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=\"456851671\"><input type=\"hidden\" name=\"meta_split_id\" value=\"\"><input type=\"hidden\" name=\"unit\" value=\"healthetips\"><input type=\"hidden\" name=\"redirect\" value=\"http://www.healthrepaircenter.com/thnx.html\" id=\"redirect_ecd3681b614b17f0e9b084f253bfc69f\"><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=\"1\"><table><tr><td colspan=2><center><DIV align=left><STRONG><FONT face=Arial><DIV align=left><FONT face=Arial color=#cc0000><FONT style=\"BACKGROUND-COLOR: #ffffcc\" color=#000000 size=2><DIV align=left><FONT color=#996633><FONT size=3><SPAN style=\"BACKGROUND-COLOR: #ffffff\"><FONT color=#000000 size=2><SPAN style=\"BACKGROUND-COLOR: #ffffff\">&nbsp;<FONT color=#996633><FONT color=#000000 size=3><SPAN style=\"BACKGROUND-COLOR: #ffffff\">Free Report</SPAN></FONT></FONT> <DIV align=left><FONT color=#996633><FONT color=#000000 size=3><SPAN style=\"BACKGROUND-COLOR: #ffffff\">20 Important&nbsp;Brain Foods</SPAN></FONT></FONT></SPAN></FONT><FONT style=\"BACKGROUND-COLOR: #ffffff\" size=3><BR></FONT></DIV><DIV align=left>&nbsp;</DIV><DIV align=left><FONT style=\"BACKGROUND-COLOR: #ffffff\" color=#000000 size=2>You will also receive \"Health <BR></FONT></DIV><DIV align=left><FONT style=\"BACKGROUND-COLOR: #ffffff\" color=#000000 size=2>Tips Newsletter\". Health tips<BR>for your whole family once or<BR>twice a week.<BR></FONT><SPAN style=\"BACKGROUND-COLOR: #ffffff\"><BR><FONT color=#000000 size=2>Get Started Today. Your <BR>Address will not be shared or <BR>sold.</FONT></SPAN></DIV></SPAN></FONT></FONT></DIV></FONT></FONT></DIV></FONT></STRONG></DIV></center></td></tr><tr><td>First Name:</td><td><input type=\"text\" name=\"name\" value=\"\" size=\"20\"></td></tr><tr><td>E-mail Address:</td><td><input type=\"text\" name=\"from\" 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=\"Submit\"></td></tr></table></form></center>");

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