document.write('');
document.write('  <table>');
document.write('<form method="post" action="http://51572.formmailer.onetwomax.de/">');
document.write('    <tr bgcolor="#A89DC5">');
document.write('      <td bgcolor="#A89DC5" colspan="2"><font color="#5B5275" face="Verdana" size="1">Join Membership </font></td>');
document.write('    </tr>');
document.write('    <tr bgcolor="#A89DC5">');
document.write('      <td bgcolor="#A89DC5"><font color="#5B5275" face="Verdana" size="1">Name *</font></td>');
document.write('      <td bgcolor="#A89DC5"><font color="#5B5275" face="Verdana" size="1">');
document.write('        <input style=" border: 1px solid #5B5275; background-color: #A89DC5; color: #5B5275; font-family: Verdana;" type="text" name="user_input[id3]" value="" size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr bgcolor="#A89DC5">');
document.write('      <td bgcolor="#A89DC5"><font color="#5B5275" face="Verdana" size="1">E-Mail *</font></td>');
document.write('      <td bgcolor="#A89DC5"><font color="#5B5275" face="Verdana" size="1">');
document.write('        <input style=" border: 1px solid #5B5275; background-color: #A89DC5; color: #5B5275; font-family: Verdana;" type="text" name="user_input[id4]" value="" size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr bgcolor="#A89DC5">');
document.write('      <td bgcolor="#A89DC5"><font color="#5B5275" face="Verdana" size="1">URL *</font></td>');
document.write('      <td bgcolor="#A89DC5"><font color="#5B5275" face="Verdana" size="1">');
document.write('        <input style=" border: 1px solid #5B5275; background-color: #A89DC5; color: #5B5275; font-family: Verdana;" type="text" name="user_input[id5]" value="" size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr bgcolor="#A89DC5">');
document.write('      <td bgcolor="#A89DC5"><font color="#5B5275" face="Verdana" size="1">Nachricht * Comment</font></td>');
document.write('      <td bgcolor="#A89DC5"><font color="#5B5275" face="Verdana" size="1">');
document.write('        <textarea style=" border: 1px solid #5B5275; background-color: #A89DC5; color: #5B5275; font-family: Verdana;" name="user_input[id6]" style="width:100%" rows="7"></textarea>');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td colspan="2" align="center" valign="middle">');
document.write('        <input type="hidden" name="mq" value="\'">');
document.write('        <input type="hidden" name="action" value="send_mail">');
document.write('        <input type="hidden" name="entry" value="51572">');
document.write('        <input type="submit" name="submit" value="Abschicken">');
document.write('        <input type="reset" name="reset" value="Zur&uuml;cksetzen">');
document.write('      </td>');
document.write('    </tr>');
document.write('</form>');
document.write('  </table>');
document.write('');