   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=\"1971538977\"><input type=\"hidden\" name=\"meta_split_id\" value=\"\"><input type=\"hidden\" name=\"unit\" value=\"premedhelpmattg\"><input type=\"hidden\" name=\"redirect\" value=\"http://premedhelp.com/blog/?page_id=50\" id=\"redirect_49f3b0c4fe2919c285a300505f569572\"><input type=\"hidden\" name=\"meta_redirect_onlist\" value=\"http://premedhelp.com/blog/?page_id=52\"><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><H3><FONT face=Georgia><EM>The secrets to applying to med school <U>despite</U> a <FONT color=#ff0066>low GPA</FONT> or <FONT style=\"BACKGROUND-COLOR: #ffff99\">not-great test-taking skills</FONT> on the MCAT will be sent to you as soon as you answer these 4 simple questions:</EM></FONT></H3></center></td></tr><tr><td colspan=\"2\" align=\"left\">How would you describe your GPA?:</td></tr><tr><td colspan=\"2\"><input type=\"radio\" name=\"custom GPA\" value=\"Above 3.7 - I'm a God!\"> Above 3.7 - I'm a God!</td></tr><tr><td colspan=\"2\"><input type=\"radio\" name=\"custom GPA\" value=\"Between 3.5 and 3.7 - Proud!\"> Between 3.5 and 3.7 - Proud!</td></tr><tr><td colspan=\"2\"><input type=\"radio\" name=\"custom GPA\" value=\"Between 3.3 and 3.5 - Nervous!\"> Between 3.3 and 3.5 - Nervous!</td></tr><tr><td colspan=\"2\"><input type=\"radio\" name=\"custom GPA\" value=\"Between 3.1 and 3.3 - Worried!\"> Between 3.1 and 3.3 - Worried!</td></tr><tr><td colspan=\"2\"><input type=\"radio\" name=\"custom GPA\" value=\"Below 3.1 - Am I Screwed?\"> Below 3.1 - Am I Screwed?</td></tr><tr><td colspan=\"2\" align=\"left\">What's your MCAT score (actual or best guess)?:</td></tr><tr><td colspan=\"2\"><input type=\"radio\" name=\"custom MCAT\" value=\"Above 33 - I love taking tests\"> Above 33 - I love taking tests</td></tr><tr><td colspan=\"2\"><input type=\"radio\" name=\"custom MCAT\" value=\"Between 30 and 33 - Am I OK?\"> Between 30 and 33 - Am I OK?</td></tr><tr><td colspan=\"2\"><input type=\"radio\" name=\"custom MCAT\" value=\"Between 28 and 30 - Uh oh. Help?\"> Between 28 and 30 - Uh oh. Help?</td></tr><tr><td colspan=\"2\"><input type=\"radio\" name=\"custom MCAT\" value=\"Below 28 - I'm really scared. Help.\"> Below 28 - I'm really scared. Help.</td></tr><tr><td>When will you apply?:</td><td><select name=\"custom Apply Year\"><option value=\"2009\">2009</option><option value=\"2010\">2010</option><option value=\"Either 2009 or 2010\">Either 2009 or 2010</option><option value=\"2011\">2011</option><option value=\"2012\">2012</option><option value=\"Either 2011 or 2012\">Either 2011 or 2012</option></select></td></tr><tr><td valign=\"top\">What question can I answer for you?:</td><td><textarea name=\"custom Big Fear\" rows=\"10\" cols=\"30\">Enter your question here, then type your name and email below.</textarea></td></tr><tr><td>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>Cell Phone:</td><td><input type=\"text\" name=\"custom Cell\" value=\"\" size=\"20\"></td></tr>    <tr><td colspan=2><center><H5 align=left><FONT face=Georgia>Even with a not-great GPA or sub-par MCAT, it's not over! I look forward to talking with you about your concerns.</FONT></H5><H5 align=left><FONT face=Georgia>Talk soon,</FONT></H5><H5 align=left><FONT face=Georgia>Don Osborne&nbsp;/ PreMedHelp.com</FONT></H5></center></td></tr><tr><td align=\"center\" colspan=\"2\"><input type=\"submit\" name=\"submit\" value=\"Free Instant Help!\"></td></tr></table></form></center>");

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