document.write("<form method=post action=\"http://app.icontact.com/icp/signup.php\" name=\"icpsignup\" accept-charset=\"UTF-8\" onsubmit=\"return verifyRequired();\" >\n<input type=hidden name=redirect value=\"http://www.icontact.com/www/signup/thanks.html\" />\n<input type=hidden name=errorredirect value=\"http://www.icontact.com/www/signup/error.html\" />\n<script type=\"text/javascript\">\nfunction verifyRequired() {\n  if (document.icpsignup[\"fields_email\"].value == \"\") {\n    document.icpsignup[\"fields_email\"].focus();\n    alert(\"The Email field is required.\");\n    return false;\n  }\n\n\nreturn true;\n}\n<\/script>\n<div id=\"SignUp\">\n<table width=\"100%\" class=\"signupframe\" border=\"0\" cellspacing=\"0\" cellpadding=\"5\">\n    <tr>\n      <td valign=top>\n  <font color=\"#ffffff\">Email Address:<\/font> <br>\n   <input type=text name=\"fields_email\">\n        <input type=hidden name=\"listid\" value=\"2820\">\n    <input type=hidden name=\"specialid:2820\" value=\"7NPH\">\n\n    <input type=hidden name=clientid value=\"181275\">\n    <input type=hidden name=formid value=\"180\">\n    <input type=hidden name=reallistid value=\"1\">\n    <input type=hidden name=doubleopt value=\"0\">\n <input type=\"submit\" name=\"Submit\" value=\"Submit\">\n<\/td>\n<\/tr>\n       <\/table>\n<\/div>\n<\/form>");