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=\"1773266588\"><input type=\"hidden\" name=\"meta_split_id\" value=\"\"><input type=\"hidden\" name=\"unit\" value=\"gallery4collect\"><input type=\"hidden\" name=\"redirect\" value=\"http://gallery4collectors.com/CollectorsClubBenefits.htm\" id=\"redirect_30be81d21e50d90ead23ca4d11634103\"><input type=\"hidden\" name=\"meta_redirect_onlist\" value=\"\"><input type=\"hidden\" name=\"meta_adtracking\" value=\"PrintCollect page\"><input type=\"hidden\" name=\"meta_message\" value=\"1\"><input type=\"hidden\" name=\"meta_required\" value=\"name,from\"><input type=\"hidden\" name=\"meta_forward_vars\" value=\"0\"><table><tr><td colspan=2><center><DIV align=center><STRONG><FONT color=#990000 size=4>Collectors Club - Membership Sign Up Form</FONT></STRONG></DIV><DIV align=center><FONT size=5><STRONG><FONT size=4>To receive all the benefits,&nbsp;complete this simple form below!</FONT></STRONG>&nbsp;</FONT></DIV></center></td></tr><tr><td>First & Last Name:</td><td><input type=\"text\" name=\"name\" value=\"\" size=\"20\"></td></tr><tr><td>Email Address:</td><td><input type=\"text\" name=\"from\" value=\"\" size=\"20\"></td></tr><tr><td>Favorite Artist:</td><td><input type=\"text\" name=\"custom Favorite Artist\" value=\"\" size=\"20\"></td></tr><tr><td>How did you find us:</td><td><input type=\"text\" name=\"custom How did you find us\" value=\"\" size=\"20\"></td></tr><tr><td>Comments or Questions:</td><td><input type=\"text\" name=\"custom Comments or Questions\" value=\"\" size=\"20\"></td></tr>    <tr><td colspan=2><center><DIV align=center><STRONG>Click the \"Submit\" button below &amp; you'll automatically go to our Club Members page to receive al your benefits!!&nbsp;</STRONG></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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