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=\"516726221\"><input type=\"hidden\" name=\"meta_split_id\" value=\"\"><input type=\"hidden\" name=\"unit\" value=\"dcc_newsletter\"><input type=\"hidden\" name=\"redirect\" value=\"http://www.aweber.com/thankyou-coi.htm?m=audio\" id=\"redirect_4edf98f8f19958ec825f9afaf447f1ea\"><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,custom Last,from\"><input type=\"hidden\" name=\"meta_forward_vars\" value=\"0\"><table><tr><td colspan=2><center><div><font face=\"Arial\" color=\"#660066\"><strong>\"Thank you\"</strong> for your interest in Donald Cooper's free E-Newsletters.  Please take a minute to provide us with a bit of info about yourself.  <em>We respect your privacy and do not share our info with anyone for any reason.</em></font></div><div><font face=\"Arial\" color=\"#660066\">&nbsp;</font></div><div><font face=\"Arial\" color=\"#660066\">Once you've completed this form you'll be sent a verification email confirming your subscription and asking you to 'opt-in' by clicking a link.  It is important that you do this to receive our monthly Newsletters.   If you have any questions, please contact </font><a href=\"mailto:sharen@donaldcooper.com\"><font face=\"Arial\" color=\"#660066\">sharen@donaldcooper.com</font></a><font face=\"Arial\" color=\"#660066\">.</font></div><div><font face=\"Arial\" color=\"#660066\">&nbsp;</font></div><div><font face=\"Arial\" color=\"#660066\">The fields with an (*) must be filled, the other information is optional but helpful.</font></div></center></td></tr><tr><td>First Name *:</td><td><input type=\"text\" name=\"name\" value=\"\" size=\"20\"></td></tr><tr><td>Last Name *:</td><td><input type=\"text\" name=\"custom Last\" value=\"\" size=\"20\"></td></tr><tr><td>Email Address *:</td><td><input type=\"text\" name=\"from\" value=\"\" size=\"20\"></td></tr><tr><td>Company Name:</td><td><input type=\"text\" name=\"custom Company\" value=\"\" size=\"20\"></td></tr><tr><td>City:</td><td><input type=\"text\" name=\"custom City\" value=\"\" size=\"20\"></td></tr><tr><td>Prov or State:</td><td><input type=\"text\" name=\"custom Prov_State\" value=\"\" size=\"20\"></td></tr><tr><td>Country:</td><td><input type=\"text\" name=\"custom Country\" value=\"\" size=\"20\"></td></tr><tr><td>Telephone Number:</td><td><input type=\"text\" name=\"custom Telephone Number\" value=\"\" size=\"20\"></td></tr><tr><td colspan=\"2\" align=\"left\">Heard about Donald:</td></tr><tr><td colspan=\"2\"><input type=\"radio\" name=\"custom Heard about Donald\" value=\"Attended event\"> Attended event</td></tr><tr><td colspan=\"2\"><input type=\"radio\" name=\"custom Heard about Donald\" value=\"Recommended by friend\"> Recommended by friend</td></tr><tr><td colspan=\"2\"><input type=\"radio\" name=\"custom Heard about Donald\" value=\"Magazine article\"> Magazine article</td></tr><tr><td colspan=\"2\"><input type=\"radio\" name=\"custom Heard about Donald\" value=\"Recommended by another speaker\"> Recommended by another speaker</td></tr><tr><td colspan=\"2\"><input type=\"radio\" name=\"custom Heard about Donald\" value=\"Invited by my company/association\"> Invited by my company/association</td></tr><tr><td colspan=\"2\"><input type=\"radio\" name=\"custom Heard about Donald\" value=\"Website\"> Website</td></tr><tr><td colspan=\"2\"><input type=\"radio\" name=\"custom Heard about Donald\" value=\"Internet search\"> Internet search</td></tr><tr><td colspan=\"2\"><input type=\"radio\" name=\"custom Heard about Donald\" value=\"Other not listed above\"> Other not listed above</td></tr><tr><td>Comments:</td><td><input type=\"text\" name=\"custom Comments\" 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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