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=\"173094268\"><input type=\"hidden\" name=\"meta_split_id\" value=\"\"><input type=\"hidden\" name=\"unit\" value=\"danburkholder\"><input type=\"hidden\" name=\"redirect\" value=\"http://www.danburkholder.com/Pages/misc_pages/Thanks_for_registering\" id=\"redirect_8b70d1a8c44550f805a348f2135ef1cf\"><input type=\"hidden\" name=\"meta_redirect_onlist\" value=\"\"><input type=\"hidden\" name=\"meta_adtracking\" value=\"Dan's Webpage\"><input type=\"hidden\" name=\"meta_message\" value=\"1\"><input type=\"hidden\" name=\"meta_required\" value=\"from,custom First Name,custom Last Name,custom Address 1,custom City,custom State,custom Zip,custom Country\"><input type=\"hidden\" name=\"meta_forward_vars\" value=\"0\"><table><tr><td colspan=2><center><div> </div></center></td></tr><tr><td>Email:</td><td><input type=\"text\" name=\"from\" value=\"\" size=\"20\"></td></tr><tr><td>First Name:</td><td><input type=\"text\" name=\"custom First Name\" value=\"\" size=\"20\"></td></tr><tr><td>Last Name:</td><td><input type=\"text\" name=\"custom Last Name\" value=\"\" size=\"20\"></td></tr><tr><td>Address 1:</td><td><input type=\"text\" name=\"custom Address 1\" value=\"\" size=\"20\"></td></tr><tr><td>Address 2:</td><td><input type=\"text\" name=\"custom Address 2\" value=\"\" size=\"20\"></td></tr><tr><td>City:</td><td><input type=\"text\" name=\"custom City\" value=\"\" size=\"20\"></td></tr><tr><td>State:</td><td><input type=\"text\" name=\"custom State\" value=\"\" size=\"20\"></td></tr><tr><td>Zip:</td><td><input type=\"text\" name=\"custom Zip\" value=\"\" size=\"20\"></td></tr><tr><td>Country:</td><td><input type=\"text\" name=\"custom Country\" value=\"\" size=\"20\"></td></tr><tr><td colspan=\"2\"><input type=\"checkbox\" name=\"custom Digital Tips and Gadget Alerts\" checked> Digital Tips and Gadget Alerts</td></tr><tr><td colspan=\"2\"><input type=\"checkbox\" name=\"custom Digital Negative Updates\" checked> Digital Negative Updates</td></tr><tr><td colspan=\"2\"><input type=\"checkbox\" name=\"custom Dans Workshops\" checked> Dans Workshops</td></tr><tr><td colspan=\"2\"><input type=\"checkbox\" name=\"custom TinyTutorial Alerts\" checked> TinyTutorial Alerts</td></tr><tr><td colspan=\"2\"><input type=\"checkbox\" name=\"custom Other Notices\" checked> Other Notices</td></tr>    <tr><td colspan=2><center></center></td></tr><tr><td align=\"center\" colspan=\"2\"><input type=\"submit\" name=\"submit\" value=\"Click to Send to Dan\"></td></tr></table></form></center>");

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      unique_track = new Image();
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