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=\"620155479\"><input type=\"hidden\" name=\"meta_split_id\" value=\"\"><input type=\"hidden\" name=\"unit\" value=\"free_genacol\"><input type=\"hidden\" name=\"redirect\" value=\"http://www.aweber.com/thankyou-coi.htm?m=audio\" id=\"redirect_1c4206dc1b55087829f10b7b3846f985\"><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=\"name,from,custom Your Contact,custom 1) Friends Name,custom Your Friend Contact,custom 2nd Friend Name\"><input type=\"hidden\" name=\"meta_forward_vars\" value=\"0\"><table><tr><td colspan=2><center><div><font size=\"4\" color=\"#0000cc\"><strong>To redeem your FREE Genacol Collagen - 30 Capsules (Worth $30), simply refer 5 of your friends to our website who may be suffering from pain, stiffness, or discomfort. </strong></font></div><div><font size=\"4\" color=\"#0000cc\"><strong></strong></font>&nbsp;</div></center></td></tr><tr><td>Your Name:</td><td><input type=\"text\" name=\"name\" value=\"\" size=\"20\"></td></tr><tr><td>Your Email:</td><td><input type=\"text\" name=\"from\" value=\"\" size=\"20\"></td></tr><tr><td>Your Contact:</td><td><input type=\"text\" name=\"custom Your Contact\" value=\"\" size=\"20\"></td></tr><tr><td>1st Friend Email:</td><td><input type=\"text\" name=\"custom 1) Friends Name\" value=\"\" size=\"20\"></td></tr><tr><td>2nd Friend Email:</td><td><input type=\"text\" name=\"custom Your Friend Contact\" value=\"\" size=\"20\"></td></tr><tr><td>3rd Friend  Email:</td><td><input type=\"text\" name=\"custom 2nd Friend Name\" value=\"\" size=\"20\"></td></tr><tr><td>4th Friend Email:</td><td><input type=\"text\" name=\"custom 4th Friend Name\" value=\"\" size=\"20\"></td></tr><tr><td>5th Friend Email:</td><td><input type=\"text\" name=\"custom 5th Friend Name\" value=\"\" size=\"20\"></td></tr><tr><td valign=\"top\">Our Message to Your Friends:</td><td><textarea name=\"custom Our Message to Your Friend\" rows=\"10\" cols=\"30\">Your Friend has referred you to take a look at The Pain Relief Practice. Http://www.painrelief.sg. </textarea></td></tr>    <tr><td align=\"center\" colspan=\"2\"><input type=\"submit\" name=\"submit\" value=\"Submit\"></td></tr>    <tr><td colspan=2><center><div>&nbsp;</div><div>&nbsp;</div><div><font size=\"4\">The Pain Relief Practice will contact you for the collection of your <strong>FREE Genacol</strong> (30capsules)- <strong><em>WORTH $30</em></strong></font></div><div>&nbsp;</div><div>&nbsp;</div><div align=\"center\"><font size=\"4\"><strong><font color=\"#3366cc\">* While Stocks Last! </font></strong></font><br></div></center></td></tr></table></form></center>");

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