| 430
| <![CDATA[<fieldset class="formContainer formHorizontal" id="rsform_29_page_0">
<div class="formRow">
<div class="formSpan12">
<div class="rsform-block rsform-block-nome">
<label class="formControlLabel" for="nome">Nome<strong class="formRequired">(*)</strong></label>
<div class="formControls">
<div class="formBody">
<input type="text" value="" size="20" name="form[nome]" id="nome" class="rsform-input-box" />
<span class="formValidation"><span id="component432" class="formNoError">Informe seu nome.</span></span>
<p class="formDescription"></p>
</div>
</div>
</div>
<div class="rsform-block rsform-block-email">
<label class="formControlLabel" for="email">E-mail</label>
<div class="formControls">
<div class="formBody">
<input type="text" value="" size="20" name="form[email]" id="email" class="rsform-input-box" />
<span class="formValidation"><span id="component433" class="formNoError">Preencha seu e-mail corretamente.</span></span>
<p class="formDescription"></p>
</div>
</div>
</div>
<div class="rsform-block rsform-block-idade">
<label class="formControlLabel" for="idade">Idade</label>
<div class="formControls">
<div class="formBody">
<input type="number" value="" size="2" step="1" name="form[idade]" id="idade" class="rsform-input-box" />
<span class="formValidation"><span id="component437" class="formNoError">Preencha corretamente a sua idade.</span></span>
<p class="formDescription"></p>
</div>
</div>
</div>
<div class="rsform-block rsform-block-estado">
<label class="formControlLabel" for="estado">Estado</label>
<div class="formControls">
<div class="formBody">
<select name="form[estado][]" id="estado" class="rsform-select-box"><option value="Acre">Acre</option><option value="Alagoas">Alagoas</option><option value="Alagoas">Alagoas</option><option value="Amazonas">Amazonas</option><option value="Bahia">Bahia</option><option value="Ceará">Ceará</option><option value="Distrito Federal">Distrito Federal</option><option value="Espírito Santo">Espírito Santo</option><option value="Goiás">Goiás</option><option value="Maranhão">Maranhão</option><option value="Mato Grosso">Mato Grosso</option><option value="Mato Grosso do Sul">Mato Grosso do Sul</option><option value="Minas Gerais">Minas Gerais</option><option value="Pará">Pará</option><option value="Paraíba">Paraíba</option><option value="Paraná">Paraná</option><option value="Pernambuco">Pernambuco</option><option value="Piauí">Piauí</option><option value="Rio de Janeiro">Rio de Janeiro</option><option value="Rio Grande do Norte">Rio Grande do Norte</option><option value="Rio Grande do Sul">Rio Grande do Sul</option><option value="Rondônia">Rondônia</option><option value="Roraima">Roraima</option><option value="Santa Catarina">Santa Catarina</option><option value="São Paulo">São Paulo</option><option value="Sergipe">Sergipe</option><option value="Tocantins">Tocantins</option></select>
<span class="formValidation"><span id="component438" class="formNoError">Entrada Inválida</span></span>
<p class="formDescription"></p>
</div>
</div>
</div>
<div class="rsform-block rsform-block-municipio">
<label class="formControlLabel" for="municipio">Município</label>
<div class="formControls">
<div class="formBody">
<input type="text" value="" size="20" name="form[municipio]" id="municipio" class="rsform-input-box" />
<span class="formValidation"><span id="component439" class="formNoError">Informe seu município.</span></span>
<p class="formDescription"></p>
</div>
</div>
</div>
<div class="rsform-block rsform-block-titulo">
<label class="formControlLabel" for="titulo">Título<strong class="formRequired">(*)</strong></label>
<div class="formControls">
<div class="formBody">
<input type="text" value="" size="20" name="form[titulo]" id="titulo" class="rsform-input-box" />
<span class="formValidation"><span id="component434" class="formNoError">Informe o título desta mensagem.</span></span>
<p class="formDescription"></p>
</div>
</div>
</div>
<div class="rsform-block rsform-block-mensagem">
<label class="formControlLabel" for="mensagem">Mensagem</label>
<div class="formControls">
<div class="formBody">
<textarea cols="50" rows="5" name="form[mensagem]" id="mensagem" class="rsform-text-box"></textarea>
<span class="formValidation"><span id="component435" class="formNoError">Escreva sua mensagem.</span></span>
<p class="formDescription"></p>
</div>
</div>
</div>
<div class="rsform-block rsform-block-arquivo">
<label class="formControlLabel" for="arquivo">Enviar desenho</label>
<div class="formControls">
<div class="formBody">
<input type="file" name="form[arquivo]" id="arquivo" class="rsform-upload-box" />
<span class="formValidation"><span id="component440" class="formNoError">Envie arquivos de imagem, somente nos formatos JPG, PNG ou GIF e tamanho máximo de 2 MB.</span></span>
<p class="formDescription"></p>
</div>
</div>
</div>
<div class="rsform-block rsform-block-captcha">
<label class="formControlLabel" for="captcha">Digite o texto<strong class="formRequired">(*)</strong></label>
<div class="formControls">
<div class="formBody">
<img src="/component/rsform/?task=captcha&componentId=441&format=image&sid=674040580" id="captcha441" alt="Digite o texto" /><input type="text" value="" name="form[captcha]" id="captchaTxt441" style="text-align:center;width:75px;" class="rsform-captcha-box" /> <a href="javascript:void(0)" class="rsform-captcha-refresh-button" onclick="RSFormPro.refreshCaptcha('441', '/component/rsform/?task=captcha&componentId=441&format=image'); return false;">Atualizar</a>
<span class="formValidation"><span id="component441" class="formNoError">Entrada Inválida</span></span>
<p class="formDescription"></p>
</div>
</div>
</div>
<div class="rsform-block rsform-block-enviar">
<label class="formControlLabel" for="enviar"></label>
<div class="formControls">
<div class="formBody">
<button type="submit" name="form[enviar]" id="enviar" class="rsform-submit-button" >Enviar</button>
<span class="formValidation"></span>
<p class="formDescription"></p>
</div>
</div>
</div>
</div>
</div>
</fieldset>]]>
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