Basic HTML - Single Page

I need an extremely simple project done... I need a single page, with an image in the top-center, and an opt-in form over that image. I built this page but I don't know how to make the opt-in form line up in the correct place in all browsers (IE and FF display it differently). I will provide the image, and the pages that I already have done just in case that makes it easier. I have one page with the image already sliced up, because I know you might want to build the page that way. Here is the page I'm having problems with: [login to view URL] (The text boxes and button should be next to the words (name, email, phone)