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<title>&#1491;&#1507; &#1495;&#1491;&#1513; 1</title>
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      <input type="hidden" value="medikal/post" name="tsscript">
      <td>&nbsp;
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          <input class="input" dir="rtl" size="25" name="fname"></td>
          <td class="font" align="left">&nbsp;&nbsp;:&#1513;&#1501; &#1502;&#1500;&#1488;</td>
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          <input class="input" size="3" name="kidomet">&nbsp;-&nbsp;<input class="input" size="17" name="phone"></td>
          <td class="font" align="left">&nbsp;&nbsp;:&#1496;&#1500;&#1508;&#1493;&#1503;</td>
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          <td class="font" align="left">&nbsp;&nbsp;:&#1499;&#1514;&#1493;&#1489;&#1514;</td>
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          <input class="input" style="FLOAT: right" size="25" name="email"></td>
          <td class="font" align="left">&nbsp;&nbsp;:E-mail</td>
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    <span lang="HE" style="FONT-FAMILY: Arial"><font size="3">&#1508;&#1512;&#1505;&#1493;&#1501; &#1494;&#1492; &#1504;&#1513;&#1500;&#1495; &#1488;&#1500;&#1497;&#1498; 
    &#1489;&#1488;&#1493;&#1508;&#1503; &#1495;&#1491; &#1508;&#1506;&#1502;&#1497;. &#1488;&#1504;&#1493; &#1502;&#1514;&#1504;&#1510;&#1500;&#1497;&#1501; &#1488;&#1501; &#1492;&#1508;&#1512;&#1506;&#1504;&#1493; &#1488;&#1504;&#1493; &#1504;&#1499;&#1489;&#1491; &#1499;&#1500; &#1489;&#1511;&#1513;&#1492; &#1500;<a style="COLOR: blue; TEXT-DECORATION: underline" href="http://84.94.225.120/~zipi/tgova.php?action=sign">&#1492;&#1505;&#1512;&#1492;</a> 
    &#1502;&#1512;&#1513;&#1497;&#1502;&#1514; &#1492;&#1514;&#1508;&#1493;&#1510;&#1492;. </font></span></b></td>
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