document.write("<form method=\"post\" action=\"http://ymlp.com/subscribe.php?id=geheuejgmgj\">\n<table border=\"0\" align=\"center\" cellspacing=\"0\" cellpadding=\"5\">\n<tr><td colspan=\"2\"><font size=\"2\" face=\"verdana,geneva\">Vul uw e-mail adres in<br />om onze nieuwsbrief te ontvangen:</font></td></tr>\n<tr><td valign=\"top\"><font size=\"2\" face=\"verdana,geneva\">E-mail adres:</font></td><td valign=\"top\"><input type=\"text\" name=\"YMP0\" size=\"20\" /></td></tr>\n<tr><td valign=\"top\"><font size=\"2\" face=\"verdana,geneva\">Voor- en achternaam:</font></td><td valign=\"top\"><input type=\"text\" name=\"YMP3\" size=\"20\" /></td></tr>\n<td colspan=\"2\"><input type=\"radio\" name=\"action\" value=\"subscribe\" checked /> <font size=\"2\" face=\"verdana,geneva\">Inschrijven</font><input type=\"radio\" name=\"action\" value=\"unsubscribe\" /> <font size=\"2\" face=\"verdana,geneva\">Uitschrijven</font></td><tr><td colspan=\"2\"><input type=\"submit\" value=\"Verzenden\"  />&nbsp;</td></tr>\n</table>\n</form>\n");