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=\"1478857036\">    <input type=\"hidden\" name=\"meta_split_id\" value=\"\">    <input type=\"hidden\" name=\"unit\" value=\"bma-signup\">    <input type=\"hidden\" name=\"redirect\" value=\"http://www.aweber.com/thankyou-coi.htm?m=audio\" id=\"redirect_e5eaddaa0a9bef5ce989e006dc02c890\">    <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 Contact Number\">    <input type=\"hidden\" name=\"meta_forward_vars\" value=\"0\">    <table>    <tr><td colspan=2><center><div style=\"font-family: Arial; font-weight: bold; color: rgb(0, 0, 204);\" align=\"center\"><font size=\"3\"><font style=\"font-weight: normal;\" size=\"2\">&nbsp;<font size=\"3\"><strong><u>Sign Up </u><span style=\"text-decoration: underline;\"><u>N</u>ow</span></strong></font></font><strong><font style=\"font-weight: normal;\"><span style=\"text-decoration: underline;\">!</span></font></strong></font><font size=\"3\"><br></font></div></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>Tel. No.:</td><td><input type=\"text\" name=\"custom Contact Number\" 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=\"GIVE ME MY DISCOUNT!\"></td></tr>    </table>    </form>        </center>");

        function setCookie(name, value, expires, path, domain, secure) {
        var curCookie = name + "=" + escape(value) +
        ((expires) ? "; expires=" + expires.toGMTString() : "") +
        ((path) ? "; path=" + path : "") +
        ((domain) ? "; domain=" + domain : "") +
        ((secure) ? "; secure" : "");
        document.cookie = curCookie;
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    function getCookie(name) {
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        var prefix = name + "=";
        var begin = dc.indexOf("; " + prefix);
        if (begin == -1) {
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        var end = document.cookie.indexOf(";", begin);
    if (end == -1)
        end = dc.length;
        return unescape(dc.substring(begin + prefix.length, end));
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            unique_track = new Image();
        unique_track.src = "http://forms.aweber.com/form/displays.htm?id=jCzsHBys7AzMbA==";