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<center><table width="100%"height="25%" background="1.gif"><tr><td><marquee behavior="scroll"direction="right" background="1.gif"><font face="comic sans ms"size="7"color="#b00000">&#1571;&#1607;&#1604;&#1575; &#1608;&#1587;&#1607;&#1604;&#1575; &#1576;&#1603; &#1601;&#1610; &#1602;&#1587;&#1605; &#1575;&#1604;&#1578;&#1587;&#1580;&#1610;&#1604; &#1601;&#1610; &#1575;&#1604;&#1605;&#1608;&#1602;&#1593;</font></marquee></td></tr></table></center>
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<td><font face="arial"size="4"color="#b00000"><br>&#1575;&#1604;&#1573;&#1587;&#1605; &#1575;&#1571;&#1608;&#1604; :</font></td>
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<td><font face="arial"size="4"color="#b00000" 

><br>&#1575;&#1604;&#1575;&#1587;&#1605; &#1575;&#1604;&#1571;&#1582;&#1610;&#1585; :</font></td>
<td width="288" background="43.gif"><input type="text"name="the name"value=""size="40"color="#43f678"maxlength="25"></td></tr>
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<td><font face="arial"size="4"color="#b00000"background="43.gif"><br>&#1575;&#1604;&#1605;&#1572;&#1607;&#1604; &#1575;&#1604;&#1593;&#1604;&#1605;&#1610; :</font></td>
<td width="288" background="1.gif"><input type="text"name="the name"value=""size="40"maxlength="25"></td></tr>
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<td><font face="arial"size="4"color="#b00000"><br>&#1575;&#1604;&#1607;&#1608;&#1575;&#1610;&#1577; :</font></td>
<td width="288" background="1.gif"><input type="text"name="the name"value=""size="40"maxlength="25"></td></tr>
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<td><font face="arial"size="4"color="#b00000"><br>&#1575;&#1604;&#1576;&#1585;&#1610;&#1583; &#1575;&#1604;&#1573;&#1604;&#1603;&#1578;&#1585;&#1608;&#1606;&#1610; :</td>
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<font face="arial"size="4"color="#b00000"><br>&#1571;&#1583;&#1582;&#1604; &#1575;&#1604;&#1589;&#1608;&#1585;&#1577; : </font>
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<td width="-2"><font face="arial"size="4"color="#b00000" align="right" valign="top">&#1578;&#1575;&#1585;&#1610;&#1582; &#1575;&#1604;&#1605;&#1610;&#1604;&#1575;&#1583; :<br>&nbsp;</td>
<td width="-2"><font face="arial"size="4"color="#b00000"><span lang="ar-sa">&nbsp; </span>&#1575;&#1604;&#1610;&#1608;&#1605;&nbsp;&nbsp;
</font><select name="D1"><option>- -</option>
<option>1</option>
<option>2</option>
<option>3</option>
<option>4</option>
<option>5</option>
<option>6</option>
<option>7</option>
<option>8</option>
<option>9</option>
<option>10</option>
<option>11</option>
<option>12</option>
<option>13</option>
<option>14</option>
<option>15</option>
<option>16</option>
<option>17</option>
<option>18</option>
<option>19</option>
<option>20</option>
<option>21</option>
<option>22</option>
<option>23</option>
<option>24</option>
<option>25</option>
<option>26</option>
<option>27</option>
<option>28</option>
<option>29</option>
<option>30</option>
<option>31</option>
</select> 
<font face="arial"size="4"color="#b00000"><span lang="ar-sa">&#1575;&#1604;&#1588;&#1607;&#1585; <select size="1" name="12">

<option>- -</option>
<option>1</option>
<option>2</option>
<option>3</option>
<option>4</option>
<option>5</option>
<option>6</option>
<option>7</option>
<option>8</option>
<option>9</option>
<option>10</option>
<option>11</option>
<option>12</option>
</select> &#1575;&#1604;&#1587;&#1606;&#1577; <select size="1" name="2020">
<font face="arial"size="4"color="#b00000">
<option>- - - -</option>
<option>1980</option>
<option>1981</option>
<option>1982</option>
<option>1983</option>
<option>1984</option>
<option>1985</option>
<option>1986</option>
<option>1987</option>
<option>1988</option>
<option>1989</option>
<option>1990</option>
<option>1991</option>
<option>1992</option>
<option>1993</option>
<option>1994</option>
<option>1995</option>
<option>1996</option>
<option>1997</option>
<option>1998</option>
<option>1999</option>
<option>2000</option>
<option>2001</option>
<option>2002</option>
<option>2003</option>
<option>2004</option>
<option>2005</option>
<option>2006</option>
<option>2007</option>
<option>2008</option>
<option>2009</option>
<option>2010</option>
<option>2011</option>
<option>2012</option>
<option>2013</option>
<option>2014</option>
<option>2015</option>
<option>2016</option>
<option>2017</option>
<option>2018</option>
<option>2019</option>
<option>2020</option>
</select></span><font face="arial"size="4"color="#b00000"><p>&nbsp;</p>
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