tag:blogger.com,1999:blog-61499746129651163912024-02-08T09:01:34.597-08:00Reservas Kamakhya TantraUnknownnoreply@blogger.comBlogger28125tag:blogger.com,1999:blog-6149974612965116391.post-2217915918552009522012-03-07T14:19:00.005-08:002012-03-07T15:19:08.723-08:00Marcaçao em Lisboa<form id="emf-form" enctype="multipart/form-data" method="post" action="http://www.emailmeform.com/builder/form/646640"><table style="text-align:left;" cellpadding="2" cellspacing="0" border="0" bg=""><tbody><tr><td style="" colspan="2"><span>Por favor recheie todos os afastados com *<br /><br /></span></td></tr><tr valign="top"><td style="" align="left"><span><b>Nome</b></span><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_0" name="element_0" value="" class="validate[required]" type="text"><div style="padding-bottom:8px;color:#000000;"><small><span></span></small></div></td></tr><tr valign="top"><td style="" align="left"><span><b>Email</b></span><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_1" name="element_1" class="validate[required,custom[email]]" value="" size="60" type="text"><br /><br /></td></tr><tr valign="top"><td style="" align="left"><span><b>Telefone</b></span><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_2" name="element_2" class="validate[required,custom[onlyNumber]]" value="" type="text"><div style="padding-bottom:8px;color:#000000;"><small><span></span></small></div></td></tr><tr valign="top"><td style="" align="left"><b>Localidade<span>*</span></b></td><td style=""><input id="element_3" name="element_3" value="" class="validate[required]" type="text"><div style="padding-bottom:8px;color:#000000;"><small><span></span></small></div></td></tr><tr valign="top"><td style="" align="left"><span><b>Centro de Terapias</b></span><span style="color:red;"><small>*</small></span></td><td style=""><div style="width:100%;padding-bottom:5px;"><input id="element_4_0" name="element_4[]" value="Lisboa" class="validate[required]" type="checkbox"><span> Lisboa </span><input id="element_4_1" name="element_4[]" value="Vigo" class="validate[required]" type="checkbox"><span style="font-size: 100%; "> Vigo</span></div><div style="width:100%;padding-bottom:5px;"></td></tr><tr valign="top"><td style="" align="left"><b>Terapeutas</b><span style="color:red;"><small>*</small></span></div></td><td style=""><div style="width:100%;padding-bottom:5px;"><input id="element_4_0" name="element_4[]" value="Terapeuta Homem" class="validate[required]" type="checkbox"><span> Terapeuta Homem </span></div><div style="width:100%;padding-bottom:5px;"><input id="element_4_1" name="element_4[]" value="Terapeuta Mulher" class="validate[required]" type="checkbox"><span> Terapeuta Mulher </span></div><div style="width:100%;padding-bottom:5px;"><input id="element_4_2" name="element_4[]" value="Terapeutas Mulher e Mulher" class="validate[required]" type="checkbox"><span> Terapeutas Mulher e Mulher </span></div><div style="width:100%;padding-bottom:5px;"><input id="element_4_3" name="element_4[]" value="Terapeutas Homem e Mulher" class="validate[required]" type="checkbox"><span> Terapeutas Homem e Mulher </span></div><div style="width:100%;padding-bottom:5px;"><input id="element_4_1" name="element_4[]" value="Terapeutas Homem e Homem" class="validate[required]" type="checkbox"><span> Terapeutas Homem e Homem </span></div><div style="clear:both;"></div><div style="padding-bottom:8px;color:#000000;"><small><span></span></small></div></td></tr><tr valign="top"><td style="" align="left"><span><b>Tipo de Massagem</b></span><span style="color:red;"><small>*</small></span></td><td style=""><select id="element_5" name="element_5" class="validate[required]"><option value="" selected="selected"> Selecione </option><option value=" Tantra Individual para Mulher em marquesa"> Tantra Individual para Mulher em marquesa</option><option value="Tantra Individual para Mulher em Tatami">Tantra Individual para Mulher em Tatami</option><option value="Tantra quatro mãos para Mulher">Tantra quatro mãos para Mulher</option><option value=" Tantra Vamacara para Mulher"> Tantra Vamacara para Mulher</option><option value="Tantra Fusion para Mulher">Tantra Fusion para Mulher</option><option value="Kamakhya Mixto para Mulher">Kamakhya Mixto para Mulher</option><option value="Massagem Mandala para Mulher">Massagem Mandala para Mulher</option><option value="Tantra Individual para Homem em marquesa">Tantra Individual para Homem em marquesa</option><option value="Tantra Individual para Homem em tatami">Tantra Individual para Homem em tatami</option><option value="Tantra quatro mãos para Homem">Tantra quatro mãos para Homem</option><option value=" Tantra Vamacara para Homem"> Tantra Vamacara para Homem</option><option value="Tantra Fusion para Homem com terapeuta Homem">Tantra Fusion para Homem com terapeuta Homem</option><option value="Kamakhya Mixto para Homem">Kamakhya Mixto para Homem</option><option value="Massagem Mandala para Homem">Massagem Mandala para Homem</option><option value="Tantra Casais na mesma sala">Tantra Casais na mesma sala</option><option value="Tantra Casais em salas separadas">Tantra Casais em salas separadas</option><option value="Massagem quatro mãos para Casais">Massagem quatro mãos para Casais</option><option value="Ritual dos Sentidos para Casais">Ritual dos Sentidos para Casais</option><option value="Massagem Kamakhya para Casais com terapeuta Homem">Massagem Kamakhya para Casais com terapeuta Homem</option><option value="Massagem Kamakhya para Casais com terapeuta Mulher">Massagem Kamakhya para Casais com terapeuta Mulher</option><option value="Massagem Mandala para Casais">Massagem Mandala para Casais</option><option value="Massagem Luxury para Casais com terapeuta Homem">Massagem Luxury para Casais com terapeuta Homem</option><option value="Massagem Luxury para Casais com terapeuta Mulher">Massagem Luxury para Casais com terapeuta Mulher</option><option value="Massagem Luxury para Casais con terapeutas Mulher e Homem">Massagem Luxury para Casais con terapeutas Mulher e Homem</option></select><div style="padding-bottom:8px;color:#000000;"><small><span></span></small></div></td></tr><tr valign="top"><td style="" align="left"><span><b>Data Marcaçao</b></span><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_6" name="element_6" value="" class="validate[required]" type="text"><div style="padding-bottom:8px;color:#000000;"><small><span>Completar ( dia/mes/ano )</span></small></div></td></tr><tr valign="top"><td style="" align="left"><span><b>Hora</b></span><span style="color:red;"><small>*</small></span></td><td style=""><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_0" name="element_7" value="11:00" class="validate[required]" type="radio"><span> 11:00 </span></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_1" name="element_7" value="11:30" class="validate[required]" type="radio"><span> 11:30 </span></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_2" name="element_7" value="12:00" class="validate[required]" type="radio"><span> 12:00 </span></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_3" name="element_7" value="12:30" class="validate[required]" type="radio"><span> 12:30 </span></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_4" name="element_7" value="16:30" class="validate[required]" type="radio"><span> 16:30 </span></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_5" name="element_7" value="17:00" class="validate[required]" type="radio"><span> 17:00 </span></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_6" name="element_7" value="17:30" class="validate[required]" type="radio"><span> 17:30 </span></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_7" name="element_7" value="18:00" class="validate[required]" type="radio"><span> 18:00 </span></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_8" name="element_7" value="18:30" class="validate[required]" type="radio"><span> 18:30 </span></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_9" name="element_7" value="19:00" class="validate[required]" type="radio"><span> 19:00 </span></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_10" name="element_7" value="19:30" class="validate[required]" type="radio"><span> 19:30 </span></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_11" name="element_7" value="20:00" class="validate[required]" type="radio"><span> 20:00 </span></div><div style="clear:both;"></div><div style="padding-bottom:8px;color:#000000;"><small><span>Horario Portugal</span></small></div></td></tr><tr valign="top"><td style="" align="left"><span><b>Comentarios</b></span><span style="color:red;"><small></small></span></td><td style=""><textarea id="element_8" name="element_8" cols="60" rows="5" class="validate[optional] "></textarea><div style="padding-bottom:8px;color:#000000;"><small><span></span></small></div></td></tr><tr><td colspan="2" align="right"><input name="element_counts" value="9" type="hidden"><input value="Enviar email" type="submit"><input value="Clear" type="reset"></td></tr></tbody></table></form><div><span>Powered by</span><span style="position: relative; padding-left: 3px; bottom: -5px;"><img src="http://www.emailmeform.com/builder/images/footer-logo.png" /></span><span>EMF </span><a style="text-decoration:none;" href="http://www.emailmeform.com/" target="_blank"><span>Web Form</span></a></div>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-6149974612965116391.post-14972674471575384782010-10-11T05:07:00.000-07:002011-11-16T09:13:04.199-08:00Sessões Privadas<form id="emf-form" enctype="multipart/form-data" method="post" action="http://www.emailmeform.com/builder/form/n6hkCa6Dv9dQl1NuH"><table style="text-align:left;" cellpadding="2" cellspacing="0" border="0" bg=""><tbody><tr><td style="" colspan="2"><span><b style="font-size:20px;">Marcaçao Psicoterapia Sexual para Casal</b><br /><label style="font-size:15px;">Rechei todos os afastados<br /></label><br /></span></td></tr><tr valign="top"><td style="" align=""><span><b>Nome</b></span><span style="color:red;"><small>*</small></span></td></tr><tr><td style=""><input id="element_0" name="element_0" value="" class="validate[required]" type="text"><div style="padding-bottom:8px;color:#000000;"><small><span></span></small></div></td></tr><tr valign="top"><td style="" align=""><span><b>Nome</b></span><span style="color:red;"><small>*</small></span></td></tr><tr><td style=""><input id="element_1" name="element_1" value="" class="validate[required]" type="text"><div style="padding-bottom:8px;color:#000000;"><small><span></span></small></div></td></tr><tr valign="top"><td style="" align=""><span><b>Email</b></span><span style="color:red;"><small>*</small></span></td></tr><tr><td style=""><input id="element_2" name="element_2" class="validate[required,custom[email]]" value="" type="text"></td></tr><tr valign="top"><td style="" align=""></td></tr><tr valign="top"><td style="" align=""><b><br />Telefone</b><span style="color:red;"><small>*</small></span></td></tr><tr><td style=""><input id="element_3" name="element_3" class="validate[required,custom[telephone]]" value="" type="text"><div style="padding-bottom:8px;color:#000000;"><small><span></span></small></div></td></tr><tr valign="top"><td style="" align=""><span><b>Data da Terapia</b></span><span style="color:red;"><small>*</small></span></td></tr><tr><td style=""><input id="element_4" name="element_4" value="" class="validate[required]" type="text"><div style="padding-bottom:8px;color:#000000;"><small><span>( dia/mes/ano )</span></small></div></td></tr><tr valign="top"><td style="" align=""><span><b>Hora Seleccionada ( hora Espanha )</b></span><span style="color:red;"><small>*</small></span></td></tr><tr><td style=""><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_5_0" name="element_5" value="10:00" class="validate[required]" type="radio"><span> 10:00 </span></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_5_1" name="element_5" value="10:30" class="validate[required]" type="radio"><span> 10:30 </span></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_5_2" name="element_5" value="16:30" class="validate[required]" type="radio"><span> 16:30 </span></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_5_3" name="element_5" value="17:00" class="validate[required]" type="radio"><span> 17:00 </span></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_5_4" name="element_5" value="17:30" class="validate[required]" type="radio"><span> 17:30 </span></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_5_5" name="element_5" value="18:00" class="validate[required]" type="radio"><span> 18:00 </span></div><div style="clear:both;"></div><div style="padding-bottom:8px;color:#000000;"><small><span></span></small></div></td></tr><tr valign="top"><td style="" align=""><span><b>Que nos interessa desta Terapia</b></span><span style="color:red;"><small>*</small></span></td></tr><tr><td style=""><textarea id="element_6" name="element_6" cols="60" rows="10" class="validate[required] "></textarea><div style="padding-bottom:8px;color:#000000;"><small><span>Teus comentarios</span></small></div></td></tr><tr><td colspan="2" align="right"><input name="element_counts" value="7" type="hidden"><input value="Enviar" type="submit"><input value="Clear" type="reset"></td></tr></tbody></table></form><div><span>Powered by</span><span style="position: relative; padding-left: 3px; bottom: -5px;"><img src="http://www.emailmeform.com/builder/images/footer-logo.png" /></span><span>EMF </span><a style="text-decoration:none;" href="http://www.emailmeform.com/" target="_blank"><span>Web Form</span></a></div>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-6149974612965116391.post-86202925471355789432010-10-11T03:57:00.001-07:002012-03-07T14:19:26.016-08:00Marcaçao Massagem<form id="emf-form" enctype="multipart/form-data" method="post" action="http://www.emailmeform.com/builder/form/646640"><table style="text-align:left;" cellpadding="2" cellspacing="0" border="0" bg=""><tbody><tr><td style="" colspan="2"><span>Por favor recheie todos os afastados com *<br /><br /></span></td></tr><tr valign="top"><td style="" align="left"><span><b>Nome</b></span><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_0" name="element_0" value="" class="validate[required]" type="text"><div style="padding-bottom:8px;color:#000000;"><small><span></span></small></div></td></tr><tr valign="top"><td style="" align="left"><span><b>Email</b></span><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_1" name="element_1" class="validate[required,custom[email]]" value="" size="60" type="text"><br /><br /></td></tr><tr valign="top"><td style="" align="left"><span><b>Telefone</b></span><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_2" name="element_2" class="validate[required,custom[onlyNumber]]" value="" type="text"><div style="padding-bottom:8px;color:#000000;"><small><span></span></small></div></td></tr><tr valign="top"><td style="" align="left"><span><b>Localidade</b></span><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_3" name="element_3" value="" class="validate[required]" type="text"><div style="padding-bottom:8px;color:#000000;"><small><span></span></small></div></td></tr><tr valign="top"><td style="" align="left"><span><b>Terapeutas</b></span><span style="color:red;"><small>*</small></span></td><td style=""><div style="width:100%;padding-bottom:5px;"><input id="element_4_0" name="element_4[]" value="Terapeuta Homem" class="validate[required]" type="checkbox"><span> Terapeuta Homem </span></div><div style="width:100%;padding-bottom:5px;"><input id="element_4_1" name="element_4[]" value="Terapeuta Mulher" class="validate[required]" type="checkbox"><span> Terapeuta Mulher </span></div><div style="width:100%;padding-bottom:5px;"><input id="element_4_2" name="element_4[]" value="Terapeutas Mulher e Mulher" class="validate[required]" type="checkbox"><span> Terapeutas Mulher e Mulher </span></div><div style="width:100%;padding-bottom:5px;"><input id="element_4_3" name="element_4[]" value="Terapeutas Homem e Mulher" class="validate[required]" type="checkbox"><span> Terapeutas Homem e Mulher </span></div><div style="width:100%;padding-bottom:5px;"><input id="element_4_1" name="element_4[]" value="Terapeutas Homem e Homem" class="validate[required]" type="checkbox"><span> Terapeutas Homem e Homem </span></div><div style="clear:both;"></div><div style="padding-bottom:8px;color:#000000;"><small><span></span></small></div></td></tr><tr valign="top"><td style="" align="left"><span><b>Tipo de Massagem</b></span><span style="color:red;"><small>*</small></span></td><td style=""><select id="element_5" name="element_5" class="validate[required]"><option value="" selected="selected"> Selecione </option><option value=" Tantra Individual para Mulher em marquesa"> Tantra Individual para Mulher em marquesa</option><option value="Tantra Individual para Mulher em Tatami">Tantra Individual para Mulher em Tatami</option><option value="Tantra quatro mãos para Mulher">Tantra quatro mãos para Mulher</option><option value=" Tantra Vamacara para Mulher"> Tantra Vamacara para Mulher</option><option value="Tantra Fusion para Mulher">Tantra Fusion para Mulher</option><option value="Kamakhya Mixto para Mulher">Kamakhya Mixto para Mulher</option><option value="Massagem Mandala para Mulher">Massagem Mandala para Mulher</option><option value="Tantra Individual para Homem em marquesa">Tantra Individual para Homem em marquesa</option><option value="Tantra Individual para Homem em tatami">Tantra Individual para Homem em tatami</option><option value="Tantra quatro mãos para Homem">Tantra quatro mãos para Homem</option><option value=" Tantra Vamacara para Homem"> Tantra Vamacara para Homem</option><option value="Tantra Fusion para Homem com terapeuta Homem">Tantra Fusion para Homem com terapeuta Homem</option><option value="Kamakhya Mixto para Homem">Kamakhya Mixto para Homem</option><option value="Massagem Mandala para Homem">Massagem Mandala para Homem</option><option value="Tantra Casais na mesma sala">Tantra Casais na mesma sala</option><option value="Tantra Casais em salas separadas">Tantra Casais em salas separadas</option><option value="Massagem quatro mãos para Casais">Massagem quatro mãos para Casais</option><option value="Ritual dos Sentidos para Casais">Ritual dos Sentidos para Casais</option><option value="Massagem Kamakhya para Casais com terapeuta Homem">Massagem Kamakhya para Casais com terapeuta Homem</option><option value="Massagem Kamakhya para Casais com terapeuta Mulher">Massagem Kamakhya para Casais com terapeuta Mulher</option><option value="Massagem Mandala para Casais">Massagem Mandala para Casais</option><option value="Massagem Luxury para Casais com terapeuta Homem">Massagem Luxury para Casais com terapeuta Homem</option><option value="Massagem Luxury para Casais com terapeuta Mulher">Massagem Luxury para Casais com terapeuta Mulher</option><option value="Massagem Luxury para Casais con terapeutas Mulher e Homem">Massagem Luxury para Casais con terapeutas Mulher e Homem</option></select><div style="padding-bottom:8px;color:#000000;"><small><span></span></small></div></td></tr><tr valign="top"><td style="" align="left"><span><b>Data Marcaçao</b></span><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_6" name="element_6" value="" class="validate[required]" type="text"><div style="padding-bottom:8px;color:#000000;"><small><span>Completar ( dia/mes/ano )</span></small></div></td></tr><tr valign="top"><td style="" align="left"><span><b>Hora</b></span><span style="color:red;"><small>*</small></span></td><td style=""><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_0" name="element_7" value="11:00" class="validate[required]" type="radio"><span> 11:00 </span></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_1" name="element_7" value="11:30" class="validate[required]" type="radio"><span> 11:30 </span></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_2" name="element_7" value="12:00" class="validate[required]" type="radio"><span> 12:00 </span></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_3" name="element_7" value="12:30" class="validate[required]" type="radio"><span> 12:30 </span></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_4" name="element_7" value="16:30" class="validate[required]" type="radio"><span> 16:30 </span></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_5" name="element_7" value="17:00" class="validate[required]" type="radio"><span> 17:00 </span></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_6" name="element_7" value="17:30" class="validate[required]" type="radio"><span> 17:30 </span></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_7" name="element_7" value="18:00" class="validate[required]" type="radio"><span> 18:00 </span></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_8" name="element_7" value="18:30" class="validate[required]" type="radio"><span> 18:30 </span></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_9" name="element_7" value="19:00" class="validate[required]" type="radio"><span> 19:00 </span></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_10" name="element_7" value="19:30" class="validate[required]" type="radio"><span> 19:30 </span></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_11" name="element_7" value="20:00" class="validate[required]" type="radio"><span> 20:00 </span></div><div style="clear:both;"></div><div style="padding-bottom:8px;color:#000000;"><small><span>Horario Espanha</span></small></div></td></tr><tr valign="top"><td style="" align="left"><span><b>Comentarios</b></span><span style="color:red;"><small></small></span></td><td style=""><textarea id="element_8" name="element_8" cols="60" rows="5" class="validate[optional] "></textarea><div style="padding-bottom:8px;color:#000000;"><small><span></span></small></div></td></tr><tr><td colspan="2" align="right"><input name="element_counts" value="9" type="hidden"><input value="Enviar email" type="submit"><input value="Clear" type="reset"></td></tr></tbody></table></form><div><span>Powered by</span><span style="position: relative; padding-left: 3px; bottom: -5px;"><img src="http://www.emailmeform.com/builder/images/footer-logo.png" /></span><span>EMF </span><a style="text-decoration:none;" href="http://www.emailmeform.com/" target="_blank"><span>Web Form</span></a></div>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-6149974612965116391.post-87884642067186122042010-10-11T03:15:00.001-07:002012-02-07T14:23:13.863-08:00Reservas<form id="emf-form" enctype="multipart/form-data" method="post" action="http://www.emailmeform.com/builder/form/eQbOq6DWS9edudB5XaF8E"><table style="text-align:left;" cellpadding="2" cellspacing="0" border="0" bg=""><tbody><tr><td style="" colspan="2"><span><br /></span></td></tr><tr valign="top"><td style="" align="left"><span><b>Nombre</b></span><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_0" name="element_0" value="" class="validate[required]" type="text"><div style="padding-bottom:8px;color:#000000;"><small><span></span></small></div></td></tr><tr valign="top"><td style="" align="left"><span><b>Email</b></span><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_1" name="element_1" class="validate[required,custom[email]]" value="" size="60" type="text"><br /><br /></td></tr><tr valign="top"><td style="" align="left"><span><b>Telefono</b></span><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_2" name="element_2" class="validate[required,custom[telephone]]" value="" type="text"><div style="padding-bottom:8px;color:#000000;"><small><span></span></small></div></td></tr><tr valign="top"><td style="" align="left"><span><b>Localidad</b></span><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_3" name="element_3" value="" class="validate[required]" type="text"><div style="padding-bottom:8px;color:#000000;"><small><span></span></small></div></td></tr><tr valign="top"><td style="" align="left"><span><b>Terapeuta</b></span><span style="color:red;"><small>*</small></span></td><td style=""><div style="width:100%;padding-bottom:5px;"><input id="element_4_0" name="element_4" value="Terapeuta Mujer" class="validate[required]" type="radio"><span> Terapeuta Mujer </span></div><div style="width:100%;padding-bottom:5px;"><input id="element_4_1" name="element_4" value="Terapeuta hombre" class="validate[required]" type="radio"><span> Terapeuta hombre </span></div><div style="width:100%;padding-bottom:5px;"><input id="element_4_2" name="element_4" value="Terapeutas Mujer y Mujer" class="validate[required]" type="radio"><span> Terapeutas Mujer y Mujer </span></div><div style="width:100%;padding-bottom:5px;"><input id="element_4_3" name="element_4" value="Terapeutas Mujer y Hombre" class="validate[required]" type="radio"><span> Terapeutas Mujer y Hombre </span></div><div style="width:100%;padding-bottom:5px;"><input id="element_4_1" name="element_4[]" value="Terapeutas Hombre y Hombre" class="validate[required]" type="radio"><span> Terapeutas Hombre y Hombre </span></div><div style="clear:both;"></div><div style="padding-bottom:8px;color:#000000;"><small><span></span></small></div></td></tr><tr valign="top"><td style="" align="left"><span><b>Terapia</b></span><span style="color:red;"><small>*</small></span></td><td style=""><select id="element_5" name="element_5" class="validate[required]"><option value="" selected="selected">Seleccionar</option><option value="Tantra Individual para Mujer en Camilla ">Tantra Individual para Mujer en Camilla </option><option value="Tantra Individual para Mujer en Tatami">Tantra Individual para Mujer en Tatami</option><option value="Tantra Cuatro Manos para Mujer">Tantra Cuatro Manos para Mujer</option><option value="Tantra Vamacara para Mujer">Tantra Vamacara para Mujer</option><option value="Tantra Fusion para Mujer">Tantra Fusion para Mujer</option><option value="Kamakhya Mixto para Mujer">Kamakhya Mixto para Mujer</option><option value="Masaje Mandala para Mujer">Masaje Mandala para Mujer</option><option value="Tantra Individual para Hombre en Camilla">Tantra Individual para Hombre en Camilla</option><option value="Tantra Individual para Hombre en Tatami">Tantra Individual para Hombre en Tatami</option><option value="Tantra Cuatro Manos para Hombre">Tantra Cuatro Manos para Hombre</option><option value="Tantra Vamacara para Hombre">Tantra Vamacara para Hombre</option><option value="Tantra Fusion para Hombre con terapeuta Hombre">Tantra Fusion para Hombre con terapeuta Hombre</option><option value="Kamakhya Mixto para Hombre">Kamakhya Mixto para Hombre</option><option value="Masaje Mandala para Hombre">Masaje Mandala para Hombre</option><option value="Tantra Pareja en la misma sala">Tantra Pareja en la misma sala</option><option value="Tantra Pareja en salas separadas">Tantra Pareja en salas separadas</option><option value="Masaje cuatro manos para parejas">Masaje cuatro manos para parejas</option><option value="Ritual de los Sentidos para parejas">Ritual de los Sentidos para parejas</option><option value="Masaje Kamakhya para parejas terapeuta hombre">Masaje Kamakhya para parejas terapeuta hombre</option><option value="Masaje Kamakhya para parejas terapeuta mujer">Masaje Kamakhya para parejas terapeuta mujer</option><option value="Masaje Mandala para parejas">Masaje Mandala para Parejas</option><option value="Masaje Luxury para parejas con terapeuta hombre">Masaje Luxury para parejas con terapeuta hombre</option><option value="Masaje Luxury para parejas con terapeuta mujer">Masaje Luxury para parejas con terapeuta mujer</option><option value="Masaje Luxury para parejas con terapeutas hombre y mujer">Masaje Luxury para parejas con terapeutas hombre y mujer</option></select><div style="padding-bottom:8px;color:#000000;"><small><span></span></small></div></td></tr><tr valign="top"><td style="" align="left"><span><b>Fecha Reserva</b></span><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_6" name="element_6" value="" class="validate[required]" type="text"><div style="padding-bottom:8px;color:#000000;"><small><span>Fecha completa (dia/mes/año)</span></small></div></td></tr><tr valign="top"><td style="" align="left"><span><b>Seleccionar Hora</b></span><span style="color:red;"><small>*</small></span></td><td style=""><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_0" name="element_7" value="11:00" class="validate[required]" type="radio"><span> 11:00 </span></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_1" name="element_7" value="11:30" class="validate[required]" type="radio"><span> 11:30 </span></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_2" name="element_7" value="12:00" class="validate[required]" type="radio"><span> 12:00 </span></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_3" name="element_7" value="12:30" class="validate[required]" type="radio"><span> 12:30 </span></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_4" name="element_7" value="16:30" class="validate[required]" type="radio"><span> 16:30 </span></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_5" name="element_7" value="17:00" class="validate[required]" type="radio"><span> 17:00 </span></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_6" name="element_7" value="17:30" class="validate[required]" type="radio"><span> 17:30 </span></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_7" name="element_7" value="18:00" class="validate[required]" type="radio"><span> 18:00 </span></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_8" name="element_7" value="18:30" class="validate[required]" type="radio"><span> 18:30 </span></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_9" name="element_7" value="19:00" class="validate[required]" type="radio"><span> 19:00 </span></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_10" name="element_7" value="19:30" class="validate[required]" type="radio"><span> 19:30 </span></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_11" name="element_7" value="20:00" class="validate[required]" type="radio"><span> 20:00 </span></div><div style="clear:both;"></div><div style="padding-bottom:8px;color:#000000;"><small><span>Otros horarios consultar en observaciones</span></small></div></td></tr><tr valign="top"><td style="" align="left"><span><b>Observaciones</b></span><span style="color:red;"><small></small></span></td><td style=""><textarea id="element_8" name="element_8" cols="45" rows="10" class="validate[optional] "></textarea><div style="padding-bottom:8px;color:#000000;"><small><span>Rellene todos los apartados marcados con *</span></small></div></td></tr><tr><td colspan="2" align="left"><input name="element_counts" value="9" type="hidden"><input value="Enviar" type="submit"></td></tr></tbody></table></form><div><span>Powered by</span><span style="position: relative; padding-left: 3px; bottom: -5px;"><img src="http://www.emailmeform.com/builder/images/footer-logo.png" /></span><span>EMF </span><a style="text-decoration:none;" href="http://www.emailmeform.com/" target="_blank"><span>PHP FormS</span></a></div>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-6149974612965116391.post-11857321296802735452010-10-10T17:25:00.000-07:002011-11-16T15:10:31.277-08:00Sesiones Privadas para Pareja<form id="emf-form" enctype="multipart/form-data" method="post" action="http://www.emailmeform.com/builder/form/kvL2b080IdxR1K2i3uheA"><table style="text-align:left;" cellpadding="2" cellspacing="0" border="0" bg=""><tbody><tr><td style="" colspan="2"><span><b style="font-size:20px;">Psicoterapia Sexual para Parejas</b><br /><label style="font-size:15px;">Rellene todos los apartados<br /></label><br /></span></td></tr><tr valign="top"><td style="" align=""><span><b>Nombre</b></span><span style="color:red;"><small>*</small></span></td></tr><tr><td style=""><input id="element_0" name="element_0" value="" class="validate[required]" type="text"><div style="padding-bottom:8px;color:#000000;"><small><span></span></small></div></td></tr><tr valign="top"><td style="" align=""><span><b>Nombre</b></span><span style="color:red;"><small>*</small></span></td></tr><tr><td style=""><input id="element_1" name="element_1" value="" class="validate[required]" type="text"><div style="padding-bottom:8px;color:#000000;"><small><span></span></small></div></td></tr><tr valign="top"><td style="" align=""><span><b>Email</b></span><span style="color:red;"><small>*</small></span></td></tr><tr><td style=""><input id="element_2" name="element_2" class="validate[required,custom[email]]" value="" type="text"><div style="padding-bottom:8px;color:#000000;"><small><span></span></small></div></td></tr><tr valign="top"><td style="" align=""><span class="Apple-style-span"><span><small><div style="text-align: left; "><span style="font-size: medium; "><b>Teléfono</b></span><span style="font-size: medium; color: red; "><small>*</small></span></div></small></span></span></td></tr><tr><td style=""><input id="element_3" name="element_3" class="validate[required,custom[telephone]]" value="" type="text"><div style="padding-bottom:8px;color:#000000;"><small><span></span></small></div></td></tr><tr valign="top"><td style="" align=""><span><b>Fecha de la Terapia</b></span><span style="color:red;"><small>*</small></span></td></tr><tr><td style=""><input id="element_4" name="element_4" value="" class="validate[required]" type="text"><div style="padding-bottom:8px;color:#000000;"><small><span>( dia/mes/año )</span></small></div></td></tr><tr valign="top"><td style="" align=""><span><b>Hora Seleccionada</b></span><span style="color:red;"><small>*</small></span></td></tr><tr><td style=""><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_5_0" name="element_5" value="10:00" class="validate[required]" type="radio"><span> 10:00 </span></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_5_1" name="element_5" value="10:30" class="validate[required]" type="radio"><span> 10:30 </span></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_5_2" name="element_5" value="16:30" class="validate[required]" type="radio"><span> 16:30 </span></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_5_3" name="element_5" value="17:00" class="validate[required]" type="radio"><span> 17:00 </span></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_5_4" name="element_5" value="17:30" class="validate[required]" type="radio"><span> 17:30 </span></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_5_5" name="element_5" value="18:00" class="validate[required]" type="radio"><span> 18:00 </span></div><div style="clear:both;"></div><div style="padding-bottom:8px;color:#000000;"><small><span></span></small></div></td></tr><tr valign="top"><td style="" align=""><span><b>Que buscamos con esta terapia</b></span><span style="color:red;"><small>*</small></span></td></tr><tr><td style=""><textarea id="element_6" name="element_6" cols="60" rows="10" class="validate[required] "></textarea><div style="padding-bottom:8px;color:#000000;"><small><span>Indicanos tus comentarios</span></small></div></td></tr><tr><td colspan="2" align="right"><input name="element_counts" value="7" type="hidden"><input value="Enviar" type="submit"><input value="Clear" type="reset"></td></tr></tbody></table></form><div><span>Powered by</span><span style="position: relative; padding-left: 3px; bottom: -5px;"><img src="http://www.emailmeform.com/builder/images/footer-logo.png" /></span><span>EMF </span><a style="text-decoration:none;" href="http://www.emailmeform.com/" target="_blank"><span>Email Form</span></a></div>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-6149974612965116391.post-77077594079687418462010-10-10T16:38:00.000-07:002010-10-10T16:54:02.350-07:00Masajes para Parejas<form id="emf-form" enctype="multipart/form-data" method="post" action="http://www.emailmeform.com/builder/form/G6Z02D4T6N8"><table style="text-align:left;" cellpadding="2" cellspacing="0" border="0" bgcolor="#FFFFFF"><tr><td style="" colspan="2"><font face="Verdana" size="2" color="#000000"><b style="font-size:20px;">Reserva Terapias</b><br /><label style="font-size:15px;">Rellene todos los apartados<br /></label><br /></font></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Nombre</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_0" name="element_0" value="" size="60" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Email</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_1" name="element_1" class="validate[required,custom[email]]" value="" size="60" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Telefono</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_2" name="element_2" class="validate[required,custom[telephone]]" value="" size="30" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Localidad</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_3" name="element_3" value="" size="30" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Fecha de la reserva</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_4" name="element_4" value="" size="30" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana">(dia/mes/año)</font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Hora seleccionada</b></font><span style="color:red;"><small>*</small></span></td><td style=""><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_5_0" name="element_5" value="10:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 10:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_5_1" name="element_5" value="10:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 10:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_5_2" name="element_5" value="11:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 11:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_5_3" name="element_5" value="11:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 11:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_5_4" name="element_5" value="12:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 12:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_5_5" name="element_5" value="12:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 12:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_5_6" name="element_5" value="16:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 16:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_5_7" name="element_5" value="17:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 17:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_5_8" name="element_5" value="17:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 17:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_5_9" name="element_5" value="18:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 18:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_5_10" name="element_5" value="18:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 18:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_5_11" name="element_5" value="19:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 19:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_5_12" name="element_5" value="19:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 19:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_5_13" name="element_5" value="20:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 20:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_5_14" name="element_5" value="20:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 20:30 </font></div><div style="clear:both;"></div><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td colspan="2" style=""><h3 style="font-size:14px;padding:10px 0 6px 0;border-top:1px dotted #CCCCCC;" id="element_6" name="element_6"><font face="Verdana" size="2" color="#000000">Terapia seleccionada ( elija su masaje )</font></h3><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Masaje Kamakhya</b></font><span style="color:red;"><small></small></span></td><td style=""><div style="width:100%;padding-bottom:5px;"><input id="element_7_0" name="element_7[]" value="Con terapeuta Mujer" class="validate[optional]" type="checkbox" /><font face="Verdana" size="2" color="#000000"> Con terapeuta Mujer </font></div><div style="width:100%;padding-bottom:5px;"><input id="element_7_1" name="element_7[]" value="Con terapeuta Hombre" class="validate[optional]" type="checkbox" /><font face="Verdana" size="2" color="#000000"> Con terapeuta Hombre </font></div><div style="clear:both;"></div><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td colspan="2" style=""><h3 style="font-size:14px;padding:10px 0 6px 0;border-top:1px dotted #CCCCCC;" id="element_8" name="element_8"><font face="Verdana" size="2" color="#000000"></font></h3><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Masaje Vamacara</b></font><span style="color:red;"><small></small></span></td><td style=""><div style="width:100%;padding-bottom:5px;"><input id="element_9_0" name="element_9[]" value="Con terapeuta Mujer" class="validate[optional]" type="checkbox" /><font face="Verdana" size="2" color="#000000"> Con terapeuta Mujer </font></div><div style="width:100%;padding-bottom:5px;"><input id="element_9_1" name="element_9[]" value="Con terapeuta Hombre" class="validate[optional]" type="checkbox" /><font face="Verdana" size="2" color="#000000"> Con terapeuta Hombre </font></div><div style="width:100%;padding-bottom:5px;"><input id="element_9_2" name="element_9[]" value="Con terapeutas Mujer y Hombre" class="validate[optional]" type="checkbox" /><font face="Verdana" size="2" color="#000000"> Con terapeutas Mujer y Hombre </font></div><div style="clear:both;"></div><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td colspan="2" style=""><h3 style="font-size:14px;padding:10px 0 6px 0;border-top:1px dotted #CCCCCC;" id="element_10" name="element_10"><font face="Verdana" size="2" color="#000000"></font></h3><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Ritual de los Sentidos</b></font><span style="color:red;"><small></small></span></td><td style=""><div style="width:100%;padding-bottom:5px;"><input id="element_11_0" name="element_11[]" value="Con terapeutas Mujer y Hombre" class="validate[optional]" type="checkbox" /><font face="Verdana" size="2" color="#000000"> Con terapeutas Mujer y Hombre </font></div><div style="clear:both;"></div><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td colspan="2" style=""><h3 style="font-size:14px;padding:10px 0 6px 0;border-top:1px dotted #CCCCCC;" id="element_12" name="element_12"><font face="Verdana" size="2" color="#000000"></font></h3><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Tantra<br />En la misma sala</b></font><span style="color:red;"><small></small></span></td><td style=""><div style="width:100%;padding-bottom:5px;"><input id="element_13_0" name="element_13[]" value="Basico con terapeutas hombre y mujer" class="validate[optional]" type="checkbox" /><font face="Verdana" size="2" color="#000000"> Basico con terapeutas hombre y mujer </font></div><div style="width:100%;padding-bottom:5px;"><input id="element_13_1" name="element_13[]" value="Basico con terapeutas mujer y mujer" class="validate[optional]" type="checkbox" /><font face="Verdana" size="2" color="#000000"> Basico con terapeutas mujer y mujer </font></div><div style="width:100%;padding-bottom:5px;"><input id="element_13_2" name="element_13[]" value="Completo con terapeutas mujer y mujer" class="validate[optional]" type="checkbox" /><font face="Verdana" size="2" color="#000000"> Completo con terapeutas mujer y mujer </font></div><div style="width:100%;padding-bottom:5px;"><input id="element_13_3" name="element_13[]" value="Completo con terapeutas mujer y hombre" class="validate[optional]" type="checkbox" /><font face="Verdana" size="2" color="#000000"> Completo con terapeutas mujer y hombre </font></div><div style="clear:both;"></div><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td colspan="2" style=""><h3 style="font-size:14px;padding:10px 0 6px 0;border-top:1px dotted #CCCCCC;" id="element_14" name="element_14"><font face="Verdana" size="2" color="#000000"></font></h3><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Tantra<br />En salas separadas</b></font><span style="color:red;"><small></small></span></td><td style=""><div style="width:100%;padding-bottom:5px;"><input id="element_15_0" name="element_15[]" value="Basico con terapeutas hombre y mujer" class="validate[optional]" type="checkbox" /><font face="Verdana" size="2" color="#000000"> Basico con terapeutas hombre y mujer </font></div><div style="width:100%;padding-bottom:5px;"><input id="element_15_1" name="element_15[]" value="Basico con terapeutas mujer y mujer" class="validate[optional]" type="checkbox" /><font face="Verdana" size="2" color="#000000"> Basico con terapeutas mujer y mujer </font></div><div style="width:100%;padding-bottom:5px;"><input id="element_15_2" name="element_15[]" value="Completo con terapeutas mujer y mujer" class="validate[optional]" type="checkbox" /><font face="Verdana" size="2" color="#000000"> Completo con terapeutas mujer y mujer </font></div><div style="width:100%;padding-bottom:5px;"><input id="element_15_3" name="element_15[]" value="Completo con terapeutas mujer y hombre" class="validate[optional]" type="checkbox" /><font face="Verdana" size="2" color="#000000"> Completo con terapeutas mujer y hombre </font></div><div style="clear:both;"></div><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td colspan="2" style=""><h3 style="font-size:14px;padding:10px 0 6px 0;border-top:1px dotted #CCCCCC;" id="element_16" name="element_16"><font face="Verdana" size="2" color="#000000"></font></h3><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Observaciones</b></font><span style="color:red;"><small></small></span></td><td style=""><textarea id="element_17" name="element_17" cols="45" rows="10" class="validate[optional] "></textarea><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr><td colspan="2" align="left"><input name="element_counts" value="18" type="hidden" /><input value="Enviar" type="submit" /></td></tr></table></form><div><font face="Verdana" size="2" color="#000000">Powered by</font><span style="position: relative; padding-left: 3px; bottom: -5px;"><img src="http://www.emailmeform.com/builder/images/footer-logo.png" /></span><font face="Verdana" size="2" color="#000000">EMF </font><a style="text-decoration:none;" href="http://www.emailmeform.com" target="_blank"><font face="Verdana" size="2" color="#000000">Web Form</font></a></div>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-6149974612965116391.post-70847848804982403402010-10-10T15:49:00.001-07:002011-03-12T15:26:17.467-08:00Workshop para Casal<form id="emf-form" enctype="multipart/form-data" method="post" action="http://www.emailmeform.com/builder/form/RaD49d7On51E20I2Nbee"><table style="text-align:left;" cellpadding="2" cellspacing="0" border="0" bgcolor="transparent"><tr><td style="" colspan="2"><font face="Verdana" size="2" color="#000000"><b style="font-size:20px;">Marcaçao e Inscrição</b><br /><label style="font-size:15px;">recheie todos os afastados<br /></label><br /></font></td></tr><tr valign="top"><td style="" align=""><font face="Verdana" size="2" color="#000000"><b>Nome</b></font><span style="color:red;"><small>*</small></span></td></tr><tr><td style=""><input id="element_0" name="element_0" value="" size="60" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align=""><font face="Verdana" size="2" color="#000000"><b>Idade</b></font><span style="color:red;"><small>*</small></span></td></tr><tr><td style=""><input id="element_1" name="element_1" class="validate[required,custom[onlyNumber]]" value="" size="1" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align=""><font face="Verdana" size="2" color="#000000"><b>Nome</b></font><span style="color:red;"><small>*</small></span></td></tr><tr><td style=""><input id="element_2" name="element_2" value="" size="60" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align=""><font face="Verdana" size="2" color="#000000"><b>Idade</b></font><span style="color:red;"><small>*</small></span></td></tr><tr><td style=""><input id="element_3" name="element_3" class="validate[required,custom[onlyNumber]]" value="" size="1" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align=""><font face="Verdana" size="2" color="#000000"><b>Email</b></font><span style="color:red;"><small>*</small></span></td></tr><tr><td style=""><input id="element_4" name="element_4" class="validate[required,custom[email]]" value="" size="60" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align=""><font face="Verdana" size="2" color="#000000"><b>Telefone</b></font><span style="color:red;"><small>*</small></span></td></tr><tr><td style=""><input id="element_5" name="element_5" class="validate[required,custom[telephone]]" value="" size="30" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align=""><font face="Verdana" size="2" color="#000000"><b>Somos</b></font><span style="color:red;"><small>*</small></span></td></tr><tr><td style=""><div style="width:100%;padding-bottom:5px;"><input id="element_6_0" name="element_6" value="Casal" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> Casal </font></div><div style="width:100%;padding-bottom:5px;"><input id="element_6_1" name="element_6" value="Amigos" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> Amigos </font></div><div style="width:100%;padding-bottom:5px;"><input id="element_6_2" name="element_6" value="Companheiros de trabalho" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> Companheiros de trabalho </font></div><div style="clear:both;"></div><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align=""><font face="Verdana" size="2" color="#000000"><b>Seleccionar:</b></font><span style="color:red;"><small>*</small></span></td></tr><tr><td style=""><div style="width:100%;padding-bottom:5px;"><input id="element_7_0" name="element_7[]" value="Workshop de Iniciaçao ao Tantra" class="validate[required]" type="checkbox" /><font face="Verdana" size="2" color="#000000"> Workshop de Iniciaçao ao Tantra </font></div><div style="width:100%;padding-bottom:5px;"><input id="element_7_1" name="element_7[]" value="Workshop de Maithuna" class="validate[required]" type="checkbox" /><font face="Verdana" size="2" color="#000000"> Workshop de Maithuna </font></div><span style="color:red;"></small></span></td></tr><tr><td style=""><div style="width:100%;padding-bottom:5px;"><input id="element_7_0" name="element_7[]" value="Workshop de Poliamore" class="validate[required]" type="checkbox" /><font face="Verdana" size="2" color="#000000"> Workshop de Poliamore </font></div style="width:100%;padding-bottom:5px;"><input id="element_7_1" name="element_7[]" value="Workshop Privado" class="validate[required]" type="checkbox" /><font face="Verdana" size="2" color="#000000"> Workshop Privado </font><div style="width:100%;padding-bottom:5px;"><input id="element_7_0" name="element_7[]" value="Workshop de Sexualidade Tantrica" class="validate[required]" type="checkbox" /><font face="Verdana" size="2" color="#000000"> Workshop de Sexualidade Tantrica </font></div style="width:100%;padding-bottom:5px;"><input id="element_7_0" name="element_7[]" value="Workshop do Yoni" class="validate[required]" type="checkbox" /><font face="Verdana" size="2" color="#000000"> Workshop do yoni </font><div style="width:100%;padding-bottom:5px;"></div><input id="element_7_0" name="element_7[]" value="Workshop do Lingam" class="validate[required]" type="checkbox" /><font face="Verdana" size="2" color="#000000"> Workshop Lingam </font><div style="clear:both;"></div><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align=""><font face="Verdana" size="2" color="#000000"><b>Data do Workshop</b></font><span style="color:red;"><small>*</small></span></td></tr><tr><td style=""><input id="element_8" name="element_8" value="" size="30" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana">( dia/mes/año )</font></small></div></td></tr><tr valign="top"><td style="" align=""><font face="Verdana" size="2" color="#000000"><b>Que buscamos neste workshop</b></font><span style="color:red;"><small>*</small></span></td></tr><tr><td style=""><textarea id="element_9" name="element_9" cols="60" rows="10" class="validate[required] "></textarea><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana">Teus comentários nos ajudassem a formar um grupo<br />mas igualado</font></small></div></td></tr><tr><td colspan="2" align="right"><input name="element_counts" value="10" type="hidden" /><input value="Enviar" type="submit" /><input value="Clear" type="reset" /></td></tr></table></form><div><font face="Verdana" size="2" color="#000000">Powered by</font><span style="position: relative; padding-left: 3px; bottom: -5px;"><img src="http://www.emailmeform.com/builder/images/footer-logo.png" /></span><font face="Verdana" size="2" color="#000000">EMF </font><a style="text-decoration:none;" href="http://www.emailmeform.com" target="_blank"><font face="Verdana" size="2" color="#000000">Email Form</font></a></div>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-6149974612965116391.post-89090304186532807832010-10-10T14:41:00.001-07:002011-03-12T15:41:10.027-08:00Taller para parejas<form id="emf-form" enctype="multipart/form-data" method="post" action="http://www.emailmeform.com/builder/form/6fMFZ8K45ku7UO30"><table style="text-align:left;" cellpadding="2" cellspacing="0" border="0" bgcolor="transparent"><tr><td style="" colspan="2"><font face="Verdana" size="2" color="#000000"><b style="font-size:20px;">Reserva e Inscripcion</b><br /><label style="font-size:15px;">Rellene todos los apartados<br /></label><br /></font></td></tr><tr valign="top"><td style="" align=""><font face="Verdana" size="2" color="#000000"><b>Nombre</b></font><span style="color:red;"><small>*</small></span></td></tr><tr><td style=""><input id="element_0" name="element_0" value="" size="60" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align=""><font face="Verdana" size="2" color="#000000"><b>Edad</b></font><span style="color:red;"><small>*</small></span></td></tr><tr><td style=""><input id="element_1" name="element_1" class="validate[required,custom[onlyNumber]]" value="" size="1" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align=""><font face="Verdana" size="2" color="#000000"><b>Nombre</b></font><span style="color:red;"><small>*</small></span></td></tr><tr><td style=""><input id="element_2" name="element_2" value="" size="60" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align=""><font face="Verdana" size="2" color="#000000"><b>Edad</b></font><span style="color:red;"><small>*</small></span></td></tr><tr><td style=""><input id="element_3" name="element_3" class="validate[required,custom[onlyNumber]]" value="" size="1" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align=""><font face="Verdana" size="2" color="#000000"><b>Email</b></font><span style="color:red;"><small>*</small></span></td></tr><tr><td style=""><input id="element_4" name="element_4" class="validate[required,custom[email]]" value="" size="60" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align=""><font face="Verdana" size="2" color="#000000"><b>Teléfono</b></font><span style="color:red;"><small>*</small></span></td></tr><tr><td style=""><input id="element_5" name="element_5" class="validate[required,custom[telephone]]" value="" size="30" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align=""><font face="Verdana" size="2" color="#000000"><b>Somos</b></font><span style="color:red;"><small>*</small></span></td></tr><tr><td style=""><div style="width:100%;padding-bottom:5px;"><input id="element_6_0" name="element_6" value="Pareja" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> Pareja </font></div><div style="width:100%;padding-bottom:5px;"><input id="element_6_1" name="element_6" value="Amigos" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> Amigos </font></div><div style="width:100%;padding-bottom:5px;"><input id="element_6_2" name="element_6" value="Compañeros de Trabajo" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> Compañeros de Trabajo </font></div><div style="clear:both;"></div><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align=""><font face="Verdana" size="2" color="#000000"><b>Seleccionar:</b></font><span style="color:red;"><small>*</small></span></td></tr><tr><td style=""><div style="width:100%;padding-bottom:5px;"><input id="element_7_0" name="element_7[]" value="Taller de Inicacion al Tantra" class="validate[required]" type="checkbox" /><font face="Verdana" size="2" color="#000000"> Taller de Inicacion al Tantra </font></div><div style="width:100%;padding-bottom:5px;"><input id="element_7_1" name="element_7[]" value="Taller de Maithuna" class="validate[required]" type="checkbox" /><font face="Verdana" size="2" color="#000000"> Taller de Maithuna </font></div><div style="width:100%;padding-bottom:5px;"><input id="element_7_2" name="element_7[]" value="Taller de Poliamore" class="validate[required]" type="checkbox" /><font face="Verdana" size="2" color="#000000"> Taller de Poliamore </font></div><div style="width:100%;padding-bottom:5px;"><input id="element_7_0" name="element_7[]" value="Taller de Sexualidad Tantrica" class="validate[required]" type="checkbox" /><font face="Verdana" size="2" color="#000000"> Taller de Sexualidad Tantrica </font></div><div style="width:100%;padding-bottom:5px;"><input id="element_7_1" name="element_7[]" value="Taller del Yoni" class="validate[required]" type="checkbox" /><font face="Verdana" size="2" color="#000000"> Taller del Yoni </font></div><div style="width:100%;padding-bottom:5px;"><input id="element_7_2" name="element_7[]" value="Taller del Lingam" class="validate[required]" type="checkbox" /><font face="Verdana" size="2" color="#000000"> Taller del Lingam </font></div><div style="width:100%;padding-bottom:5px;"><input id="element_7_2" name="element_7[]" value="Talleres Privados" class="validate[required]" type="checkbox" /><font face="Verdana" size="2" color="#000000"> Talleres Privados </font></div><div style="clear:both;"></div><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align=""><font face="Verdana" size="2" color="#000000"><b>Fecha del Taller</b></font><span style="color:red;"><small>*</small></span></td></tr><tr><td style=""><input id="element_8" name="element_8" value="" size="30" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana">( dia/mes/año )</font></small></div></td></tr><tr valign="top"><td style="" align=""><font face="Verdana" size="2" color="#000000"><b>Que buscamos en este taller</b></font><span style="color:red;"><small>*</small></span></td></tr><tr><td style=""><textarea id="element_9" name="element_9" cols="60" rows="10" class="validate[required] "></textarea><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana">Tus comentarios nos ayudaran a formar un grupo mas<br />homogeneo</font></small></div></td></tr><tr><td colspan="2" align="right"><input name="element_counts" value="10" type="hidden" /><input value="Enviar" type="submit" /><input value="Clear" type="reset" /></td></tr></table></form><div><font face="Verdana" size="2" color="#000000">Powered by</font><span style="position: relative; padding-left: 3px; bottom: -5px;"><img src="http://www.emailmeform.com/builder/images/footer-logo.png" /></span><font face="Verdana" size="2" color="#000000">EMF </font><a style="text-decoration:none;" href="http://www.emailmeform.com" target="_blank"><font face="Verdana" size="2" color="#000000">Email Form</font></a></div>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-6149974612965116391.post-56967801474311892992010-10-09T18:24:00.000-07:002010-10-09T18:36:34.423-07:00Workshops de Tantra<form id="emf-form" enctype="multipart/form-data" method="post" action="http://www.emailmeform.com/builder/form/G6Z02D4T6N8"><table style="text-align:left;" cellpadding="2" cellspacing="0" border="0" bgcolor="#FFFFFF"><tr><td style="" colspan="2"><font face="Verdana" size="2" color="#000000"><b style="font-size:20px;">Inscrição</b><br /><label style="font-size:15px;">recheie todos os afastados<br /></label><br /></font></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Nome</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_0" name="element_0" value="" size="60" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Edad</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_1" name="element_1" class="validate[required,custom[onlyNumber]]" value="" size="1" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Nome</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_2" name="element_2" value="" size="60" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Edad</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_3" name="element_3" class="validate[required,custom[onlyNumber]]" value="" size="1" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Email</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_4" name="element_4" class="validate[required,custom[email]]" value="" size="60" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Telefono</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_5" name="element_5" class="validate[required,custom[telephone]]" value="" size="30" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Localidad</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_6" name="element_6" value="" size="30" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Somos:</b></font><span style="color:red;"><small>*</small></span></td><td style=""><div style="width:100%;padding-bottom:5px;"><input id="element_7_0" name="element_7" value="Casal" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> Casal </font></div><div style="width:100%;padding-bottom:5px;"><input id="element_7_1" name="element_7" value="Amigos" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> Amigos </font></div><div style="width:100%;padding-bottom:5px;"><input id="element_7_2" name="element_7" value="companheiros de trabalho" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> companheiros de trabalho </font></div><div style="clear:both;"></div><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Data do Workshop</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_8" name="element_8" value="" size="30" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana">(dia/mes/año)</font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Seleccionar</b></font><span style="color:red;"><small>*</small></span></td><td style=""><div style="width:100%;padding-bottom:5px;"><input id="element_9_0" name="element_9[]" value="Workshop de Iniciaçao ao Tantra" class="validate[required]" type="checkbox" /><font face="Verdana" size="2" color="#000000"> Workshop de Iniciaçao ao Tantra </font></div><div style="width:100%;padding-bottom:5px;"><input id="element_9_1" name="element_9[]" value="Workshop de Maithuna" class="validate[required]" type="checkbox" /><font face="Verdana" size="2" color="#000000"> Workshop de Maithuna </font></div><div style="width:100%;padding-bottom:5px;"><input id="element_9_2" name="element_9[]" value="Workshop de Poliamore" class="validate[required]" type="checkbox" /><font face="Verdana" size="2" color="#000000"> Workshop de Poliamore </font></div><div style="clear:both;"></div><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Que buscamos en este Workshop</b></font><span style="color:red;"><small>*</small></span></td><td style=""><textarea id="element_10" name="element_10" cols="45" rows="10" class="validate[required] "></textarea><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana">para fazer grupo homogêneos necessitamos saber <br />vossos objetivos no workshop</font></small></div></td></tr><tr><td colspan="2" align="left"><input name="element_counts" value="11" type="hidden" /><input value="Enviar" type="submit" /></td></tr></table></form><div><font face="Verdana" size="2" color="#000000">Powered by</font><span style="position: relative; padding-left: 3px; bottom: -5px;"><img src="http://www.emailmeform.com/builder/images/footer-logo.png" /></span><font face="Verdana" size="2" color="#000000">EMF </font><a style="text-decoration:none;" href="http://www.emailmeform.com" target="_blank"><font face="Verdana" size="2" color="#000000">Web Form</font></a></div>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-6149974612965116391.post-42467348877360545192010-10-09T18:17:00.000-07:002010-10-09T18:18:15.151-07:00Talleres de Parejas<form id="emf-form" enctype="multipart/form-data" method="post" action="http://www.emailmeform.com/builder/form/G6Z02D4T6N8"><table style="text-align:left;" cellpadding="2" cellspacing="0" border="0" bgcolor="#FFFFFF"><tr><td style="" colspan="2"><font face="Verdana" size="2" color="#000000"><b style="font-size:20px;">Reserva de Inscripción</b><br /><label style="font-size:15px;">Rellene todos los apartados<br /></label><br /></font></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Nombre</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_0" name="element_0" value="" size="60" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Edad</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_1" name="element_1" class="validate[required,custom[onlyNumber]]" value="" size="1" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Nombre</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_2" name="element_2" value="" size="60" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Edad</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_3" name="element_3" class="validate[required,custom[onlyNumber]]" value="" size="1" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Email</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_4" name="element_4" class="validate[required,custom[email]]" value="" size="60" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Telefono</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_5" name="element_5" class="validate[required,custom[telephone]]" value="" size="30" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Localidad</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_6" name="element_6" value="" size="30" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Somos:</b></font><span style="color:red;"><small>*</small></span></td><td style=""><div style="width:100%;padding-bottom:5px;"><input id="element_7_0" name="element_7" value="Pareja" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> Pareja </font></div><div style="width:100%;padding-bottom:5px;"><input id="element_7_1" name="element_7" value="Amigos" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> Amigos </font></div><div style="width:100%;padding-bottom:5px;"><input id="element_7_2" name="element_7" value="Compañeros de Trabajo" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> Compañeros de Trabajo </font></div><div style="clear:both;"></div><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Fecha del Taller</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_8" name="element_8" value="" size="30" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana">(dia/mes/año)</font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Seleccionar</b></font><span style="color:red;"><small>*</small></span></td><td style=""><div style="width:100%;padding-bottom:5px;"><input id="element_9_0" name="element_9[]" value="Taller de Iniciacion al Tantra" class="validate[required]" type="checkbox" /><font face="Verdana" size="2" color="#000000"> Taller de Iniciacion al Tantra </font></div><div style="width:100%;padding-bottom:5px;"><input id="element_9_1" name="element_9[]" value="Taller de Maithuna" class="validate[required]" type="checkbox" /><font face="Verdana" size="2" color="#000000"> Taller de Maithuna </font></div><div style="width:100%;padding-bottom:5px;"><input id="element_9_2" name="element_9[]" value="Taller de Poliamore" class="validate[required]" type="checkbox" /><font face="Verdana" size="2" color="#000000"> Taller de Poliamore </font></div><div style="clear:both;"></div><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Que buscamos en este Taller</b></font><span style="color:red;"><small>*</small></span></td><td style=""><textarea id="element_10" name="element_10" cols="45" rows="10" class="validate[required] "></textarea><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana">Para hacer grupos homogéneos necesitamos saber<br />vuestros objetivos en el taller </font></small></div></td></tr><tr><td colspan="2" align="left"><input name="element_counts" value="11" type="hidden" /><input value="Enviar" type="submit" /></td></tr></table></form><div><font face="Verdana" size="2" color="#000000">Powered by</font><span style="position: relative; padding-left: 3px; bottom: -5px;"><img src="http://www.emailmeform.com/builder/images/footer-logo.png" /></span><font face="Verdana" size="2" color="#000000">EMF </font><a style="text-decoration:none;" href="http://www.emailmeform.com" target="_blank"><font face="Verdana" size="2" color="#000000">Web Form</font></a></div>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-6149974612965116391.post-17093157891590528972010-10-09T17:55:00.000-07:002010-10-09T17:58:47.800-07:00Sessões privadas para Casais<form id="emf-form" enctype="multipart/form-data" method="post" action="http://www.emailmeform.com/builder/form/G6Z02D4T6N8"><table style="text-align:left;" cellpadding="2" cellspacing="0" border="0" bgcolor="#FFFFFF"><tr><td style="" colspan="2"><font face="Verdana" size="2" color="#000000"><b style="font-size:20px;">Solicitude de Marcaçao</b><br /><label style="font-size:15px;">recheie todos os afastados<br /></label><br /></font></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Nombre</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_0" name="element_0" value="" size="60" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Email</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_1" name="element_1" class="validate[required,custom[email]]" value="" size="60" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Telefono</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_2" name="element_2" class="validate[required,custom[telephone]]" value="" size="30" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Localidad</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_3" name="element_3" value="" size="30" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Terapia</b></font><span style="color:red;"><small>*</small></span></td><td style=""><select id="element_4" name="element_4" class="validate[required]"><option value=""selected="selected">Seleccionar</option><option value="Sessões privadas para Casais">Sessões privadas para Casais</option></select><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Data Marcaçao</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_5" name="element_5" value="" size="30" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana">Data completa (dia/mes/ano)</font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Seleccionar Hora</b></font><span style="color:red;"><small>*</small></span></td><td style=""><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_6_0" name="element_6" value="10:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 10:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_6_1" name="element_6" value="16:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 16:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_6_2" name="element_6" value="17:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 17:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_6_3" name="element_6" value="17:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 17:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_6_4" name="element_6" value="18:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 18:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_6_5" name="element_6" value="18:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 18:30 </font></div><div style="clear:both;"></div><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana">Otros horarios consultar en observaciones</font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Observaciones</b></font><span style="color:red;"><small></small></span></td><td style=""><textarea id="element_7" name="element_7" cols="45" rows="10" class="validate[optional] "></textarea><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr><td colspan="2" align="left"><input name="element_counts" value="8" type="hidden" /><input value="Enviar" type="submit" /></td></tr></table></form><div><font face="Verdana" size="2" color="#000000">Powered by</font><span style="position: relative; padding-left: 3px; bottom: -5px;"><img src="http://www.emailmeform.com/builder/images/footer-logo.png" /></span><font face="Verdana" size="2" color="#000000">EMF </font><a style="text-decoration:none;" href="http://www.emailmeform.com" target="_blank"><font face="Verdana" size="2" color="#000000">Web Form</font></a></div>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-6149974612965116391.post-5565846534563772232010-10-09T17:52:00.000-07:002010-10-09T17:53:07.119-07:00Sesiones Privadas para Parejas<form id="emf-form" enctype="multipart/form-data" method="post" action="http://www.emailmeform.com/builder/form/G6Z02D4T6N8"><table style="text-align:left;" cellpadding="2" cellspacing="0" border="0" bgcolor="#FFFFFF"><tr><td style="" colspan="2"><font face="Verdana" size="2" color="#000000"><b style="font-size:20px;">Solicitud de Reserva</b><br /><label style="font-size:15px;">Rellene todos los apartados<br /></label><br /></font></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Nombre</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_0" name="element_0" value="" size="60" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Email</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_1" name="element_1" class="validate[required,custom[email]]" value="" size="60" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Telefono</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_2" name="element_2" class="validate[required,custom[telephone]]" value="" size="30" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Localidad</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_3" name="element_3" value="" size="30" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Terapia</b></font><span style="color:red;"><small>*</small></span></td><td style=""><select id="element_4" name="element_4" class="validate[required]"><option value=""selected="selected">Seleccionar</option><option value="Sesion Privada para parejas">Sesion Privada para parejas</option></select><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Fecha Reserva</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_5" name="element_5" value="" size="30" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana">Fecha completa (dia/mes/año)</font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Seleccionar Hora</b></font><span style="color:red;"><small>*</small></span></td><td style=""><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_6_0" name="element_6" value="10:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 10:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_6_1" name="element_6" value="16:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 16:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_6_2" name="element_6" value="17:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 17:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_6_3" name="element_6" value="17:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 17:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_6_4" name="element_6" value="18:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 18:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_6_5" name="element_6" value="18:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 18:30 </font></div><div style="clear:both;"></div><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana">Otros horarios consultar en observaciones</font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Observaciones</b></font><span style="color:red;"><small></small></span></td><td style=""><textarea id="element_7" name="element_7" cols="45" rows="10" class="validate[optional] "></textarea><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr><td colspan="2" align="left"><input name="element_counts" value="8" type="hidden" /><input value="Enviar" type="submit" /></td></tr></table></form><div><font face="Verdana" size="2" color="#000000">Powered by</font><span style="position: relative; padding-left: 3px; bottom: -5px;"><img src="http://www.emailmeform.com/builder/images/footer-logo.png" /></span><font face="Verdana" size="2" color="#000000">EMF </font><a style="text-decoration:none;" href="http://www.emailmeform.com" target="_blank"><font face="Verdana" size="2" color="#000000">Web Form</font></a></div>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-6149974612965116391.post-83765452391949317852010-10-09T17:41:00.000-07:002010-10-09T17:46:08.309-07:00Massagem Vamacara para Casais<form id="emf-form" enctype="multipart/form-data" method="post" action="http://www.emailmeform.com/builder/form/G6Z02D4T6N8"><table style="text-align:left;" cellpadding="2" cellspacing="0" border="0" bgcolor="#FFFFFF"><tr><td style="" colspan="2"><font face="Verdana" size="2" color="#000000"><b style="font-size:20px;">Solicitude de Marcaçao</b><br /><label style="font-size:15px;">Rellene todos los apartados<br /></label><br /></font></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Nome</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_0" name="element_0" value="" size="60" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Email</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_1" name="element_1" class="validate[required,custom[email]]" value="" size="60" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Telefono</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_2" name="element_2" class="validate[required,custom[telephone]]" value="" size="30" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Localidade</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_3" name="element_3" value="" size="30" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Terapeutas</b></font><span style="color:red;"><small>*</small></span></td><td style=""><div style="width:100%;padding-bottom:5px;"><input id="element_4_0" name="element_4" value="Terapeuta Mulher" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> Terapeuta Mulher </font></div><div style="width:100%;padding-bottom:5px;"><input id="element_4_1" name="element_4" value="Terapeuta Homem" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> Terapeuta Homem </font></div><div style="width:100%;padding-bottom:5px;"><input id="element_4_2" name="element_4" value="Terapeutas Mulher e Homem" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> Terapeutas Mulher e Homem </font></div><div style="clear:both;"></div><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Terapia</b></font><span style="color:red;"><small>*</small></span></td><td style=""><select id="element_5" name="element_5" class="validate[required]"><option value=""selected="selected">Seleccionar</option><option value="Massagem Vamacara para Casais">Massagem Vamacara para Casais</option></select><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Fecha Reserva</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_6" name="element_6" value="" size="30" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana">Data completa (dia/mes/ano)</font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Seleccionar Hora</b></font><span style="color:red;"><small>*</small></span></td><td style=""><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_0" name="element_7" value="11:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 11:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_1" name="element_7" value="11:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 11:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_2" name="element_7" value="12:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 12:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_3" name="element_7" value="12:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 12:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_4" name="element_7" value="16:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 16:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_5" name="element_7" value="17:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 17:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_6" name="element_7" value="17:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 17:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_7" name="element_7" value="18:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 18:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_8" name="element_7" value="18:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 18:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_9" name="element_7" value="19:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 19:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_10" name="element_7" value="19:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 19:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_11" name="element_7" value="20:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 20:00 </font></div><div style="clear:both;"></div><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana">Otros horarios consultar en observaciones</font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Observaciones</b></font><span style="color:red;"><small></small></span></td><td style=""><textarea id="element_8" name="element_8" cols="45" rows="10" class="validate[optional] "></textarea><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr><td colspan="2" align="left"><input name="element_counts" value="9" type="hidden" /><input value="Enviar" type="submit" /></td></tr></table></form><div><font face="Verdana" size="2" color="#000000">Powered by</font><span style="position: relative; padding-left: 3px; bottom: -5px;"><img src="http://www.emailmeform.com/builder/images/footer-logo.png" /></span><font face="Verdana" size="2" color="#000000">EMF </font><a style="text-decoration:none;" href="http://www.emailmeform.com" target="_blank"><font face="Verdana" size="2" color="#000000">Web Form</font></a></div>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-6149974612965116391.post-68991856696744268422010-10-09T17:39:00.000-07:002010-10-09T17:40:20.071-07:00Masaje Vamacara para parejas<form id="emf-form" enctype="multipart/form-data" method="post" action="http://www.emailmeform.com/builder/form/G6Z02D4T6N8"><table style="text-align:left;" cellpadding="2" cellspacing="0" border="0" bgcolor="#FFFFFF"><tr><td style="" colspan="2"><font face="Verdana" size="2" color="#000000"><b style="font-size:20px;">Solicitud de Reserva</b><br /><label style="font-size:15px;">Rellene todos los apartados<br /></label><br /></font></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Nombre</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_0" name="element_0" value="" size="60" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Email</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_1" name="element_1" class="validate[required,custom[email]]" value="" size="60" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Telefono</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_2" name="element_2" class="validate[required,custom[telephone]]" value="" size="30" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Localidad</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_3" name="element_3" value="" size="30" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Terapeutas</b></font><span style="color:red;"><small>*</small></span></td><td style=""><div style="width:100%;padding-bottom:5px;"><input id="element_4_0" name="element_4" value="Terapeuta Mujer" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> Terapeuta Mujer </font></div><div style="width:100%;padding-bottom:5px;"><input id="element_4_1" name="element_4" value="Terapeuta Hombre" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> Terapeuta Hombre </font></div><div style="width:100%;padding-bottom:5px;"><input id="element_4_2" name="element_4" value="Terapeutas Mujer y Hombre" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> Terapeutas Mujer y Hombre </font></div><div style="clear:both;"></div><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Terapia</b></font><span style="color:red;"><small>*</small></span></td><td style=""><select id="element_5" name="element_5" class="validate[required]"><option value=""selected="selected">Seleccionar</option><option value="Masaje Vamacara para Parejas">Masaje Vamacara para Parejas</option></select><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Fecha Reserva</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_6" name="element_6" value="" size="30" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana">Fecha completa (dia/mes/año)</font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Seleccionar Hora</b></font><span style="color:red;"><small>*</small></span></td><td style=""><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_0" name="element_7" value="11:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 11:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_1" name="element_7" value="11:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 11:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_2" name="element_7" value="12:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 12:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_3" name="element_7" value="12:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 12:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_4" name="element_7" value="16:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 16:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_5" name="element_7" value="17:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 17:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_6" name="element_7" value="17:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 17:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_7" name="element_7" value="18:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 18:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_8" name="element_7" value="18:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 18:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_9" name="element_7" value="19:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 19:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_10" name="element_7" value="19:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 19:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_11" name="element_7" value="20:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 20:00 </font></div><div style="clear:both;"></div><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana">Otros horarios consultar en observaciones</font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Observaciones</b></font><span style="color:red;"><small></small></span></td><td style=""><textarea id="element_8" name="element_8" cols="45" rows="10" class="validate[optional] "></textarea><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr><td colspan="2" align="left"><input name="element_counts" value="9" type="hidden" /><input value="Enviar" type="submit" /></td></tr></table></form><div><font face="Verdana" size="2" color="#000000">Powered by</font><span style="position: relative; padding-left: 3px; bottom: -5px;"><img src="http://www.emailmeform.com/builder/images/footer-logo.png" /></span><font face="Verdana" size="2" color="#000000">EMF </font><a style="text-decoration:none;" href="http://www.emailmeform.com" target="_blank"><font face="Verdana" size="2" color="#000000">Web Form</font></a></div>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-6149974612965116391.post-46108429888168942582010-10-09T17:32:00.000-07:002010-10-09T17:36:32.684-07:00Massagem Kamakhya para Casais<form id="emf-form" enctype="multipart/form-data" method="post" action="http://www.emailmeform.com/builder/form/G6Z02D4T6N8"><table style="text-align:left;" cellpadding="2" cellspacing="0" border="0" bgcolor="#FFFFFF"><tr><td style="" colspan="2"><font face="Verdana" size="2" color="#000000"><b style="font-size:20px;">Solicitude de Marcaçao</b><br /><label style="font-size:15px;">recheie todos os afastados<br /></label><br /></font></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Nombre</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_0" name="element_0" value="" size="60" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Email</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_1" name="element_1" class="validate[required,custom[email]]" value="" size="60" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Telefone</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_2" name="element_2" class="validate[required,custom[telephone]]" value="" size="30" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Localidad</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_3" name="element_3" value="" size="30" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Terapeuta</b></font><span style="color:red;"><small>*</small></span></td><td style=""><div style="width:100%;padding-bottom:5px;"><input id="element_4_0" name="element_4" value="Terapeuta Mulher" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> Terapeuta Mulher </font></div><div style="width:100%;padding-bottom:5px;"><input id="element_4_1" name="element_4" value="Terapeuta Homem" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> Terapeuta Homem </font></div><div style="clear:both;"></div><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Terapia</b></font><span style="color:red;"><small>*</small></span></td><td style=""><select id="element_5" name="element_5" class="validate[required]"><option value=""selected="selected">Seleccionar</option><option value="Massage Kamakhya para Casais">Massage Kamakhya para Casais</option></select><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Fecha Reserva</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_6" name="element_6" value="" size="30" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana">Data completa (dia/mes/ano)</font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Seleccionar Hora</b></font><span style="color:red;"><small>*</small></span></td><td style=""><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_0" name="element_7" value="11:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 11:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_1" name="element_7" value="11:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 11:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_2" name="element_7" value="12:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 12:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_3" name="element_7" value="12:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 12:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_4" name="element_7" value="16:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 16:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_5" name="element_7" value="17:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 17:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_6" name="element_7" value="17:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 17:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_7" name="element_7" value="18:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 18:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_8" name="element_7" value="18:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 18:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_9" name="element_7" value="19:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 19:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_10" name="element_7" value="19:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 19:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_11" name="element_7" value="20:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 20:00 </font></div><div style="clear:both;"></div><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana">Otros horarios consultar en observaciones</font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Observaciones</b></font><span style="color:red;"><small></small></span></td><td style=""><textarea id="element_8" name="element_8" cols="45" rows="10" class="validate[optional] "></textarea><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr><td colspan="2" align="left"><input name="element_counts" value="9" type="hidden" /><input value="Enviar" type="submit" /></td></tr></table></form><div><font face="Verdana" size="2" color="#000000">Powered by</font><span style="position: relative; padding-left: 3px; bottom: -5px;"><img src="http://www.emailmeform.com/builder/images/footer-logo.png" /></span><font face="Verdana" size="2" color="#000000">EMF </font><a style="text-decoration:none;" href="http://www.emailmeform.com" target="_blank"><font face="Verdana" size="2" color="#000000">Web Form</font></a></div>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-6149974612965116391.post-28235054954901166722010-10-09T17:26:00.001-07:002010-10-09T17:29:30.881-07:00Masaje Kamakhya para parejas<form id="emf-form" enctype="multipart/form-data" method="post" action="http://www.emailmeform.com/builder/form/G6Z02D4T6N8"><table style="text-align:left;" cellpadding="2" cellspacing="0" border="0" bgcolor="#FFFFFF"><tr><td style="" colspan="2"><font face="Verdana" size="2" color="#000000"><b style="font-size:20px;">Solicitud de Reserva</b><br /><label style="font-size:15px;">Rellene todos los apartados<br /></label><br /></font></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Nombre</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_0" name="element_0" value="" size="60" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Email</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_1" name="element_1" class="validate[required,custom[email]]" value="" size="60" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Telefono</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_2" name="element_2" class="validate[required,custom[telephone]]" value="" size="30" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Localidad</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_3" name="element_3" value="" size="30" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Terapeuta</b></font><span style="color:red;"><small>*</small></span></td><td style=""><div style="width:100%;padding-bottom:5px;"><input id="element_4_0" name="element_4" value="Terapeuta Mujer" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> Terapeuta Mujer </font></div><div style="width:100%;padding-bottom:5px;"><input id="element_4_1" name="element_4" value="Terapeuta Hombre" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> Terapeuta Hombre </font></div><div style="clear:both;"></div><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Terapia</b></font><span style="color:red;"><small>*</small></span></td><td style=""><select id="element_5" name="element_5" class="validate[required]"><option value=""selected="selected">Seleccionar</option><option value="Masaje Kamakhya para parejas">Masaje Kamakhya para parejas</option></select><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Fecha Reserva</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_6" name="element_6" value="" size="30" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana">Fecha completa (dia/mes/año)</font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Seleccionar Hora</b></font><span style="color:red;"><small>*</small></span></td><td style=""><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_0" name="element_7" value="11:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 11:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_1" name="element_7" value="11:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 11:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_2" name="element_7" value="12:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 12:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_3" name="element_7" value="12:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 12:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_4" name="element_7" value="16:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 16:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_5" name="element_7" value="17:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 17:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_6" name="element_7" value="17:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 17:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_7" name="element_7" value="18:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 18:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_8" name="element_7" value="18:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 18:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_9" name="element_7" value="19:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 19:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_10" name="element_7" value="19:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 19:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_11" name="element_7" value="20:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 20:00 </font></div><div style="clear:both;"></div><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana">Otros horarios consultar en observaciones</font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Observaciones</b></font><span style="color:red;"><small></small></span></td><td style=""><textarea id="element_8" name="element_8" cols="45" rows="10" class="validate[optional] "></textarea><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr><td colspan="2" align="left"><input name="element_counts" value="9" type="hidden" /><input value="Enviar" type="submit" /></td></tr></table></form><div><font face="Verdana" size="2" color="#000000">Powered by</font><span style="position: relative; padding-left: 3px; bottom: -5px;"><img src="http://www.emailmeform.com/builder/images/footer-logo.png" /></span><font face="Verdana" size="2" color="#000000">EMF </font><a style="text-decoration:none;" href="http://www.emailmeform.com" target="_blank"><font face="Verdana" size="2" color="#000000">Web Form</font></a></div>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-6149974612965116391.post-44482508628583595002010-10-09T17:09:00.000-07:002010-10-09T17:15:08.132-07:00Tantra Casais e Ritual dos Sentidos<form id="emf-form" enctype="multipart/form-data" method="post" action="http://www.emailmeform.com/builder/form/G6Z02D4T6N8"><table style="text-align:left;" cellpadding="2" cellspacing="0" border="0" bgcolor="#FFFFFF"><tr><td style="" colspan="2"><font face="Verdana" size="2" color="#000000"><b style="font-size:20px;">Solicitude de Marcaçao</b><br /><label style="font-size:15px;">Recheie todos os afastados<br /></label><br /></font></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Nombre</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_0" name="element_0" value="" size="60" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Email</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_1" name="element_1" class="validate[required,custom[email]]" value="" size="60" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Telefono</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_2" name="element_2" class="validate[required,custom[telephone]]" value="" size="30" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Localidad</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_3" name="element_3" value="" size="30" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Terapeutas</b></font><span style="color:red;"><small>*</small></span></td><td style=""><div style="width:100%;padding-bottom:5px;"><input id="element_4_0" name="element_4" value="Terapeutas Mulher e Homem" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> Terapeutas Mulher e Homem </font></div><div style="clear:both;"></div><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Terapias</b></font><span style="color:red;"><small>*</small></span></td><td style=""><select id="element_5" name="element_5" class="validate[required]"><option value=""selected="selected">Seleccionar</option><option value="Tantra Casais e Ritual dos Sentidos">Tantra Casais e Ritual dos Sentidos</option></select><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Fecha Reserva</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_6" name="element_6" value="" size="30" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana">Data completa (dia/mes/ano)</font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Seleccionar Hora</b></font><span style="color:red;"><small>*</small></span></td><td style=""><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_0" name="element_7" value="11:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 11:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_1" name="element_7" value="11:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 11:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_2" name="element_7" value="12:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 12:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_3" name="element_7" value="12:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 12:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_4" name="element_7" value="16:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 16:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_5" name="element_7" value="17:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 17:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_6" name="element_7" value="17:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 17:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_7" name="element_7" value="18:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 18:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_8" name="element_7" value="18:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 18:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_9" name="element_7" value="19:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 19:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_10" name="element_7" value="19:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 19:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_11" name="element_7" value="20:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 20:00 </font></div><div style="clear:both;"></div><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana">Otros horarios consultar en observaciones</font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Observaciones</b></font><span style="color:red;"><small></small></span></td><td style=""><textarea id="element_8" name="element_8" cols="45" rows="10" class="validate[optional] "></textarea><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr><td colspan="2" align="left"><input name="element_counts" value="9" type="hidden" /><input value="Enviar" type="submit" /></td></tr></table></form><div><font face="Verdana" size="2" color="#000000">Powered by</font><span style="position: relative; padding-left: 3px; bottom: -5px;"><img src="http://www.emailmeform.com/builder/images/footer-logo.png" /></span><font face="Verdana" size="2" color="#000000">EMF </font><a style="text-decoration:none;" href="http://www.emailmeform.com" target="_blank"><font face="Verdana" size="2" color="#000000">Web Form</font></a></div>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-6149974612965116391.post-36716680873636441232010-10-09T17:06:00.000-07:002010-10-09T17:07:28.887-07:00Tantra y Ritual de los Sentidos<form id="emf-form" enctype="multipart/form-data" method="post" action="http://www.emailmeform.com/builder/form/G6Z02D4T6N8"><table style="text-align:left;" cellpadding="2" cellspacing="0" border="0" bgcolor="#FFFFFF"><tr><td style="" colspan="2"><font face="Verdana" size="2" color="#000000"><b style="font-size:20px;">Solicitud de Reserva</b><br /><label style="font-size:15px;">Rellene todos los apartados<br /></label><br /></font></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Nombre</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_0" name="element_0" value="" size="60" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Email</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_1" name="element_1" class="validate[required,custom[email]]" value="" size="60" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Telefono</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_2" name="element_2" class="validate[required,custom[telephone]]" value="" size="30" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Localidad</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_3" name="element_3" value="" size="30" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Terapeutas</b></font><span style="color:red;"><small>*</small></span></td><td style=""><div style="width:100%;padding-bottom:5px;"><input id="element_4_0" name="element_4" value="Terapeutas Mujer y Hombre" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> Terapeutas Mujer y Hombre </font></div><div style="clear:both;"></div><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Terapias</b></font><span style="color:red;"><small>*</small></span></td><td style=""><select id="element_5" name="element_5" class="validate[required]"><option value=""selected="selected">Seleccionar</option><option value="Tantra Parejas y Ritual de los Sentidos">Tantra Parejas y Ritual de los Sentidos</option></select><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Fecha Reserva</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_6" name="element_6" value="" size="30" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana">Fecha completa (dia/mes/año)</font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Seleccionar Hora</b></font><span style="color:red;"><small>*</small></span></td><td style=""><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_0" name="element_7" value="11:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 11:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_1" name="element_7" value="11:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 11:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_2" name="element_7" value="12:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 12:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_3" name="element_7" value="12:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 12:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_4" name="element_7" value="16:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 16:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_5" name="element_7" value="17:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 17:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_6" name="element_7" value="17:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 17:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_7" name="element_7" value="18:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 18:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_8" name="element_7" value="18:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 18:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_9" name="element_7" value="19:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 19:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_10" name="element_7" value="19:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 19:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_11" name="element_7" value="20:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 20:00 </font></div><div style="clear:both;"></div><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana">Otros horarios consultar en observaciones</font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Observaciones</b></font><span style="color:red;"><small></small></span></td><td style=""><textarea id="element_8" name="element_8" cols="45" rows="10" class="validate[optional] "></textarea><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr><td colspan="2" align="left"><input name="element_counts" value="9" type="hidden" /><input value="Enviar" type="submit" /></td></tr></table></form><div><font face="Verdana" size="2" color="#000000">Powered by</font><span style="position: relative; padding-left: 3px; bottom: -5px;"><img src="http://www.emailmeform.com/builder/images/footer-logo.png" /></span><font face="Verdana" size="2" color="#000000">EMF </font><a style="text-decoration:none;" href="http://www.emailmeform.com" target="_blank"><font face="Verdana" size="2" color="#000000">Web Form</font></a></div>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-6149974612965116391.post-24962956299911743552010-10-09T16:53:00.001-07:002010-10-09T16:59:59.841-07:00Tantra Casais<form id="emf-form" enctype="multipart/form-data" method="post" action="http://www.emailmeform.com/builder/form/G6Z02D4T6N8"><table style="text-align:left;" cellpadding="2" cellspacing="0" border="0" bgcolor="#FFFFFF"><tr><td style="" colspan="2"><font face="Verdana" size="2" color="#000000"><b style="font-size:20px;">Solicitude de Marcaçao</b><br /><label style="font-size:15px;">recheie todos os afastados<br /></label><br /></font></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Nome</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_0" name="element_0" value="" size="60" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Email</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_1" name="element_1" class="validate[required,custom[email]]" value="" size="60" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Telefono</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_2" name="element_2" class="validate[required,custom[telephone]]" value="" size="30" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Localidad</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_3" name="element_3" value="" size="30" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Terapeutas</b></font><span style="color:red;"><small>*</small></span></td><td style=""><div style="width:100%;padding-bottom:5px;"><input id="element_4_0" name="element_4" value="Terapeutas Mulher e Mulher" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> Terapeutas Mulher e Mulher </font></div><div style="width:100%;padding-bottom:5px;"><input id="element_4_1" name="element_4" value="Terapeutas Mulher e Homem" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> Terapeutas Mulher e Homem </font></div><div style="clear:both;"></div><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Terapias</b></font><span style="color:red;"><small>*</small></span></td><td style=""><select id="element_5" name="element_5" class="validate[required]"><option value=""selected="selected">Seleccionar</option><option value="tantra casais na mesma sala ">tantra casais na mesma sala </option><option value="tantra casais em salas separadas">tantra casais em salas separadas</option></select><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Opciones:</b></font><span style="color:red;"><small>*</small></span></td><td style=""><div style="width:100%;padding-bottom:5px;"><input id="element_6_0" name="element_6[]" value="Tantra Completo" class="validate[required]" type="checkbox" /><font face="Verdana" size="2" color="#000000"> Tantra Completo </font></div><div style="width:100%;padding-bottom:5px;"><input id="element_6_1" name="element_6[]" value="Tantra Basico" class="validate[required]" type="checkbox" /><font face="Verdana" size="2" color="#000000"> Tantra Basico </font></div><div style="clear:both;"></div><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Data Marcaçao</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_7" name="element_7" value="" size="30" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana">Data completa (dia/mes/ano)</font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Seleccionar Hora</b></font><span style="color:red;"><small>*</small></span></td><td style=""><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_8_0" name="element_8" value="11:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 11:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_8_1" name="element_8" value="11:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 11:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_8_2" name="element_8" value="12:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 12:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_8_3" name="element_8" value="12:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 12:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_8_4" name="element_8" value="16:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 16:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_8_5" name="element_8" value="17:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 17:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_8_6" name="element_8" value="17:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 17:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_8_7" name="element_8" value="18:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 18:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_8_8" name="element_8" value="18:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 18:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_8_9" name="element_8" value="19:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 19:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_8_10" name="element_8" value="19:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 19:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_8_11" name="element_8" value="20:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 20:00 </font></div><div style="clear:both;"></div><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana">Otros horarios consultar en observaciones</font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Observaciones</b></font><span style="color:red;"><small></small></span></td><td style=""><textarea id="element_9" name="element_9" cols="45" rows="10" class="validate[optional] "></textarea><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr><td colspan="2" align="left"><input name="element_counts" value="10" type="hidden" /><input value="Enviar" type="submit" /></td></tr></table></form><div><font face="Verdana" size="2" color="#000000">Powered by</font><span style="position: relative; padding-left: 3px; bottom: -5px;"><img src="http://www.emailmeform.com/builder/images/footer-logo.png" /></span><font face="Verdana" size="2" color="#000000">EMF </font><a style="text-decoration:none;" href="http://www.emailmeform.com" target="_blank"><font face="Verdana" size="2" color="#000000">Web Form</font></a></div>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-6149974612965116391.post-76284617862845061562010-10-09T16:47:00.000-07:002010-10-09T16:48:48.878-07:00Tantra Parejas<form id="emf-form" enctype="multipart/form-data" method="post" action="http://www.emailmeform.com/builder/form/G6Z02D4T6N8"><table style="text-align:left;" cellpadding="2" cellspacing="0" border="0" bgcolor="#FFFFFF"><tr><td style="" colspan="2"><font face="Verdana" size="2" color="#000000"><b style="font-size:20px;">Solicitud de Reserva</b><br /><label style="font-size:15px;">Rellene todos los apartados<br /></label><br /></font></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Nombre</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_0" name="element_0" value="" size="60" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Email</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_1" name="element_1" class="validate[required,custom[email]]" value="" size="60" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Telefono</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_2" name="element_2" class="validate[required,custom[telephone]]" value="" size="30" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Localidad</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_3" name="element_3" value="" size="30" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Terapeutas</b></font><span style="color:red;"><small>*</small></span></td><td style=""><div style="width:100%;padding-bottom:5px;"><input id="element_4_0" name="element_4" value="Terapeutas Mujer y Mujer" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> Terapeutas Mujer y Mujer </font></div><div style="width:100%;padding-bottom:5px;"><input id="element_4_1" name="element_4" value="Terapeutas Mujer y Hombre" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> Terapeutas Mujer y Hombre </font></div><div style="clear:both;"></div><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Terapias</b></font><span style="color:red;"><small>*</small></span></td><td style=""><select id="element_5" name="element_5" class="validate[required]"><option value=""selected="selected">Seleccionar</option><option value="Tantra Parejas en la misma sala ">Tantra Parejas en la misma sala </option><option value="Tantra Parejas en salas separadas">Tantra Parejas en salas separadas</option></select><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Opciones:</b></font><span style="color:red;"><small>*</small></span></td><td style=""><div style="width:100%;padding-bottom:5px;"><input id="element_6_0" name="element_6[]" value="Tantra Completo" class="validate[required]" type="checkbox" /><font face="Verdana" size="2" color="#000000"> Tantra Completo </font></div><div style="width:100%;padding-bottom:5px;"><input id="element_6_1" name="element_6[]" value="Tantra Basico" class="validate[required]" type="checkbox" /><font face="Verdana" size="2" color="#000000"> Tantra Basico </font></div><div style="clear:both;"></div><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Fecha Reserva</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_7" name="element_7" value="" size="30" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana">Fecha completa (dia/mes/año)</font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Seleccionar Hora</b></font><span style="color:red;"><small>*</small></span></td><td style=""><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_8_0" name="element_8" value="11:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 11:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_8_1" name="element_8" value="11:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 11:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_8_2" name="element_8" value="12:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 12:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_8_3" name="element_8" value="12:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 12:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_8_4" name="element_8" value="16:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 16:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_8_5" name="element_8" value="17:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 17:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_8_6" name="element_8" value="17:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 17:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_8_7" name="element_8" value="18:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 18:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_8_8" name="element_8" value="18:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 18:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_8_9" name="element_8" value="19:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 19:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_8_10" name="element_8" value="19:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 19:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_8_11" name="element_8" value="20:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 20:00 </font></div><div style="clear:both;"></div><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana">Otros horarios consultar en observaciones</font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Observaciones</b></font><span style="color:red;"><small></small></span></td><td style=""><textarea id="element_9" name="element_9" cols="45" rows="10" class="validate[optional] "></textarea><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr><td colspan="2" align="left"><input name="element_counts" value="10" type="hidden" /><input value="Enviar" type="submit" /></td></tr></table></form><div><font face="Verdana" size="2" color="#000000">Powered by</font><span style="position: relative; padding-left: 3px; bottom: -5px;"><img src="http://www.emailmeform.com/builder/images/footer-logo.png" /></span><font face="Verdana" size="2" color="#000000">EMF </font><a style="text-decoration:none;" href="http://www.emailmeform.com" target="_blank"><font face="Verdana" size="2" color="#000000">Web Form</font></a></div>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-6149974612965116391.post-77703446450642702082010-10-08T19:12:00.000-07:002010-10-08T19:20:50.181-07:00Tantra Fusion para Homem<form id="emf-form" enctype="multipart/form-data" method="post" action="http://www.emailmeform.com/builder/form/oQ0VBhd7K8T11DbNfi8C0k0L"><table style="text-align:left;" cellpadding="2" cellspacing="0" border="0" bgcolor="#FFFFFF"><tr><td style="" colspan="2"><font face="Verdana" size="2" color="#000000"><b style="font-size:20px;">Solicitud de Marcaçao</b><br /><label style="font-size:15px;">Recheie todos os afastados<br /></label><br /></font></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Nombre</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_0" name="element_0" value="" size="60" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Email</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_1" name="element_1" class="validate[required,custom[email]]" value="" size="60" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Telefone</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_2" name="element_2" class="validate[required,custom[telephone]]" value="" size="30" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Localidad</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_3" name="element_3" value="" size="30" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Terapeuta</b></font><span style="color:red;"><small>*</small></span></td><td style=""><div style="width:100%;padding-bottom:5px;"><input id="element_4_0" name="element_4" value="Terapeuta Homem " class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> Terapeuta Homem </font></div><div style="clear:both;"></div><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Terapia</b></font><span style="color:red;"><small>*</small></span></td><td style=""><select id="element_5" name="element_5" class="validate[required]"><option value=""selected="selected">Seleccionar</option><option value="Tantra Fusion para Homem">Tantra Fusion para Homem</option></select><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Fecha Reserva</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_6" name="element_6" value="" size="30" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana">Data completa (dia/mes/ano)</font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Seleccionar Hora</b></font><span style="color:red;"><small>*</small></span></td><td style=""><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_0" name="element_7" value="11:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 11:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_1" name="element_7" value="11:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 11:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_2" name="element_7" value="12:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 12:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_3" name="element_7" value="12:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 12:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_4" name="element_7" value="16:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 16:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_5" name="element_7" value="17:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 17:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_6" name="element_7" value="17:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 17:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_7" name="element_7" value="18:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 18:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_8" name="element_7" value="18:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 18:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_9" name="element_7" value="19:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 19:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_10" name="element_7" value="19:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 19:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_11" name="element_7" value="20:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 20:00 </font></div><div style="clear:both;"></div><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana">Otros horarios consultar en observaciones</font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Observaciones</b></font><span style="color:red;"><small></small></span></td><td style=""><textarea id="element_8" name="element_8" cols="45" rows="10" class="validate[optional] "></textarea><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr><td colspan="2" align="left"><input name="element_counts" value="9" type="hidden" /><input value="Enviar" type="submit" /></td></tr></table></form><div><font face="Verdana" size="2" color="#000000">Powered by</font><span style="position: relative; padding-left: 3px; bottom: -5px;"><img src="http://www.emailmeform.com/builder/images/footer-logo.png" /></span><font face="Verdana" size="2" color="#000000">EMF </font><a style="text-decoration:none;" href="http://www.emailmeform.com" target="_blank"><font face="Verdana" size="2" color="#000000">Web Form</font></a></div>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-6149974612965116391.post-79342534318223569992010-10-08T18:56:00.000-07:002010-10-08T19:23:37.453-07:00Tantra Fusion para hombre<form id="emf-form" enctype="multipart/form-data" method="post" action="http://www.emailmeform.com/builder/form/oQ0VBhd7K8T11DbNfi8C0k0L"><table style="text-align:left;" cellpadding="2" cellspacing="0" border="0" bgcolor="#FFFFFF"><tr><td style="" colspan="2"><font face="Verdana" size="2" color="#000000"><b style="font-size:20px;">Solicitud de Reserva</b><br /><label style="font-size:15px;">Rellene todos los apartados<br /></label><br /></font></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Nombre</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_0" name="element_0" value="" size="60" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Email</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_1" name="element_1" class="validate[required,custom[email]]" value="" size="60" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Telefono</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_2" name="element_2" class="validate[required,custom[telephone]]" value="" size="30" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Localidad</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_3" name="element_3" value="" size="30" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Terapeuta</b></font><span style="color:red;"><small>*</small></span></td><td style=""><div style="width:100%;padding-bottom:5px;"><input id="element_4_0" name="element_4" value="Terapeuta Hombre " class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> Terapeuta Hombre </font></div><div style="clear:both;"></div><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Terapia</b></font><span style="color:red;"><small>*</small></span></td><td style=""><select id="element_5" name="element_5" class="validate[required]"><option value=""selected="selected">Seleccionar</option><option value="Tantra Fusion para Hombre">Tantra Fusion para Hombre</option></select><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Fecha Reserva</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_6" name="element_6" value="" size="30" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana">Fecha completa (dia/mes/año)</font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Seleccionar Hora</b></font><span style="color:red;"><small>*</small></span></td><td style=""><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_0" name="element_7" value="11:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 11:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_1" name="element_7" value="11:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 11:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_2" name="element_7" value="12:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 12:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_3" name="element_7" value="12:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 12:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_4" name="element_7" value="16:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 16:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_5" name="element_7" value="17:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 17:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_6" name="element_7" value="17:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 17:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_7" name="element_7" value="18:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 18:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_8" name="element_7" value="18:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 18:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_9" name="element_7" value="19:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 19:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_10" name="element_7" value="19:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 19:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_11" name="element_7" value="20:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 20:00 </font></div><div style="clear:both;"></div><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana">Otros horarios consultar en observaciones</font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Observaciones</b></font><span style="color:red;"><small></small></span></td><td style=""><textarea id="element_8" name="element_8" cols="45" rows="10" class="validate[optional] "></textarea><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr><td colspan="2" align="left"><input name="element_counts" value="9" type="hidden" /><input value="Enviar" type="submit" /></td></tr></table></form><div><font face="Verdana" size="2" color="#000000">Powered by</font><span style="position: relative; padding-left: 3px; bottom: -5px;"><img src="http://www.emailmeform.com/builder/images/footer-logo.png" /></span><font face="Verdana" size="2" color="#000000">EMF </font><a style="text-decoration:none;" href="http://www.emailmeform.com" target="_blank"><font face="Verdana" size="2" color="#000000">Web Form</font></a></div>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-6149974612965116391.post-62780717784005829922010-10-08T18:48:00.000-07:002010-10-08T18:53:35.051-07:00Tantra Fusion para Mulher<form id="emf-form" enctype="multipart/form-data" method="post" action="http://www.emailmeform.com/builder/form/oQ0VBhd7K8T11DbNfi8C0k0L"><table style="text-align:left;" cellpadding="2" cellspacing="0" border="0" bgcolor="#FFFFFF"><tr><td style="" colspan="2"><font face="Verdana" size="2" color="#000000"><b style="font-size:20px;">Solicitud de Marcaçao</b><br /><label style="font-size:15px;">Recheie todos os afastados<br /></label><br /></font></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Nome</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_0" name="element_0" value="" size="60" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Email</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_1" name="element_1" class="validate[required,custom[email]]" value="" size="60" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Telefone</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_2" name="element_2" class="validate[required,custom[telephone]]" value="" size="30" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Localidade</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_3" name="element_3" value="" size="30" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Terapeuta</b></font><span style="color:red;"><small>*</small></span></td><td style=""><div style="width:100%;padding-bottom:5px;"><input id="element_4_0" name="element_4" value="Terapeuta Mulher" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> Terapeuta Mulher </font></div><div style="width:100%;padding-bottom:5px;"><input id="element_4_1" name="element_4" value="Terapeuta Homem " class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> Terapeuta Homem </font></div><div style="clear:both;"></div><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Terapia</b></font><span style="color:red;"><small>*</small></span></td><td style=""><select id="element_5" name="element_5" class="validate[required]"><option value=""selected="selected">Seleccionar</option><option value="Tantra Fusion para Mulher">Tantra Fusion para Mulher</option></select><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Data Marcaçao</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_6" name="element_6" value="" size="30" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana">Data completa (dia/mes/ano)</font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Seleccionar Hora</b></font><span style="color:red;"><small>*</small></span></td><td style=""><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_0" name="element_7" value="11:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 11:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_1" name="element_7" value="11:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 11:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_2" name="element_7" value="12:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 12:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_3" name="element_7" value="12:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 12:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_4" name="element_7" value="16:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 16:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_5" name="element_7" value="17:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 17:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_6" name="element_7" value="17:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 17:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_7" name="element_7" value="18:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 18:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_8" name="element_7" value="18:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 18:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_9" name="element_7" value="19:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 19:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_10" name="element_7" value="19:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 19:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_11" name="element_7" value="20:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 20:00 </font></div><div style="clear:both;"></div><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana">Otros horarios consultar en observaciones</font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Observaciones</b></font><span style="color:red;"><small></small></span></td><td style=""><textarea id="element_8" name="element_8" cols="45" rows="10" class="validate[optional] "></textarea><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr><td colspan="2" align="left"><input name="element_counts" value="9" type="hidden" /><input value="Enviar" type="submit" /></td></tr></table></form><div><font face="Verdana" size="2" color="#000000">Powered by</font><span style="position: relative; padding-left: 3px; bottom: -5px;"><img src="http://www.emailmeform.com/builder/images/footer-logo.png" /></span><font face="Verdana" size="2" color="#000000">EMF </font><a style="text-decoration:none;" href="http://www.emailmeform.com" target="_blank"><font face="Verdana" size="2" color="#000000">Web Form</font></a></div>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-6149974612965116391.post-41718420331667049842010-10-08T18:41:00.000-07:002010-10-08T18:45:24.385-07:00Tantra Fusion para Mujer<form id="emf-form" enctype="multipart/form-data" method="post" action="http://www.emailmeform.com/builder/form/oQ0VBhd7K8T11DbNfi8C0k0L"><table style="text-align:left;" cellpadding="2" cellspacing="0" border="0" bgcolor="#FFFFFF"><tr><td style="" colspan="2"><font face="Verdana" size="2" color="#000000"><b style="font-size:20px;">Solicitud de Reserva</b><br /><label style="font-size:15px;">Rellene todos los apartados<br /></label><br /></font></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Nombre</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_0" name="element_0" value="" size="60" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Email</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_1" name="element_1" class="validate[required,custom[email]]" value="" size="60" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Telefono</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_2" name="element_2" class="validate[required,custom[telephone]]" value="" size="30" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Localidad</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_3" name="element_3" value="" size="30" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Terapeuta</b></font><span style="color:red;"><small>*</small></span></td><td style=""><div style="width:100%;padding-bottom:5px;"><input id="element_4_0" name="element_4" value="Terapeuta Mujer" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> Terapeuta Mujer </font></div><div style="width:100%;padding-bottom:5px;"><input id="element_4_1" name="element_4" value="Terapeuta Hombre " class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> Terapeuta Hombre </font></div><div style="clear:both;"></div><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Terapia</b></font><span style="color:red;"><small>*</small></span></td><td style=""><select id="element_5" name="element_5" class="validate[required]"><option value=""selected="selected">Seleccionar</option><option value="Tantra Fusion para Mujer">Tantra Fusion para Mujer</option></select><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Fecha Reserva</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_6" name="element_6" value="" size="30" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana">Fecha completa (dia/mes/año)</font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Seleccionar Hora</b></font><span style="color:red;"><small>*</small></span></td><td style=""><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_0" name="element_7" value="11:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 11:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_1" name="element_7" value="11:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 11:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_2" name="element_7" value="12:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 12:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_3" name="element_7" value="12:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 12:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_4" name="element_7" value="16:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 16:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_5" name="element_7" value="17:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 17:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_6" name="element_7" value="17:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 17:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_7" name="element_7" value="18:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 18:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_8" name="element_7" value="18:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 18:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_9" name="element_7" value="19:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 19:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_10" name="element_7" value="19:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 19:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_7_11" name="element_7" value="20:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 20:00 </font></div><div style="clear:both;"></div><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana">Otros horarios consultar en observaciones</font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Observaciones</b></font><span style="color:red;"><small></small></span></td><td style=""><textarea id="element_8" name="element_8" cols="45" rows="10" class="validate[optional] "></textarea><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr><td colspan="2" align="left"><input name="element_counts" value="9" type="hidden" /><input value="Enviar" type="submit" /></td></tr></table></form><div><font face="Verdana" size="2" color="#000000">Powered by</font><span style="position: relative; padding-left: 3px; bottom: -5px;"><img src="http://www.emailmeform.com/builder/images/footer-logo.png" /></span><font face="Verdana" size="2" color="#000000">EMF </font><a style="text-decoration:none;" href="http://www.emailmeform.com" target="_blank"><font face="Verdana" size="2" color="#000000">Web Form</font></a></div>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-6149974612965116391.post-19953578960612156392010-10-08T18:16:00.000-07:002010-10-08T18:26:26.602-07:00Massagem Tantra a Quatro Maos<form id="emf-form" enctype="multipart/form-data" method="post" action="http://www.emailmeform.com/builder/form/9b1eQrz28O0tM44c5fPm"><table style="text-align:left;" cellpadding="2" cellspacing="0" border="0" bgcolor="#FFFFFF"><tr><td style="" colspan="2"><font face="Verdana" size="2" color="#000000"><b style="font-size:20px;">Solicitud de Marcaçao</b><br /><label style="font-size:15px;">Recheie todos os afastados<br /></label><br /></font></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Nome</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_0" name="element_0" value="" size="60" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Email</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_1" name="element_1" class="validate[required,custom[email]]" value="" size="60" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Telefone</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_2" name="element_2" class="validate[required,custom[telephone]]" value="" size="30" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Localidade</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_3" name="element_3" value="" size="30" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Terapeutas</b></font><span style="color:red;"><small>*</small></span></td><td style=""><div style="width:100%;padding-bottom:5px;"><input id="element_4_0" name="element_4" value="Terapeutas Mulher e Mulher" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> Terapeutas Mulher e Mulher </font></div><div style="width:100%;padding-bottom:5px;"><input id="element_4_1" name="element_4" value="Terapeutas Homem e Mulher" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> Terapeutas Homem e Mulher </font></div><div style="clear:both;"></div><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Terapia</b></font><span style="color:red;"><small>*</small></span></td><td style=""><select id="element_5" name="element_5" class="validate[required]"><option value=""selected="selected">Seleccionar</option><option value="Tantra quatro mãos para Mulher ">Tantra quatro mãos para Mulher </option><option value="Tantra quatro mãos para Homem">Tantra quatro mãos para Homem</option></select><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Opciones:</b></font><span style="color:red;"><small>*</small></span></td><td style=""><div style="width:100%;padding-bottom:5px;"><input id="element_6_0" name="element_6[]" value="Tantra Completo" class="validate[required]" type="checkbox" /><font face="Verdana" size="2" color="#000000"> Tantra Completo </font></div><div style="width:100%;padding-bottom:5px;"><input id="element_6_1" name="element_6[]" value="Tantra Basico" class="validate[required]" type="checkbox" /><font face="Verdana" size="2" color="#000000"> Tantra Basico </font></div><div style="clear:both;"></div><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Data Marcaçao</b></font><span style="color:red;"><small>*</small></span></td><td style=""><input id="element_7" name="element_7" value="" size="30" class="validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana">Data completa (dia/mes/ano)</font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Seleccionar Hora</b></font><span style="color:red;"><small>*</small></span></td><td style=""><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_8_0" name="element_8" value="11:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 11:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_8_1" name="element_8" value="11:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 11:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_8_2" name="element_8" value="12:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 12:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_8_3" name="element_8" value="12:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 12:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_8_4" name="element_8" value="16:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 16:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_8_5" name="element_8" value="17:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 17:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_8_6" name="element_8" value="17:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 17:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_8_7" name="element_8" value="18:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 18:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_8_8" name="element_8" value="18:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 18:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_8_9" name="element_8" value="19:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 19:00 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_8_10" name="element_8" value="19:30" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 19:30 </font></div><div style="float:left;width:33%;padding-bottom:5px;"><input id="element_8_11" name="element_8" value="20:00" class="validate[required]" type="radio" /><font face="Verdana" size="2" color="#000000"> 20:00 </font></div><div style="clear:both;"></div><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana">Otros horarios consultar en observaciones</font></small></div></td></tr><tr valign="top"><td style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Observaciones</b></font><span style="color:red;"><small></small></span></td><td style=""><textarea id="element_9" name="element_9" cols="45" rows="10" class="validate[optional] "></textarea><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div></td></tr><tr><td colspan="2" align="left"><input name="element_counts" value="10" type="hidden" /><input value="Enviar" type="submit" /></td></tr></table></form><div><font face="Verdana" size="2" color="#000000">Powered by</font><span style="position: relative; padding-left: 3px; bottom: -5px;"><img src="http://www.emailmeform.com/builder/images/footer-logo.png" /></span><font face="Verdana" size="2" color="#000000">EMF </font><a style="text-decoration:none;" href="http://www.emailmeform.com" target="_blank"><font face="Verdana" size="2" color="#000000">PHP Form</font></a></div>Unknownnoreply@blogger.com