document.write("<style>\n.link,\n.link a,\n.signupframe\n{\n	color: #226699;\n	font-family: Arial, Helvetica, sans-serif;\n	font-size: 13px;\n	}\n	.link,\n	.link a {\n		text-decoration: none;\n		}\n	.signupframe {\n		border: 1px solid #000000;\n		background: #ffffff;\n		}\n.signupframe .required {\n	font-size: 10px;\n	}\n<\/style>\n<form method=\"post\" action=\"http://app.icontact.com/icp/signup.php\" name=\"icpsignup\" id=\"icpsignup2195\" accept-charset=\"UTF-8\" onsubmit=\"return verifyRequired2195();\" >\n<input type=\"hidden\" name=\"redirect\" value=\"http://www.icontact.com/www/signup/thanks.html\">\n<input type=\"hidden\" name=\"errorredirect\" value=\"http://www.icontact.com/www/signup/error.html\">\n\n<div id=\"SignUp\">\n<table width=\"260\" class=\"signupframe\" border=\"0\" cellspacing=\"0\" cellpadding=\"5\">\n	<tr>\n      <td valign=\"top\" align=\"right\">\n        <span class=\"required\">*<\/span>&nbsp;Email\n      <\/td>\n      <td align=\"left\">\n        <input type=\"text\" name=\"fields_email\">\n      <\/td>\n    <\/tr>\n    <input type=\"hidden\" name=\"listid\" value=\"24427\">\n    <input type=\"hidden\" name=\"specialid:24427\" value=\"QU43\">\n\n    <input type=\"hidden\" name=\"clientid\" value=\"204018\">\n    <input type=\"hidden\" name=\"formid\" value=\"2195\">\n    <input type=\"hidden\" name=\"reallistid\" value=\"1\">\n    <input type=\"hidden\" name=\"doubleopt\" value=\"0\">\n    <tr>\n      <td>&nbsp;<\/td>\n      <td><span class=\"required\">*<\/span> = Required Field<\/td>\n    <\/tr>\n    <tr>\n      <td>&nbsp;<\/td>\n      <td><input type=\"submit\" name=\"Submit\" value=\"Submit\"><\/td>\n    <\/tr>\n    <\/table>\n<\/div>\n<\/form>\n<script type=\"text/javascript\">\n\nvar icpForm2195 = document.getElementById(\'icpsignup2195\');\n\nif (document.location.protocol === \"https:\")\n\n	icpForm2195.action = \"https://app.icontact.com/icp/signup.php\";\nfunction verifyRequired2195() {\n  if (icpForm2195[\"fields_email\"].value == \"\") {\n    icpForm2195[\"fields_email\"].focus();\n    alert(\"The Email field is required.\");\n    return false;\n  }\n\n\nreturn true;\n}\n<\/script>\n");