{

document.write('<div align="left" style="width:220px;height:auto;border-style:solid;border-width:1px;border-color:silver">')
document.write('<form method="GET" name="frmSubscribe" action="http://safenewsletters.com/Newsletter-Sign-On.asp" style="padding:5px;">')
document.write('<table border="0" width="200"')
document.write('<tr><td colspan="2">')
document.write('<p align="center"><font size="2"><font color="#0000FF">Subscribe to Our Newsletter</font></b></td></tr>')
document.write('<tr><td width="76">First Name</td>')
document.write('<td><input type="text" name="FName" size="12" style="border: 1px solid #808080"></td></tr>')
document.write('<tr><td width="76">Last Name</td>')
document.write('<td><input type="text" name="LName" size="12" style="border: 1px solid #808080"></td></tr>')
document.write('<tr><td width="76">Email</td>')
document.write('<td><input type="text" name="Email" size="12" style="border: 1px solid #808080"></td></tr>')
document.write('<tr><td width="76"> </td>')
document.write('<td><input type="submit" value="Subscribe" name="B1"></td></tr>')
document.write('<tr><td colspan="2"><p align="center"><font size="1"><a href="http://safenewsletters.com/">Powered by Safe Newsletters</a><p></td>')
document.write('</tr>')
document.write('</table>')
document.write('<input type="hidden" name="CID" value="' + CID + '">')
document.write('</form>')
document.write('</div>')

}