<div style="background-image: url(http://www.jobtrainworks.org/wp-content/uploads/2018/04/WinterScene_3.jpg); padding:20px 300px; background-size:cover"><h2 style="text-align:center">Resource Center</h2> <br /> <form autocomplete="off" action="https://webto.salesforce.com/servlet/servlet.WebToLead?encoding=UTF-8" method="POST" ><input type=hidden name="oid" value="00D36000000q3Yo"><input type=hidden name="retURL" value="http://www.jobtrainworks.org/resource-center/"/><input type=hidden name="recordType" value="01236000001Ya1s"> <b><font size="14" ><Center>Sign In for Resource Center</Center></font></b>
<Center>
<tr><td><font size="5" > <b><label for="first_name">First Name </label></td><td><input id="first_name" maxlength="80" name="first_name" size="20" type="text" /></td></tr></b></font> <br> <br>
<tr><td><font size="5" ><b><label for="last_name">Last Name </label></td><td><input id="last_name" maxlength="80" name="last_name" size="20" type="text" /></td></tr></b></font> <br> <br>
<tr><td><font size="5" ><b><label for="phone">Phone </label></td><td><input id="phone" maxlength="80" name="phone" size="20" type="text" /></td></tr></b></font> <br> <br>
<tr><td><font size="5" ><b><label for="email">Email </label></td><td><input id="email" maxlength="80" name="email" size="20" type="text" /></td></tr></b></font> <br> <br>
<tr><td><font size="5" ><b><label for="city">City </label></td><td><input id="city" maxlength="80" name="city" size="20" type="text" /></td></tr></b></font><br>
<tr><td><font size="5" ><b><label for="Purpose">Purpose </label> </td><td>
<select id="00N3600000Sw1x6" name="00N3600000Sw1x6" style="width: 170px ;">
<option value="Use of Facility">Use of Facility</option>
<option value="Sign up for workshop">Sign up for workshop</option>
<option value="Register for a class">Register for a class</option>
</select></b></font></td></center>
<Center><input type="submit" name="submit"></Center>
<div id="error_message" class="ajax_response" style="float:left"></div>
<div id="success_message" class="ajax_response" style="float:left"></div>
</form>
</div>