document.write("<style>\n.signupframe {\n  background: #ffffff;\n  color: #000000;\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 language=javascript>\nfunction verifyRequired() {\n  if (document.icpsignup[\"fields_email\"].value == \"\") {\n    alert(\"The Email field is required.\");\n    return false;\n  }\n  if (document.icpsignup[\"fields_fname\"].value == \"\") {\n    alert(\"The First Name field is required.\");\n    return false;\n  }\n\n\nreturn true;\n}\n<\/script>\n<div id=\"SignUp\">\n<table width=\"150\" class=\"signupframe\" border=\"0\" cellspacing=\"0\" cellpadding=\"0\" align=center>\n    <tr>\n      <td valign=top align=center>\n        <font size=\"1\" face=\"Arial,Helvetica, sans-serif\">*<\/font>&nbsp;<font size=\"1\">Email<\/font>\n      <\/td>\n  <\/tr>\n     <tr>\n <td align=center>\n        <input type=text name=\"fields_email\" size=12>\n      <\/td>\n    <\/tr>\n   <tr>\n    <td valign=top align=center>\n        <font size=\"1\" face=\"Arial,Helvetica, sans-serif\">*<\/font>&nbsp;<font size=\"1\">First Name<\/font>\n      <\/td>\n   <\/tr>\n  <tr>\n    <td align=center>\n        <input type=text name=\"fields_fname\" size=12>\n      <\/td>\n    <\/tr>\n    <input type=hidden name=\"listid\" value=\"5177\" >\n    <input type=hidden name=\"specialid:5177\" value=\"DUVR\">\n\n    <input type=hidden name=clientid value=\"149649\">\n    <input type=hidden name=formid value=\"1450\">\n    <input type=hidden name=reallistid value=\"1\">\n    <input type=hidden name=doubleopt value=\"1\">\n    <TR>\n     <TD align=center><font size=\"1\">*<\/font><font size=\"1\"> = Required Field<\/FONT><\/TD>\n    <\/TR>\n    <tr>\n      <td align=center><input type=\"submit\" name=\"Submit\" value=\"Submit\"><\/td>\n    <\/tr>\n    <\/table>\n<\/div>\n<\/form>");