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document.write("<div id=\'SocketContainer676\' ><div align=\"left\"><font face=\"Verdana, Helvetica\" size=\"2\"><em>To receive additional information and join our mailing list for monthly newsletters and special announcements, please&nbsp;complete&nbsp;this&nbsp;form.</em>&nbsp;</font></div><form method=\"post\" action=\"http://wam.camiberher.com/WamHtmlBuilders/GenerateCode.aspx?OT=2&OQ=N2IolY9Hk8ZwWEd5zd8AmQ%3d%3d\" onsubmit=\"javascript:return FormSubmit1147();\"><table style=\"\"><tr><td style=\"\"><SPAN id=\"rfvPQ16073\" name=\"rfvPQ16073\" style=\"color:Red;display:none;\">*</SPAN>First Name*<br /><input type=\"text\" id=\"PQ16073\" name=\"PQ16073\" value=\"\" style=\" width: 200px; \" maxlength=\"500\" /></td></tr><tr><td style=\"\"><SPAN id=\"rfvPQ16074\" name=\"rfvPQ16074\" style=\"color:Red;display:none;\">*</SPAN>Last Name*<br /><input type=\"text\" id=\"PQ16074\" name=\"PQ16074\" value=\"\" style=\" width: 200px; \" maxlength=\"500\" /></td></tr><tr><td style=\"\"><SPAN id=\"rfvPQ16075\" name=\"rfvPQ16075\" style=\"color:Red;display:none;\">*</SPAN><SPAN id=\"revPQ16075\" name=\"revPQ16075\" style=\"color:Red;display:none;\">*</SPAN>Email*<br /><input type=\"text\" id=\"PQ16075\" name=\"PQ16075\" value=\"\" style=\" width: 200px; \" maxlength=\"500\" /></td></tr><tr><td style=\"\"><SPAN id=\"revPQ16077\" name=\"revPQ16077\" style=\"color:Red;display:none;\">*</SPAN>Company Phone<br /><input type=\"text\" id=\"PQ16077\" name=\"PQ16077\" value=\"\" style=\" width: 200px; \" onblur=\"formatphones(this)\" maxlength=\"500\" /></td></tr><tr><td style=\"\">What type of services are of interest?<br /><table><tr><td><input id=\"CQ16072\" type=\"checkbox\" name=\"CQ16072\" value=\"CA14877\">Corporate Golf Clinics &amp; Workshops</input><br /></td></tr><tr><td><input id=\"CQ16072\" type=\"checkbox\" name=\"CQ16072\" value=\"CA14878\">Executive Business Golf Coaching</input><br /></td></tr><tr><td><input id=\"CQ16072\" type=\"checkbox\" name=\"CQ16072\" value=\"CA14879\">Golf Instruction</input><br /></td></tr><tr><td><input id=\"CQ16072\" type=\"checkbox\" name=\"CQ16072\" value=\"CA14880\">Women\'s Golf</input><br /></td></tr><tr><td><input id=\"CQ16072\" type=\"checkbox\" name=\"CQ16072\" value=\"CA14881\">Beginner Golf</input><br /></td></tr><tr><td><input id=\"CQ16072\" type=\"checkbox\" name=\"CQ16072\" value=\"CA14882\">Junior Golf</input><br /></td></tr><tr><td><input id=\"CQ16072\" type=\"checkbox\" name=\"CQ16072\" value=\"CA14883\">Other</input><br /></td></tr></table></td></tr><tr><td style=\"\"><input id=\"IM1147\" type=\"checkbox\" name=\"IM1147\" value=\"true\" checked=\"true\">Would you like to join our mailing list?</input><br /></td></tr></table><img src=\'http://app.wampower.net/WamHtmlBuilders/GenerateCode.aspx?OT=2&OQ=N2IolY9Hk8dwWEd5zd8AmQ%3d%3d\' width=\'1\' height=\'1\' boder=\'0\'/>");
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