,433,26,434,435,28,30,436,451,437,438,439,269,441,442,447,448,443,444,445,452,446">
        
         <div style="float:left; max-width:250px;">
         
		 		<div>
					<input type="checkbox" id="272" class="checkbox" name="custom_attribs" value="272">
					<label for="272">Deficit Reduction</label><br>
				</div>
				
                <div>
					<input type="checkbox" id="442" class="checkbox" name="custom_attribs" value="442">
					<label for="442">The Economy and Jobs</label><br>
				</div>
                
                <div>
					<input type="checkbox" id="445" class="checkbox" name="custom_attribs" value="445">
					<label for="445">Wall Street and the Financial Sector</label><br>
				</div>
                
                <div>
					<input type="checkbox" id="451" class="checkbox" name="custom_attribs" value="451">
					<label for="451">Medicaid and Medicare</label><br>
				</div>
                
                <div>
					<input type="checkbox" id="433" class="checkbox" name="custom_attribs" value="433">
					<label for="433">Environmental Concerns</label><br>
				</div>
		 		
				<div>
					<input type="checkbox" id="452" class="checkbox" name="custom_attribs" value="452">
					<label for="452">Women's Issues</label><br>
				</div>
			
				<div>
					<input type="checkbox" id="431" class="checkbox" name="custom_attribs" value="431">
					<label for="431">Civil Rights</label><br>
				</div>
                
				<div>
					<input type="checkbox" id="434" class="checkbox" name="custom_attribs" value="434">
					<label for="434">GLBT Issues</label><br>
				</div>

<div>
					<input type="checkbox" id="432" class="checkbox" name="custom_attribs" value="432">
					<label for="432">Education</label><br>
				</div>
            
				<div>
					<input type="checkbox" id="450" class="checkbox" name="custom_attribs" value="450">
					<label for="450">Defense and National Security</label><br>
				</div>
             
				<div>
					<input type="checkbox" id="436" class="checkbox" name="custom_attribs" value="436">
					<label for="436">Media, Internet, and Telecommunications</label><br>
				</div>
                
				<div>
					<input type="checkbox" id="449" class="checkbox" name="custom_attribs" value="449">
					<label for="449">Arts and Humanities</label><br>
				</div>
        
			<div>
					<input type="checkbox" id="437" class="checkbox" name="custom_attribs" value="437">
					<label for="437">Pharmaceuticals, Nutrition and Food Safety</label><br>
				</div>
        	
				<div>
					<input type="checkbox" id="30" class="checkbox" name="custom_attribs" value="30">
					<label for="30">Housing</label><br>
				</div>
               
			</div>
            
			<div style="float:right;max-width:250px;">			
	
    
				<div>
					<input type="checkbox" id="269" class="checkbox" name="custom_attribs" value="269">
					<label for="269">Social Security</label><br>
				</div>
                
				<div>
					<input type="checkbox" id="439" class="checkbox" name="custom_attribs" value="439">
					<label for="439">Small Business</label><br>
				</div>
    
				<div>
					<input type="checkbox" id="28" class="checkbox" name="custom_attribs" value="28">
					<label for="28">Health Care</label><br>
				</div>
                
				<div>
					<input type="checkbox" id="435" class="checkbox" name="custom_attribs" value="435">
					<label for="435">Global Warming and Energy</label><br>
				</div>
    
				<div>
					<input type="checkbox" id="446" class="checkbox" name="custom_attribs" value="446">
					<label for="446">Worker's Rights, Unions, and International Trade Issues</label><br>
				</div>

<div>
					<input type="checkbox" id="430" class="checkbox" name="custom_attribs" value="430">
					<label for="430">Agriculture</label><br>
				</div>
                
				<div>
					<input type="checkbox" id="274" class="checkbox" name="custom_attribs" value="274">
					<label for="274">Citizens United, Campaign Finance and Electoral Reform</label><br>
				</div>
                
				<div>
					<input type="checkbox" id="444" class="checkbox" name="custom_attribs" value="444">
					<label for="444">Veterans</label><br>
				</div>
                
				<div>
					<input type="checkbox" id="26" class="checkbox" name="custom_attribs" value="26">
					<label for="26">Foreign Policy</label><br>
				</div>
                   
				<div>
					<input type="checkbox" id="438" class="checkbox" name="custom_attribs" value="438">
					<label for="438">Senior Issues</label><br>
				</div>
                
				<div>
					<input type="checkbox" id="441" class="checkbox" name="custom_attribs" value="441">
					<label for="441">Sportsmen Issues</label><br>
				</div>
                
				<div>
					<input type="checkbox" id="443" class="checkbox" name="custom_attribs" value="443">
					<label for="443">Transportation and Infrastructure</label><br>
				</div>
                
				<div>
					<input type="checkbox" id="15" class="checkbox" name="custom_attribs" value="15">
					<label for="15">Animal Rights</label><br>
				</div>
                
			</div>
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    </p><p><a href="http://sanders.enews.senate.gov//common/mailings/"><img src="http://sanders.senate.gov/graphics/buzzbanner240.jpg" border="0">  
<strong> READ PAST ISSUES</strong></a>  
    </p>
    <p>To view the current issue of the Vermont edition of the BERNIE BUZZ, <strong><a href="http://sanders.senate.gov/vermont/">click here</a>.</strong></p><strong>
    <table border="0" align="center" cellpadding="0" cellspacing="0"> 
      <tbody><tr> 
              <td>First Name:</td> 
              <td> 
                <input type="text" id="FIRSTNAME" name="FIRSTNAME" value="">
                </td> 
            </tr> 
            <tr> 
              <td>Last Name:</td> 
              <td> 
                <input type="text" id="LASTNAME" name="LASTNAME" value=""> 
                </td> 
            </tr> 
            <tr>
            	<td>Address:</td>
                <td>
                  <input type="text" id="RES_FULLADDRESS" name="RES_FULLADDRESS" value="">
				</td>
            </tr>
            <tr> 
              <td>City:</td> 
              <td> 
                <input type="text" id="RES_CITY" name="RES_CITY" value="">
              </td> 
            </tr> 
             <tr> 
              <td>State:</td> 
              <td> 
                <input type="text" id="RES_STATE" name="RES_STATE" value="">
              </td> 
            </tr> 
            <tr> 
              <td>Zip:</td> 
              <td> 
                <input type="text" id="RES_ZIP" name="RES_ZIP" value=""> 
                </td> 
            </tr> 
              <tr> 
              <td>Home Phone:</td> 
              <td> 
                <input type="text" id="HOMEPHONE" name="HOMEPHONE" value="">
              </td> 
            </tr> 
           <tr> 
              <td><p> </p> 
                <p><font color="red">* </font>E-Mail Address:</p></td> 
              <td> <label for="subscribe e-mail"> 
						<input type="text" id="EMAIL" name="EMAIL" value="">
                      </label></td> 
            </tr>
            <tr>
            	<td colspan="2" align="right">
            		<input type="submit" name="submitprofile" value="Submit">
            	</td>
        </tr></tbody></table>

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