FORM not printing

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Hi Guys,

Looks like I am making an elemental mistake somewhere but can't figure out where can anyone please help?

This form is not printing at all but doesn't show any error in my browser.

The URL of defected PHP:  http://www.primarywave.com/eRSP_Contact.php
The URL of How It Should Look:  http://www.primarywave.com/eRSP_Contact.htm

Thanks a lot,

C. Ghosh

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