document.write("<!-- Web Form Generator 2.0 --><center><form method=\"post\" action=\"http://www.aweber.com/scripts/addlead.pl\"><input type=\"hidden\" name=\"meta_web_form_id\" value=\"329179009\"><input type=\"hidden\" name=\"meta_split_id\" value=\"\"><input type=\"hidden\" name=\"unit\" value=\"bsd-easytch1207\"><input type=\"hidden\" name=\"redirect\" value=\"http://www.bettersandiego.com/thanxET.htm\" id=\"redirect_2c19f5c8bc3c38a98c7923362d76df63\"><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=\"name,from,custom Phone ,custom Prefer to be contacted via,custom company,custom Clinic Date\"><input type=\"hidden\" name=\"meta_forward_vars\" value=\"0\"><table><tr><td colspan=2><center><font face=\"Arial\" color=\"#3300cc\" size=\"4\"><div align=\"center\"><font face=\"Arial\" color=\"#3300cc\" size=\"4\"><div><font face=\"Arial\" color=\"#3300cc\" size=\"4\">Because we&nbsp;limit the size for each clinic- the following form is an interest form, not an official enrollment.</font></div><div>&nbsp;</div><div><font face=\"Arial\" color=\"#000066\" size=\"4\">Please be on the look-out for an email coming from 'registrar@bettersandiego.com' as this will contain all of the information you need to enroll in&nbsp;this exciting clinic if there is still space available.</font></div><div><font face=\"Arial\" color=\"#3300cc\" size=\"4\">&nbsp;</font>&nbsp;</div><div><font face=\"Arial\" color=\"#3300cc\" size=\"4\">Thanks for your time and consideration!</font></div></font></div></font></center></td></tr><tr><td>Full Name:</td><td><input type=\"text\" name=\"name\" value=\"\" size=\"20\"></td></tr><tr><td>Email:</td><td><input type=\"text\" name=\"from\" value=\"\" size=\"20\"></td></tr><tr><td>Phone #:</td><td><input type=\"text\" name=\"custom Phone \" value=\"\" size=\"20\"></td></tr><tr><td>Prefer to be contacted via:</td><td><select name=\"custom Prefer to be contacted via\"><option value=\"email\">email</option><option value=\"phone\">phone</option><option value=\"either\">either</option></select></td></tr><tr><td>Company:</td><td><input type=\"text\" name=\"custom company\" value=\"\" size=\"20\"></td></tr><tr><td>Clinic Date:</td><td><select name=\"custom Clinic Date\"><option value=\"Soonest!\">Soonest!</option><option value=\"Sat (12/22); 9:30a-1:30p\">Sat (12/22); 9:30a-1:30p</option><option value=\"Fri (12/28); 9:30a-1:30p\">Fri (12/28); 9:30a-1:30p</option></select></td></tr><tr><td>How did you hear about us?:</td><td><input type=\"text\" name=\"custom How did you hear\" 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=\"Yes, I want to attend the Easy Tech clinic!\"></td></tr></table></form></center>");

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