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For more information contact Hostedware Corporation, 16 Technology Dr Ste 116, Irvine, CA, 92618 USA. (800) 211-6967; (949) 585-1500.
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<Script src="application/JS/TakeSurvey.js"></Script>
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<SCRIPT LANGUAGE="JavaScript">

function checkChoice(field, i) {
if (i == field.length-1) { 
if (field[field.length-1].checked == true) {
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field[i].checked = false;
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else  { 
if (field[i].checked == true) {
field[field.length-1].checked = false;
	  }
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}
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<html>
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		<title>Hosted Survey</title>
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			<td valign="top">
	<font color="#669999"><font size=1><font face="Verdana,Arial,Helvetica,sans-serif"><b>USA State Primary Election Ballot (Republican Party)</b></font></font></font>
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					<input type="hidden" name="a" value="502525">
		<font color="#000000"><font size=3><font face="Verdana,Arial,Helvetica,sans-serif"><b><table border="1" cellspacing="1" style="border-left-style: solid; border-left-width: 3; border-right-style: solid; border-right-width: 3; border-top-style: solid; border-top-width: 3; border-bottom-width: 3" width="100%" id="AutoNumber1" bordercolorlight="#598A90" bordercolordark="#598A90" height="32">
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    <p align="left"><font color="#598A90">Primary Election                                   <b>OFFICIAL BALLOT</b><br>Orange County <br> March 02, 2004                                                                              Precinct 0038376-REP</font></td>
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</table></b></font></font></font></td></tr>
			<tr><td bgcolor="#EBEDED">&nbsp;</td></tr>
			
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					<input type="hidden" name="a" value="502170">
		<font color="#000000"><font size=2><font face="Verdana,Arial,Helvetica,sans-serif"><b><table border="1" cellspacing="0" width="100%" style="border-collapse: collapse; border-style: solid; border-width: 1; padding-left: 4; padding-right: 4; padding-top: 1; padding-bottom: 1" id="AutoNumber1" bordercolor="#111111" cellpadding="0" height="1">
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</table>Instruction Note:<br>
</b>Please enter your choices on the following ballot. To vote for your choice in each contest, select the box provided to the left of your choice. To vote for type-in candidate, choose the box provided to the left of the words "Type-in" and write in the name of the candidate on the space provided.<table border="1" cellspacing="0" width="100%" style="border-collapse: collapse; border-style: solid; border-width: 1; padding-left: 4; padding-right: 4; padding-top: 1; padding-bottom: 1" id="AutoNumber1" bordercolor="#111111" cellpadding="0" height="1">
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    <td width="100%" height=".5" bgcolor="#598A90"></td>
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</table></b></font></font></font></td></tr>
			<tr><td bgcolor="#EBEDED">&nbsp;</td></tr>
			
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					<input type="hidden" name="a" value="502171">
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						<font color="#000000"><font size=2><font face="Verdana,Arial,Helvetica,sans-serif"><b>PRESIDENT OF THE UNITED STATES<br>
Republican Party<br>
Vote for One</b></font></font></font>
	<tr>
	  <td width="100%"bgcolor="#EBEDED">
	<table><tr><td><input type="radio" name="rad502171" value="1065335" ><input type="hidden" name="q1code-502171-1065335" value="1"><input type="hidden" name="q1desc-502171-1065335" value="GEORGE W. BUSH"><font color="#000000"><font size=2><font face="Verdana,Arial,Helvetica,sans-serif">GEORGE W. BUSH</font></font></font>&nbsp;&nbsp;</td><td><input type="radio" name="rad502171" value="1065336" ><input type="hidden" name="q1code-502171-1065336" value="2"><input type="hidden" name="q1desc-502171-1065336" value="Type-in"><font color="#000000"><font size=2><font face="Verdana,Arial,Helvetica,sans-serif">Type-in</font></font></font>&nbsp;&nbsp;</td></tr></table></td></tr>
			<tr><td bgcolor="#EBEDED">&nbsp;</td></tr>
			
			<tr>
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					<input type="hidden" name="a" value="502173">
		<input type="hidden" name="q11" value="502173">
						<input type="hidden" name="required-502173" value="False">
						<font color="#000000"><font size=2><font face="Verdana,Arial,Helvetica,sans-serif"><b></b></font></font></font><p><p><table border=0 cellpadding=2><tr><td><font color="#000000"><font size=2><font face="Verdana,Arial,Helvetica,sans-serif"><b>If you chose type-in above, please enter your selected candidate.</b></font></font></font></td><td>
					<input type="hidden" name="a" value="502174">
					<input type="hidden" name="q3" value="502174">
					<input type="hidden" name="required-502174" value="False">
					<input type="text" name="txt502174" size="20" maxlength="30" value="" align="right">
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				</table></td></tr>
			<tr><td bgcolor="#EBEDED">&nbsp;</td></tr>
			
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				<td width="100%" bgcolor="#EBEDED">
					<input type="hidden" name="a" value="502531">
		<font color="#000000"><font size=2><font face="Verdana,Arial,Helvetica,sans-serif"><b><table border="1" cellspacing="0" width="100%" style="border-collapse: collapse; border-style: solid; border-width: 1; padding-left: 4; padding-right: 4; padding-top: 1; padding-bottom: 1" id="AutoNumber1" bordercolor="#111111" cellpadding="0" height="1">
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    <td width="100%" height=".5" bgcolor="#598A90"></td>
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</table></b></font></font></font></td></tr>
			<tr><td bgcolor="#EBEDED">&nbsp;</td></tr>
			
			<tr>
				<td width="100%" bgcolor="#EBEDED">
					<input type="hidden" name="a" value="502175">
		<input type="hidden" name="q1" value="502175">
						<input type="hidden" name="required-502175" value="False">
						<font color="#000000"><font size=2><font face="Verdana,Arial,Helvetica,sans-serif"><b>UNITED STATES SENATOR<br>
Republican Party<br>
Vote for One</b></font></font></font>
	<tr>
	  <td width="100%"bgcolor="#EBEDED">
	<table><tr><td><input type="radio" name="rad502175" value="1065337" ><input type="hidden" name="q1code-502175-1065337" value="1"><input type="hidden" name="q1desc-502175-1065337" value="TIM STOEN <br>&nbsp;&nbsp;&nbsp;&nbsp;Assistant District Attorney"><font color="#000000"><font size=2><font face="Verdana,Arial,Helvetica,sans-serif">TIM STOEN <br>&nbsp;&nbsp;&nbsp;&nbsp;Assistant District Attorney</font></font></font>&nbsp;&nbsp;</td><td><input type="radio" name="rad502175" value="1065338" ><input type="hidden" name="q1code-502175-1065338" value="2"><input type="hidden" name="q1desc-502175-1065338" value="TONI CASEY<br>&nbsp;&nbsp;&nbsp;&nbsp;Businesswoman"><font color="#000000"><font size=2><font face="Verdana,Arial,Helvetica,sans-serif">TONI CASEY<br>&nbsp;&nbsp;&nbsp;&nbsp;Businesswoman</font></font></font>&nbsp;&nbsp;</td></tr><tr><td><input type="radio" name="rad502175" value="1065339" ><input type="hidden" name="q1code-502175-1065339" value="3"><input type="hidden" name="q1desc-502175-1065339" value="HOWARD KALOOGIAN<br>&nbsp;&nbsp;&nbsp;&nbsp;Businessman/Tax Attorney"><font color="#000000"><font size=2><font face="Verdana,Arial,Helvetica,sans-serif">HOWARD KALOOGIAN<br>&nbsp;&nbsp;&nbsp;&nbsp;Businessman/Tax Attorney</font></font></font>&nbsp;&nbsp;</td><td><input type="radio" name="rad502175" value="1065340" ><input type="hidden" name="q1code-502175-1065340" value="4"><input type="hidden" name="q1desc-502175-1065340" value="DANNEY BALL<br>&nbsp;&nbsp;&nbsp;&nbsp;Businessman/Educator/Musician"><font color="#000000"><font size=2><font face="Verdana,Arial,Helvetica,sans-serif">DANNEY BALL<br>&nbsp;&nbsp;&nbsp;&nbsp;Businessman/Educator/Musician</font></font></font>&nbsp;&nbsp;</td></tr><tr><td><input type="radio" name="rad502175" value="1065341" ><input type="hidden" name="q1code-502175-1065341" value="5"><input type="hidden" name="q1desc-502175-1065341" value="BARRY L. HATCH<br> &nbsp;&nbsp;&nbsp;&nbsp;Educator"><font color="#000000"><font size=2><font face="Verdana,Arial,Helvetica,sans-serif">BARRY L. HATCH<br> &nbsp;&nbsp;&nbsp;&nbsp;Educator</font></font></font>&nbsp;&nbsp;</td><td><input type="radio" name="rad502175" value="1065342" ><input type="hidden" name="q1code-502175-1065342" value="6"><input type="hidden" name="q1desc-502175-1065342" value="ROSARIO MARIN<br>&nbsp;&nbsp;&nbsp;&nbsp;U.S. Treasurer/Lecturer"><font color="#000000"><font size=2><font face="Verdana,Arial,Helvetica,sans-serif">ROSARIO MARIN<br>&nbsp;&nbsp;&nbsp;&nbsp;U.S. Treasurer/Lecturer</font></font></font>&nbsp;&nbsp;</td></tr><tr><td><input type="radio" name="rad502175" value="1065343" ><input type="hidden" name="q1code-502175-1065343" value="7"><input type="hidden" name="q1desc-502175-1065343" value="BILL JONES<br>&nbsp;&nbsp;&nbsp;&nbsp;Farmer/Businessman"><font color="#000000"><font size=2><font face="Verdana,Arial,Helvetica,sans-serif">BILL JONES<br>&nbsp;&nbsp;&nbsp;&nbsp;Farmer/Businessman</font></font></font>&nbsp;&nbsp;</td><td><input type="radio" name="rad502175" value="1065344" ><input type="hidden" name="q1code-502175-1065344" value="8"><input type="hidden" name="q1desc-502175-1065344" value="BILL QURAISHI<br>&nbsp;&nbsp;&nbsp;&nbsp;Small Business Owner"><font color="#000000"><font size=2><font face="Verdana,Arial,Helvetica,sans-serif">BILL QURAISHI<br>&nbsp;&nbsp;&nbsp;&nbsp;Small Business Owner</font></font></font>&nbsp;&nbsp;</td></tr><tr><td><input type="radio" name="rad502175" value="1065345" ><input type="hidden" name="q1code-502175-1065345" value="9"><input type="hidden" name="q1desc-502175-1065345" value="JOHN M. VAN ZANDT<br>&nbsp;&nbsp;&nbsp;&nbsp;Businessman"><font color="#000000"><font size=2><font face="Verdana,Arial,Helvetica,sans-serif">JOHN M. VAN ZANDT<br>&nbsp;&nbsp;&nbsp;&nbsp;Businessman</font></font></font>&nbsp;&nbsp;</td><td><input type="radio" name="rad502175" value="1065346" ><input type="hidden" name="q1code-502175-1065346" value="10"><input type="hidden" name="q1desc-502175-1065346" value="JAMES STEWART<br>&nbsp;&nbsp;&nbsp;&nbsp;Small Businessman"><font color="#000000"><font size=2><font face="Verdana,Arial,Helvetica,sans-serif">JAMES STEWART<br>&nbsp;&nbsp;&nbsp;&nbsp;Small Businessman</font></font></font>&nbsp;&nbsp;</td></tr><tr><td><input type="radio" name="rad502175" value="1065347" ><input type="hidden" name="q1code-502175-1065347" value="11"><input type="hidden" name="q1desc-502175-1065347" value="Type-in"><font color="#000000"><font size=2><font face="Verdana,Arial,Helvetica,sans-serif">Type-in</font></font></font>&nbsp;&nbsp;</td></tr></table></td></tr>
			<tr><td bgcolor="#EBEDED">&nbsp;</td></tr>
			
			<tr>
				<td width="100%" bgcolor="#EBEDED">
					<input type="hidden" name="a" value="502181">
		<input type="hidden" name="q11" value="502181">
						<input type="hidden" name="required-502181" value="False">
						<font color="#000000"><font size=2><font face="Verdana,Arial,Helvetica,sans-serif"><b></b></font></font></font><p><p><table border=0 cellpadding=2><tr><td><font color="#000000"><font size=2><font face="Verdana,Arial,Helvetica,sans-serif"><b>If you chose type-in above, please enter your selected candidate.</b></font></font></font></td><td>
					<input type="hidden" name="a" value="502183">
					<input type="hidden" name="q3" value="502183">
					<input type="hidden" name="required-502183" value="False">
					<input type="text" name="txt502183" size="20" maxlength="30" value="" align="right">
				</td></tr>
				</table></td></tr>
			<tr><td bgcolor="#EBEDED">&nbsp;</td></tr>
			
			<tr>
				<td width="100%" bgcolor="#EBEDED">
					<input type="hidden" name="a" value="502533">
		<font color="#000000"><font size=2><font face="Verdana,Arial,Helvetica,sans-serif"><b><table border="1" cellspacing="0" width="100%" style="border-collapse: collapse; border-style: solid; border-width: 1; padding-left: 4; padding-right: 4; padding-top: 1; padding-bottom: 1" id="AutoNumber1" bordercolor="#111111" cellpadding="0" height="1">
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    <td width="100%" height=".5" bgcolor="#598A90"></td>
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</table></b></font></font></font></td></tr>
			<tr><td bgcolor="#EBEDED">&nbsp;</td></tr>
			
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						<font color="#000000"><font size=2><font face="Verdana,Arial,Helvetica,sans-serif"><b>UNITED STATES REPRESENTATIVE<br>
48th District<br>
Republican Party<br>
Vote for One</b></font></font></font>
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	<table><tr><td><input type="radio" name="rad502186" value="1065348" ><input type="hidden" name="q1code-502186-1065348" value="1"><input type="hidden" name="q1desc-502186-1065348" value="CHRISTOPHER COX<br>&nbsp;&nbsp;&nbsp;&nbsp;United States Representative"><font color="#000000"><font size=2><font face="Verdana,Arial,Helvetica,sans-serif">CHRISTOPHER COX<br>&nbsp;&nbsp;&nbsp;&nbsp;United States Representative</font></font></font>&nbsp;&nbsp;</td></tr><tr><td><input type="radio" name="rad502186" value="1065349" ><input type="hidden" name="q1code-502186-1065349" value="2"><input type="hidden" name="q1desc-502186-1065349" value="Type-in"><font color="#000000"><font size=2><font face="Verdana,Arial,Helvetica,sans-serif">Type-in</font></font></font>&nbsp;&nbsp;</td></tr></table></td></tr>
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						<font color="#000000"><font size=2><font face="Verdana,Arial,Helvetica,sans-serif"><b></b></font></font></font><p><p><table border=0 cellpadding=2><tr><td><font color="#000000"><font size=2><font face="Verdana,Arial,Helvetica,sans-serif"><b>If you chose type-in above, please enter your selected candidate.</b></font></font></font></td><td>
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						<font color="#000000"><font size=2><font face="Verdana,Arial,Helvetica,sans-serif"><b>STATE SENATOR<br>
33rd District<br>
Republican Party<br>
Vote for One</b></font></font></font>
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	<table><tr><td><input type="radio" name="rad502190" value="1065350" ><input type="hidden" name="q1code-502190-1065350" value="1"><input type="hidden" name="q1desc-502190-1065350" value="DICK ACKERMAN <br>&nbsp;&nbsp;&nbsp;&nbsp;State Senator, 33rd District"><font color="#000000"><font size=2><font face="Verdana,Arial,Helvetica,sans-serif">DICK ACKERMAN <br>&nbsp;&nbsp;&nbsp;&nbsp;State Senator, 33rd District</font></font></font>&nbsp;&nbsp;</td></tr><tr><td><input type="radio" name="rad502190" value="1065351" ><input type="hidden" name="q1code-502190-1065351" value="2"><input type="hidden" name="q1desc-502190-1065351" value="Type-in"><font color="#000000"><font size=2><font face="Verdana,Arial,Helvetica,sans-serif">Type-in</font></font></font>&nbsp;&nbsp;</td></tr></table></td></tr>
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						<font color="#000000"><font size=2><font face="Verdana,Arial,Helvetica,sans-serif"><b></b></font></font></font><p><p><table border=0 cellpadding=2><tr><td><font color="#000000"><font size=2><font face="Verdana,Arial,Helvetica,sans-serif"><b>If you chose type-in above, please enter your selected candidate.</b></font></font></font></td><td>
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						<font color="#000000"><font size=2><font face="Verdana,Arial,Helvetica,sans-serif"><b>MEMBER OF THE STATE ASSEMBLY<br>
73rd District<br>
Republican Party<br>
Vote for One</b></font></font></font>
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	<table><tr><td><input type="radio" name="rad502195" value="1065352" ><input type="hidden" name="q1code-502195-1065352" value="1"><input type="hidden" name="q1desc-502195-1065352" value="THOMAS W. &quot;TOM&quot; WILSON<br>&nbsp;&nbsp;&nbsp;&nbsp;County Supervisor"><font color="#000000"><font size=2><font face="Verdana,Arial,Helvetica,sans-serif">THOMAS W. "TOM" WILSON<br>&nbsp;&nbsp;&nbsp;&nbsp;County Supervisor</font></font></font>&nbsp;&nbsp;</td></tr><tr><td><input type="radio" name="rad502195" value="1065353" ><input type="hidden" name="q1code-502195-1065353" value="2"><input type="hidden" name="q1desc-502195-1065353" value="MIMI WALTERS<br>&nbsp;&nbsp;&nbsp;&nbsp;Councilwoman/Small Businesswoman"><font color="#000000"><font size=2><font face="Verdana,Arial,Helvetica,sans-serif">MIMI WALTERS<br>&nbsp;&nbsp;&nbsp;&nbsp;Councilwoman/Small Businesswoman</font></font></font>&nbsp;&nbsp;</td></tr><tr><td><input type="radio" name="rad502195" value="1065354" ><input type="hidden" name="q1code-502195-1065354" value="3"><input type="hidden" name="q1desc-502195-1065354" value="JIM GIBSON<br>&nbsp;&nbsp;&nbsp;&nbsp;Businessman/Hi-Tech Businessowner"><font color="#000000"><font size=2><font face="Verdana,Arial,Helvetica,sans-serif">JIM GIBSON<br>&nbsp;&nbsp;&nbsp;&nbsp;Businessman/Hi-Tech Businessowner</font></font></font>&nbsp;&nbsp;</td></tr><tr><td><input type="radio" name="rad502195" value="1065355" ><input type="hidden" name="q1code-502195-1065355" value="4"><input type="hidden" name="q1desc-502195-1065355" value="Type-in"><font color="#000000"><font size=2><font face="Verdana,Arial,Helvetica,sans-serif">Type-in</font></font></font>&nbsp;&nbsp;</td></tr></table></td></tr>
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						<font color="#000000"><font size=2><font face="Verdana,Arial,Helvetica,sans-serif"><b></b></font></font></font><p><p><table border=0 cellpadding=2><tr><td><font color="#000000"><font size=2><font face="Verdana,Arial,Helvetica,sans-serif"><b>If you chose type-in above, please enter your selected candidate.</b></font></font></font></td><td>
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