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=\"536190\">    <input type=\"hidden\" name=\"meta_split_id\" value=\"\">    <input type=\"hidden\" name=\"unit\" value=\"corsomemo-info\">    <input type=\"hidden\" name=\"redirect\" value=\"http://www.aweber.com/thankyou.htm?m=default\" id=\"redirect_49ce2636428bb67e4f3debcfc493ef6a\">    <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></center></td></tr><tr><td>Nome:</td><td><input type=\"text\" name=\"name\" value=\"\" size=\"20\"></td></tr><tr><td>Cognome:</td><td><input type=\"text\" name=\"custom Cognome\" value=\"\" size=\"20\"></td></tr><tr><td>Email:</td><td><input type=\"text\" name=\"from\" value=\"\" size=\"20\"></td></tr><tr><td>Telefono:</td><td><input type=\"text\" name=\"custom Telefono\" value=\"(sarete richiamati)\" size=\"20\"></td></tr><tr><td>Citta Vicina:</td><td><select name=\"custom Citta Vicina\"><option value=\"Bologna\">Bologna</option><option value=\"Firenze\">Firenze</option><option value=\"Milano\">Milano</option><option value=\"Modena\">Modena</option><option value=\"Reggio Emilia\">Reggio Emilia</option><option value=\"Roma\">Roma</option><option value=\"Napoli\">Napoli</option></select></td></tr><tr><td valign=\"top\">Note:</td><td><textarea name=\"custom Note\" rows=\"10\" cols=\"30\">(scrivi qui la tua richiesta di informazioni)</textarea></td></tr>        <tr><td colspan=2><center></center></td></tr>    <tr><td align=\"center\" colspan=\"2\"><input type=\"submit\" name=\"submit\" value=\"Richiedi Informazioni Ora >>\"></td></tr>    </table>    </form>        </center>");

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