document.write("<div><span style=\"font-size: 8pt;\"><br /></span></div>\n<form method=\"post\" action=\"https://ymlp.com/subscribe.php?id=ghseuuwgmgue\">\n<table cellpadding=\"5\" cellspacing=\"0\" align=\"center\" border=\"0\">\n<tbody>\n<tr>\n<td colspan=\"2\"><span style=\"font-size: 8pt;\">Vul je gegevens in om de&nbsp;nieuwsbrief te ontvangen:</span></td>\n</tr>\n<tr>\n<td valign=\"top\"><span style=\"font-size: 8pt;\">mail:</span></td>\n<td valign=\"top\"><span style=\"font-size: 8pt;\"><input size=\"20\" name=\"YMP0\" type=\"text\" /></span></td>\n</tr>\n<tr>\n<td valign=\"top\"><span style=\"font-size: 8pt;\">Vnaam:</span></td>\n<td valign=\"top\"><span style=\"font-size: 8pt;\"><input size=\"20\" name=\"YMP1\" type=\"text\" /></span></td>\n</tr>\n<tr>\n<td valign=\"top\"><span style=\"font-size: 8pt;\">Anaam:</span></td>\n<td valign=\"top\"><span style=\"font-size: 8pt;\"><input size=\"20\" name=\"YMP5\" type=\"text\" /></span></td>\n</tr>\n<tr>\n<td colspan=\"2\"><span style=\"font-size: 8pt;\"><input checked=\"checked\" value=\"subscribe\" name=\"action\" type=\"radio\" /> Inschrijven<input value=\"unsubscribe\" name=\"action\" type=\"radio\" /> Uitschrijven</span></td>\n</tr>\n<tr>\n<td colspan=\"2\"><span style=\"font-size: 8pt;\"><input value=\"Verzenden\" type=\"submit\" />&nbsp;</span></td>\n</tr>\n</tbody>\n</table>\n</form>");