<div class="lightbox_body"><img alt="" height="41" width="68" src="/images/icon_lightbox_alert.gif" class="icon"/><a rel="deactivate" class="lbAction lbClose" href="#"><img alt="Close" height="17" width="18" src="/images/btn_lb_close.gif"/></a><h4>Contact Brighton Hotel Motel!</h4><div class="content cnf"><form id="providerF" onSubmit="submitform=0; if (validateForm(this)) { return submitViaAjax(this); }" class="layedout provider cnf" method="post" action="/communications"><div class="ajaxform_form"><input value="process" name="task" type="hidden"/><input style="display: none;" value="" name="gotcha" type="text"/><input value="Brighton Hotel Motel" name="toName" type="hidden"/><input value="motelbrighton@netspace.net.au" name="toEmail" type="hidden"/><input value="Fiona.Dewar@northmidlands.tas.gov.au" name="bccEmail" type="hidden"/><input value="Thank you, your provider enquiry has been sent." name="thankyouMsg" type="hidden"/><ul class=""><li class="setTitle"><label>Your Name *</label><input class="txt lbName" type="text" name="fromName"/><input value="Your Name" name="CAPTIONfromName" type="hidden"/><input value="TEXT_YES|" name="VALIDATORfromName" type="hidden"/></li><li><label>Your Email Address *</label><input class="txt lbEmail" type="text" name="fromEmail"/><input value="Your Email Address" name="CAPTIONfromEmail" type="hidden"/><input value="TEXT_YES|EMAIL" name="VALIDATORfromEmail" type="hidden"/></li><li class="setTitle"><label>Your Phone Number *</label><input class="txt lbPhone" type="text" name="phone"/><input value="Your Phone Number" name="CAPTIONphone" type="hidden"/><input value="TEXT_YES|PHONENUMBER" name="VALIDATORphone" type="hidden"/></li><li class="setTitle"><label>Subject *</label><input class="txt lbSubject" type="text" name="subject"/><input value="Subject" name="CAPTIONsubject" type="hidden"/><input value="TEXT_YES|" name="VALIDATORsubject" type="hidden"/></li><li class="setTitle"><label>Enquiry *</label><textarea cols="50" rows="6" class="txt lbEnquiry" name="enquiry"></textarea><input value="Enquiry" name="CAPTIONenquiry" type="hidden"/><input value="TEXT_YES|" name="VALIDATORenquiry" type="hidden"/></li></ul><ol><li><input value="1" name="confirmation" class="checkbox" type="checkbox"/><label class="checkbox">Send yourself a confirmation email</label></li><li class="btns"><a onclick="submitform=0; if (validateForm(document.getElementById('providerF'))) { return submitViaAjax(document.getElementById('providerF')); }" class="btn submit_flat" href="#">Submit</a></li><li class="btns"><a rel="deactivate" class="btn cancel lbAction button_close_LB" href="#">Cancel</a></li></ol></div><div class="ajaxform_loading">
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