document.write("<form method=\"post\" action=\"https://ymlp.com/subscribe.php?id=ghmyejygmgb\">\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\">Voornaam:</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\">Achternaam:</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\">E-mail adres:</font></td><td valign=\"top\"><input type=\"text\" name=\"YMP0\" size=\"20\" /></td></tr>\n<tr><td colspan=\"2\"><input type=\"submit\" value=\"Submit\"  />&nbsp;</td></tr>\n</table>\n</form>\n");