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=\"968081885\">    <input type=\"hidden\" name=\"meta_split_id\" value=\"\">    <input type=\"hidden\" name=\"unit\" value=\"ccia-info\">    <input type=\"hidden\" name=\"redirect\" value=\"http://www.aweber.com/thankyou-coi.htm?m=audio\" id=\"redirect_6a1857dbe7619f175360aac6a2047248\">    <input type=\"hidden\" name=\"meta_redirect_onlist\" value=\"\">    <input type=\"hidden\" name=\"meta_adtracking\" value=\"New Subscriber\">    <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:</td><td><input type=\"text\" name=\"from\" value=\"\" size=\"20\"></td></tr><tr><td>address:</td><td><input type=\"text\" name=\"custom address\" 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>Phone:</td><td><input type=\"text\" name=\"custom Phone\" value=\"\" size=\"20\"></td></tr><tr><td>How did you hear about us:</td><td><input type=\"text\" name=\"custom How did you hear about us\" value=\"\" size=\"20\"></td></tr>        <tr><td colspan=2><center><div>Thank you for signing up!</div><div>You will get a confirming e-mail from us asking you to click a link to confirm that you wish to receive information from CCIA.</div><div>Once you click it, you're done!</div><div>Looking forward to getting to know you better.</div><div>&nbsp;</div><div>Jane Garvey</div><div>President</div><div>Chicago Creative Investors Association</div></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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