document.write("    <!-- Web Form Generator 2.0 -->    <center><form method=\"post\" action=\"http://www.aweber.com/scripts/addlead.pl\" target=\"_new\">    <input type=\"hidden\" name=\"meta_web_form_id\" value=\"407857205\">    <input type=\"hidden\" name=\"meta_split_id\" value=\"\">    <input type=\"hidden\" name=\"unit\" value=\"doctormatch\">    <input type=\"hidden\" name=\"redirect\" value=\"http://www.aweber.com/thankyou-coi.htm?m=audio\" id=\"redirect_02eea674183e9e4dec353d46c33b2e8e\">    <input type=\"hidden\" name=\"meta_redirect_onlist\" value=\"\">    <input type=\"hidden\" name=\"meta_adtracking\" value=\"\">    <input type=\"hidden\" name=\"meta_message\" value=\"1\">    <input type=\"hidden\" name=\"meta_required\" value=\"from\">    <input type=\"hidden\" name=\"meta_forward_vars\" value=\"0\">    <table>    <tr><td colspan=2><center></center></td></tr><tr><td>Email:</td><td><input type=\"text\" name=\"from\" value=\"\" size=\"20\"></td></tr><tr><td>Name:</td><td><input type=\"text\" name=\"name\" value=\"\" size=\"20\"></td></tr><tr><td>Contact Name:</td><td><input type=\"text\" name=\"custom Contact Name\" value=\"\" size=\"20\"></td></tr><tr><td>Title:</td><td><input type=\"text\" name=\"custom Title\" value=\"\" size=\"20\"></td></tr><tr><td>Phone:</td><td><input type=\"text\" name=\"custom Phone\" value=\"\" size=\"20\"></td></tr><tr><td>Address:</td><td><input type=\"text\" name=\"custom Address\" value=\"\" size=\"20\"></td></tr><tr><td colspan=\"2\" align=\"left\">Have you previously sponsored J-1 physicians:</td></tr><tr><td colspan=\"2\"><input type=\"radio\" name=\"custom Have you previously sponsored J-1 physicians\" value=\"yes\"> yes</td></tr><tr><td colspan=\"2\"><input type=\"radio\" name=\"custom Have you previously sponsored J-1 physicians\" value=\"no\"> no</td></tr><tr><td>Salary Range:</td><td><input type=\"text\" name=\"custom Salary Range\" value=\"\" size=\"20\"></td></tr><tr><td>Area of specialty and qualifications:</td><td><input type=\"text\" name=\"custom Area of specialty and qualifications\" value=\"\" size=\"20\"></td></tr><tr><td>Start Date:</td><td><input type=\"text\" name=\"custom Start Date\" value=\"\" size=\"20\"></td></tr><tr><td>How many positions are currently available:</td><td><input type=\"text\" name=\"custom How many positions are currently available\" value=\"\" size=\"20\"></td></tr>        <tr><td colspan=2><center></center></td></tr>    <tr><td align=\"center\" colspan=\"2\"><input type=\"submit\" name=\"submit\" value=\"Submit\"></td></tr>    </table>    </form>        </center>");

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