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=\"1064164548\">    <input type=\"hidden\" name=\"meta_split_id\" value=\"\">    <input type=\"hidden\" name=\"unit\" value=\"adhdparents\">    <input type=\"hidden\" name=\"redirect\" value=\"http://www.aweber.com/thankyou-coi.htm?m=audio\" id=\"redirect_3013e6cd0a83cade6052b0a6200121c8\">    <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\">    <input type=\"hidden\" name=\"meta_forward_vars\" value=\"0\">    <table>    <tr><td colspan=2><center><div>Sign up for our <font color=\"#ff0000\"><strong>free</strong></font> newsletter, and you'll receive</div><div>updates on upcoming ADHD seminars with</div><div>Dr. C, Elwood, and special guests!&nbsp; Just for</div><div>subscribing, we'll send you our special ebook,</div><div>\"5 Articles about ADHD\".&nbsp; Just so you know, we</div><div>will never share your email address with anyone</div><div>for any reason.&nbsp; We hate spam too! </div></center></td></tr><tr><td>First 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 valign=\"top\">(Optional) What is your number one concern or question about ADHD:</td><td><textarea name=\"custom (Optional) What is your number one concern or question about ADHD\" rows=\"10\" cols=\"30\">Type your question here</textarea></td></tr>        <tr><td colspan=2><center></center></td></tr>    <tr><td align=\"center\" colspan=\"2\"><input type=\"submit\" name=\"submit\" value=\"Click here to submit your info and reserve your seat!\"></td></tr>    </table>    </form>        </center>");

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