document.write("<form method=\"post\" action=\"https://ymlp.com/subscribe.php?id=gewuswjgmguu\">\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\">Algemene voorwaarden:</font></td><td valign=\"top\"><input type=\"checkbox\" name=\"YMP5[0]\" value=\"1\" />Ik aanvaard de algemene voorwaarden<br /></td></tr>\n<tr><td colspan=\"2\"><input type=\"submit\" value=\"Verzenden\"  />&nbsp;</td></tr>\n</table>\n</form>\n");