document.write("<!-- Web Form Generator 2.0 --><center><form method=\"post\" action=\"http://clients.automateyourlist.com/scripts/addlead.pl\"><input type=\"hidden\" name=\"meta_web_form_id\" value=\"876994555\"><input type=\"hidden\" name=\"meta_split_id\" value=\"\"><input type=\"hidden\" name=\"unit\" value=\"getalkaline\"><input type=\"hidden\" name=\"redirect\" value=\"http://www.getfreeweightloss.com/Thank_You.html\" id=\"redirect_8128f779ba2a787aa9f62070c7a70cf2\"><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><DIV align=center><STRONG><FONT color=#ff0000 size=5>Enter your name and email address and you'll start with my </FONT></STRONG></DIV><DIV align=center><STRONG><FONT color=#ff0000 size=5>FREE weight loss e-course.</FONT></STRONG></DIV><DIV align=center>&nbsp;</DIV><DIV align=center><STRONG>You'll receive a new&nbsp;module every day </STRONG></DIV><DIV align=center><STRONG>for the next 12 days via email.</STRONG></DIV><DIV align=center><STRONG></STRONG>&nbsp;</DIV><DIV align=center>&nbsp;</DIV></center></td></tr><tr><td>First Name:</td><td><input type=\"text\" name=\"name\" value=\"\" size=\"20\"></td></tr><tr><td>Email:</td><td><input type=\"text\" name=\"from\" value=\"\" size=\"20\"></td></tr>    <tr><td align=\"center\" colspan=\"2\"><input type=\"submit\" name=\"submit\" value=\"Send me the e-course!\"></td></tr>    <tr><td colspan=2><center><DIV align=center><STRONG></STRONG>&nbsp;</DIV><DIV align=center><STRONG>If you like what you learn in the e-course, then you can sign up for my FREE&nbsp;one-one-one weight loss coaching program at any time</STRONG></DIV><DIV align=center><STRONG>&nbsp;(details are at the end of the e-course).</STRONG></DIV><DIV align=center>&nbsp;</DIV><DIV align=center>I hate SPAM too.&nbsp; I will not share your email address with any other party.&nbsp; You can opt out of this email list at any time simply by clicking the link at the bottom of the emails.</DIV></center></td></tr></table></form></center>");

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