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=\"1040321650\"><input type=\"hidden\" name=\"meta_split_id\" value=\"\"><input type=\"hidden\" name=\"unit\" value=\"fashionretailer\"><input type=\"hidden\" name=\"redirect\" value=\"http://www.fashionretailers.org/thanks.html\" id=\"redirect_df765ec356f6677a372efc01926ce0df\"><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=\"custom Type of Membership,custom Type of Retail,custom Member Address,from\"><input type=\"hidden\" name=\"meta_forward_vars\" value=\"0\"><table><tr><td colspan=2><center><DIV align=left><FONT face=Arial size=2><STRONG>If you are a retailer, you must enter your store name and complete store address to access all areas of FashionRetailers.org.&nbsp;&nbsp; All members must&nbsp;submit complete mailing address and email information.</STRONG>&nbsp;&nbsp; <BR><BR><EM><STRONG>Please&nbsp;indicate type of membership: retailer, designer, or fashion student.</STRONG></EM>&nbsp;</FONT></DIV><DIV>&nbsp;</DIV><DIV>&nbsp;</DIV></center></td></tr><tr><td>Type of Membership:</td><td><input type=\"text\" name=\"custom Type of Membership\" value=\"\" size=\"20\"></td></tr><tr><td>Store Name:</td><td><input type=\"text\" name=\"name\" value=\"\" size=\"20\"></td></tr><tr><td>Store Address:</td><td><input type=\"text\" name=\"custom Store Location - Complete Address\" value=\"\" size=\"20\"></td></tr><tr><td>Years in Business:</td><td><input type=\"text\" name=\"custom Years in Business\" value=\"\" size=\"20\"></td></tr><tr><td>Member Name:</td><td><input type=\"text\" name=\"custom Type of Retail\" value=\"\" size=\"20\"></td></tr><tr><td>Member Mailing Address:</td><td><input type=\"text\" name=\"custom Member Address\" value=\"\" size=\"20\"></td></tr><tr><td>Email:</td><td><input type=\"text\" name=\"from\" value=\"\" size=\"20\"></td></tr>    <tr><td colspan=2><center><DIV align=left>&nbsp;</DIV><DIV align=left><FONT face=Arial><FONT size=2><STRONG>A confirmation email will be sent to the email address submitted, and you will need to confirm your membership request, before activation will occur.&nbsp; Thank you!</STRONG>&nbsp;</FONT></FONT></DIV><DIV><FONT face=Arial size=2></FONT>&nbsp;</DIV><DIV>&nbsp;</DIV></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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