document.write("<form method=\"post\" action=\"https://ymlp.com/subscribe.php?id=guebmhjgmgs\">\n<table border=\"0\" align=\"center\" cellspacing=\"0\" cellpadding=\"5\">\n<tr><td colspan=\"2\"><font size=\"2\" face=\"verdana,geneva\">Fill out your e-mail address<br />to receive our newsletter!</font></td></tr>\n<tr><td valign=\"top\"><font size=\"2\" face=\"verdana,geneva\">E-mail Address:</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\">First Name:</font></td><td valign=\"top\"><input type=\"text\" name=\"YMP1\" size=\"20\" /></td></tr>\n<tr><td valign=\"top\"><font size=\"2\" face=\"verdana,geneva\">Last Name:</font></td><td valign=\"top\"><input type=\"text\" name=\"YMP2\" size=\"20\" /></td></tr>\n<tr><td valign=\"top\"><font size=\"2\" face=\"verdana,geneva\">Country:</font></td><td valign=\"top\"><input type=\"text\" name=\"YMP3\" size=\"20\" /></td></tr>\n<tr><td valign=\"top\"><font size=\"2\" face=\"verdana,geneva\">City:</font></td><td valign=\"top\"><input type=\"text\" name=\"YMP4\" size=\"20\" /></td></tr>\n<tr><td colspan=\"2\"><font size=\"2\" face=\"verdana,geneva\">Select your interests:</font></td></tr>\n<tr><td><font size=\"2\" face=\"verdana,geneva\">Cambodia Outreach Monthly Update:</font></td><td><input type=\"checkbox\" name=\"CAT1\" value=\"1\"></td></tr>\n<tr><td><font size=\"2\" face=\"verdana,geneva\">Children At Risk:</font></td><td><input type=\"checkbox\" name=\"CAT2\" value=\"1\"></td></tr>\n<tr><td><font size=\"2\" face=\"verdana,geneva\">New Life School:</font></td><td><input type=\"checkbox\" name=\"CAT4\" value=\"1\"></td></tr>\n<tr><td><font size=\"2\" face=\"verdana,geneva\">Health & Medical:</font></td><td><input type=\"checkbox\" name=\"CAT13\" value=\"1\"></td></tr>\n<tr><td><font size=\"2\" face=\"verdana,geneva\">Prayer Team:</font></td><td><input type=\"checkbox\" name=\"CAT6\" value=\"1\"></td></tr>\n<tr><td><font size=\"2\" face=\"verdana,geneva\">Office Skills Training Center Newsletter:</font></td><td><input type=\"checkbox\" name=\"CAT29\" value=\"1\"></td></tr>\n<tr><td><font size=\"2\" face=\"verdana,geneva\">Cambodian Church Planting Center:</font></td><td><input type=\"checkbox\" name=\"CAT30\" value=\"1\"></td></tr>\n<tr><td><font size=\"2\" face=\"verdana,geneva\">Youth Ministry Newsletter:</font></td><td><input type=\"checkbox\" name=\"CAT31\" value=\"1\"></td></tr>\n<tr><td><font size=\"2\" face=\"verdana,geneva\">Reach North Phnom Penh Newsletter:</font></td><td><input type=\"checkbox\" name=\"CAT32\" value=\"1\"></td></tr>\n<tr><td><font size=\"2\" face=\"verdana,geneva\">Discipleship Ministry newsletter:</font></td><td><input type=\"checkbox\" name=\"CAT33\" value=\"1\"></td></tr>\n<tr><td><font size=\"2\" face=\"verdana,geneva\">School of Leaders Newsletter:</font></td><td><input type=\"checkbox\" name=\"CAT34\" value=\"1\"></td></tr>\n<tr><td><font size=\"2\" face=\"verdana,geneva\">Regional Care Newsletter:</font></td><td><input type=\"checkbox\" name=\"CAT35\" value=\"1\"></td></tr>\n<tr><td><font size=\"2\" face=\"verdana,geneva\">Livelihood-Cow Projects Newsletter:</font></td><td><input type=\"checkbox\" name=\"CAT36\" value=\"1\"></td></tr>\n<tr><td><font size=\"2\" face=\"verdana,geneva\">Growing Tree Internship Newsletter:</font></td><td><input type=\"checkbox\" name=\"CAT37\" value=\"1\"></td></tr>\n<tr><td><font size=\"2\" face=\"verdana,geneva\">Complementary Education Newsletter:</font></td><td><input type=\"checkbox\" name=\"CAT38\" value=\"1\"></td></tr>\n<tr><td colspan=\"2\"><input type=\"submit\" value=\"Submit\"  />&nbsp;</td></tr>\n</table>\n</form>\n");