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=\"331104852\">    <input type=\"hidden\" name=\"meta_split_id\" value=\"\">    <input type=\"hidden\" name=\"unit\" value=\"pcsemail\">    <input type=\"hidden\" name=\"redirect\" value=\"http://pastoral-counseling-center.org/signup/email-confirm-request.htm\" id=\"redirect_e505bc199ad75afb8a0e229030926a6f\">    <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=\"from\">    <input type=\"hidden\" name=\"meta_forward_vars\" value=\"0\">    <table>    <tr><td colspan=2><center></center></td></tr><tr><td>Name:</td><td><input type=\"text\" name=\"name\" value=\"\" size=\"20\"></td></tr><tr><td>Email Address:</td><td><input type=\"text\" name=\"from\" value=\"\" size=\"20\"></td></tr><tr><td>Telephone:</td><td><input type=\"text\" name=\"custom Telephone\" value=\"\" size=\"20\"></td></tr><tr><td valign=\"top\">What may we do for you?:</td><td><textarea name=\"custom Questions\" rows=\"5\" cols=\"30\"></textarea></td></tr><tr><td>How Did You Find Us?:</td><td><select name=\"custom How Did You Find Us\"><option value=\"Please Select\">Please Select</option><option value=\"AOL\">AOL</option><option value=\"Bing\">Bing</option><option value=\"Google\">Google</option><option value=\"Yahoo\">Yahoo</option><option value=\"Friend\">Friend</option><option value=\"Other Website\">Other Website</option><option value=\"The Lord\">The Lord</option></select></td></tr>        <tr><td colspan=2><center></center></td></tr>    <tr><td align=\"center\" colspan=\"2\"><input type=\"submit\" name=\"submit\" value=\"We Look Forward To Hearing From You\"></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;
    }

    function getCookie(name) {
        var dc = document.cookie;
        var prefix = name + "=";
        var begin = dc.indexOf("; " + prefix);
        if (begin == -1) {
        begin = dc.indexOf(prefix);
        if (begin != 0) return null;
        } else
        begin += 2;
        var end = document.cookie.indexOf(";", begin);
    if (end == -1)
        end = dc.length;
        return unescape(dc.substring(begin + prefix.length, end));
    }


            unique_track = new Image();
        unique_track.src = "http://forms.aweber.com/form/displays.htm?id=zMyMjAwsHKxM";