document.write("<style>\n.signupframe {\n  border: 1px solid #000000;\n  background: #FFFFFF;\n  color: #364A69;\n  font-family: Arial, Helvetica, sans-serif;\n}\n<\/style>\n<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  if (document.icpsignup[\"fields_fname\"].value == \"\") {\n    document.icpsignup[\"fields_fname\"].focus();\n    alert(\"The First Name field is required.\");\n    return false;\n  }\n  if (document.icpsignup[\"fields_lname\"].value == \"\") {\n    document.icpsignup[\"fields_lname\"].focus();\n    alert(\"The Last Name field is required.\");\n    return false;\n  }\n  if (document.icpsignup[\"fields_business\"].value == \"\") {\n    document.icpsignup[\"fields_business\"].focus();\n    alert(\"The Company field is required.\");\n    return false;\n  }\n  if (document.icpsignup[\"fields_country\"].value == \"\") {\n    document.icpsignup[\"fields_country\"].focus();\n    alert(\"The Country field is required.\");\n    return false;\n  }\n\n\nreturn true;\n}\n<\/script>\n<div id=\"SignUp\">\n<table width=\"260\" class=\"signupframe\" border=\"0\" cellspacing=\"0\" cellpadding=\"5\">\n    <tr>\n      <td valign=top align=right>\n        <font size=\"1\" face=\"Arial,Helvetica, sans-serif\">*<\/font>&nbsp;<font size=\"2\">Email<\/font>\n      <\/td>\n      <td align=left>\n        <input type=text name=\"fields_email\">\n      <\/td>\n    <\/tr>\n      <td valign=top align=right>\n        <font size=\"1\" face=\"Arial,Helvetica, sans-serif\">*<\/font>&nbsp;<font size=\"2\">First Name<\/font>\n      <\/td>\n      <td align=left>\n        <input type=text name=\"fields_fname\">\n      <\/td>\n    <\/tr>\n      <td valign=top align=right>\n        <font size=\"1\" face=\"Arial,Helvetica, sans-serif\">*<\/font>&nbsp;<font size=\"2\">Last Name<\/font>\n      <\/td>\n      <td align=left>\n        <input type=text name=\"fields_lname\">\n      <\/td>\n    <\/tr>\n      <td valign=top align=right>\n        <font size=\"1\" face=\"Arial,Helvetica, sans-serif\">*<\/font>&nbsp;<font size=\"2\">Company<\/font>\n      <\/td>\n      <td align=left>\n        <input type=text name=\"fields_business\">\n      <\/td>\n    <\/tr>\n      <td valign=top align=right>\n        <font size=\"1\" face=\"Arial,Helvetica, sans-serif\">*<\/font>&nbsp;<font size=\"2\">Country<\/font>\n      <\/td>\n      <td align=left>\n        <input type=text name=\"fields_country\">\n      <\/td>\n    <\/tr>\n    <input type=hidden name=\"listid\" value=\"65515\">\n    <input type=hidden name=\"specialid:65515\" value=\"JDQU\">\n\n    <input type=hidden name=clientid value=\"266542\">\n    <input type=hidden name=formid value=\"5631\">\n    <input type=hidden name=reallistid value=\"1\">\n    <input type=hidden name=doubleopt value=\"0\">\n    <TR>\n      <TD>&nbsp;<\/TD>\n      <TD><font size=\"1\">*<\/font><font size=\"2\"> = Required Field<\/FONT><\/TD>\n    <\/TR>\n    <tr>\n      <td>&nbsp;<\/td>\n      <td><input type=\"submit\" name=\"Submit\" value=\"Submit\"><\/td>\n    <\/tr>\n    <\/table>\n<\/div>\n<\/form>");