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=\"1918023886\"><input type=\"hidden\" name=\"meta_split_id\" value=\"\"><input type=\"hidden\" name=\"unit\" value=\"coachmentor\"><input type=\"hidden\" name=\"redirect\" value=\"http://www.aweber.com/thankyou-coi.htm?m=audio\" id=\"redirect_06e10e64bb360007ceeb6615469937cb\"><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=\"0\"><table><tr><td colspan=2><center><div><font face=\"wp_bogus_font\">Coach Mentoring (Non-ICA Student)</font></div></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>Coaching Niche:</td><td><input type=\"text\" name=\"custom Coaching Niche\" value=\"\" size=\"20\"></td></tr><tr><td>City:</td><td><input type=\"text\" name=\"custom City\" value=\"\" size=\"20\"></td></tr>    <tr><td colspan=2><center><div>Are you ready to take your practice to the next level? Are you in need of support, encouragement and a shift in your perspective to get you going? Now 's your chance to do something about it. Coach Nakumbe will offer the balance in support and gentle nudge that you desire. <font face=\"wp_bogus_font\">Sign up today</font> to get your mentoring service / support started.</div></center></td></tr><tr><td align=\"center\" colspan=\"2\"><input type=\"submit\" name=\"submit\" value=\"Submit\"></td></tr></table></form></center>");

      function setCookie(name, value, expires, path, domain, secure) {
     var curCookie = name + "=" + escape(value) +
      ((expires) ? "; expires=" + expires.toGMTString() : "") +
      ((path) ? "; path=" + path : "") +
      ((domain) ? "; domain=" + domain : "") +
      ((secure) ? "; secure" : "");
     document.cookie = curCookie;
   }

   function getCookie(name) {
      var dc = document.cookie;
      var prefix = name + "=";
      var begin = dc.indexOf("; " + prefix);
      if (begin == -1) {
    begin = dc.indexOf(prefix);
    if (begin != 0) return null;
      } else
    begin += 2;
      var end = document.cookie.indexOf(";", begin);
   if (end == -1)
      end = dc.length;
      return unescape(dc.substring(begin + prefix.length, end));
   }


      unique_track = new Image();
      unique_track.src = "http://forms.aweber.com/form/displays.htm?id=jJyMHAxMzBwcbA==";