document.write("<form method=\"post\" action=\"https://ymlp.com/subscribe.php?id=gjwesyqgmgh\">\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 adres:</font></td><td valign=\"top\"><input type=\"text\" name=\"YMP0\" 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\">General newsletter:</font></td><td><input type=\"checkbox\" name=\"CAT1\" value=\"1\"></td></tr>\n<tr><td><font size=\"2\" face=\"verdana,geneva\">USA newsletter:</font></td><td><input type=\"checkbox\" name=\"CAT13\" value=\"1\"></td></tr>\n<tr><td><font size=\"2\" face=\"verdana,geneva\">Europe newsletter:</font></td><td><input type=\"checkbox\" name=\"CAT14\" value=\"1\"></td></tr>\n<tr><td><font size=\"2\" face=\"verdana,geneva\">Japan newsletter:</font></td><td><input type=\"checkbox\" name=\"CAT15\" value=\"1\"></td></tr>\n<tr><td><font size=\"2\" face=\"verdana,geneva\">Rob Papen RE news (Propellerhead) :</font></td><td><input type=\"checkbox\" name=\"CAT31\" value=\"1\"></td></tr>\n<td colspan=\"2\"><input type=\"radio\" name=\"action\" value=\"subscribe\" checked /> <font size=\"2\" face=\"verdana,geneva\">Subscribe</font><input type=\"radio\" name=\"action\" value=\"unsubscribe\" /> <font size=\"2\" face=\"verdana,geneva\">Unsubscribe</font></td><tr><td colspan=\"2\"><input type=\"submit\" value=\"Submit\"  />&nbsp;</td></tr>\n</table>\n</form>\n");