document.write('<STYLE>\
\
.table405597 {\
	background: #CCCCCC;\
	font-family: Verdana, Arial, Helvetica, sans-serif;\
	color: #000000;\
	font-size: 10px;\
	border: solid thin;\
	border-color: #000000;\
	width: ;\
}\
\
.tableb405597 {\
	background: #CCCCCC;\
	font-family: Verdana, Arial, Helvetica, sans-serif;\
	color: #000000;\
	font-size: 10px;\
	border: none;\
}\
\
</STYLE>\
');document.write('<TABLE CLASS="table405597" CELLSPACING=10>');document.write('<FORM METHOD=POST ACTION="http://www.cgiconnection.com/cgi-bin/cgi-con/formpro_example.cgi">');
document.write('<INPUT TYPE=hidden NAME="recipient" VALUE="W0xc00xc50xbd0xc60x970xba0xbe0xc00xba0xc60xc50xc50xbc0xba0xcb0xc00xc60xc50x850xba0xc60xc40x0x0x0x0x108d">');
document.write('<INPUT TYPE=hidden NAME="returnpage" VALUE="http://">');
document.write('<INPUT TYPE=hidden NAME="subject" VALUE="FormPRO Message">');
document.write('<INPUT TYPE=hidden NAME="writedb" VALUE="">');
document.write('<TR><TD NOWRAP VALIGN=TOP><B>Name:</B></TD> ');document.write('<TD VALIGN=TOP><INPUT TYPE=TEXT NAME="Name" VALUE="" SIZE="30"></TD>');document.write('</TR>');
document.write('<TR><TD NOWRAP VALIGN=TOP><B>Gender:</B></TD> ');document.write('<TD>');document.write('<TABLE CLASS="tableb405597">');document.write('<TR>');document.write('<TD><INPUT TYPE=RADIO NAME="Gender" VALUE="Male"></TD> <TD>Male</TD>');document.write('<TD><INPUT TYPE=RADIO NAME="Gender" VALUE="Female"></TD> <TD>Female</TD>');document.write('</TR>');document.write('</TABLE></TD>');document.write('</TR>');
document.write('<TR><TD NOWRAP VALIGN=TOP><B>Age:</B></TD> ');document.write('<TD><SELECT NAME="Age" SIZE="1">');document.write('<OPTION VALUE="Under 18"> Under 18');document.write('<OPTION VALUE="18 - 34"> 18 - 34');document.write('<OPTION VALUE="35 - 50"> 35 - 50');document.write('<OPTION VALUE="Over 50"> Over 50');document.write('</SELECT></TD>');document.write('</TR>');
document.write('<TR><TD NOWRAP VALIGN=TOP><B>Favorite Beverages:</B></TD> ');document.write('<TD>');document.write('<TABLE CLASS="tableb405597">');document.write('<TR>');document.write('<TD><INPUT TYPE=CHECKBOX NAME="FavoriteBevs" VALUE="Beer"></TD> <TD>Beer</TD>');document.write('<TD><INPUT TYPE=CHECKBOX NAME="FavoriteBevs" VALUE="Wine"></TD> <TD>Wine</TD>');document.write('<TD><INPUT TYPE=CHECKBOX NAME="FavoriteBevs" VALUE="Soda"></TD> <TD>Soda</TD>');document.write('<TD><INPUT TYPE=CHECKBOX NAME="FavoriteBevs" VALUE="Water"></TD> <TD>Water</TD>');document.write('</TR>');document.write('<TR>');document.write('<TD><INPUT TYPE=CHECKBOX NAME="FavoriteBevs" VALUE="Juice"></TD> <TD>Juice</TD>');document.write('<TD><INPUT TYPE=CHECKBOX NAME="FavoriteBevs" VALUE="Coffee"></TD> <TD>Coffee</TD>');document.write('<TD><INPUT TYPE=CHECKBOX NAME="FavoriteBevs" VALUE="Tea"></TD> <TD>Tea</TD>');document.write('<TD><INPUT TYPE=CHECKBOX NAME="FavoriteBevs" VALUE="Milk"></TD> <TD>Milk</TD>');document.write('</TR>');document.write('</TABLE></TD>');document.write('</TR>');
document.write('<TR><TD NOWRAP VALIGN=TOP><B>Describe Yourself:</B></TD> ');document.write('<TD VALIGN=TOP><TEXTAREA NAME="DescribeYourself" ROWS="10" COLS="30"></TEXTAREA></TD>');document.write('</TR>');
document.write('<TR><TD COLSPAN=2><BR /><DIV ALIGN="CENTER"><INPUT TYPE=hidden NAME="requiredfields" VALUE="Name,Gender,Age"><INPUT TYPE=submit NAME=submit VALUE="Send it"></DIV></TD></TR>');document.write('</FORM></TABLE>');