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document.write("<div id=\'SocketContainer70\' ><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=N2IolY9Hk8ZwWEd5zdYE\" onsubmit=\"javascript:return FormSubmit180();\"><table style=\"\"><tr><td style=\"\"><SPAN id=\"rfvPQ3007\" name=\"rfvPQ3007\" style=\"color:Red;display:none;\">*</SPAN>First Name*<br /><input type=\"text\" id=\"PQ3007\" name=\"PQ3007\" value=\"\" style=\" width: 200px; \" maxlength=\"500\" /></td></tr><tr><td style=\"\"><SPAN id=\"rfvPQ3008\" name=\"rfvPQ3008\" style=\"color:Red;display:none;\">*</SPAN>Last Name*<br /><input type=\"text\" id=\"PQ3008\" name=\"PQ3008\" value=\"\" style=\" width: 200px; \" maxlength=\"500\" /></td></tr><tr><td style=\"\"><SPAN id=\"rfvPQ3009\" name=\"rfvPQ3009\" style=\"color:Red;display:none;\">*</SPAN><SPAN id=\"revPQ3009\" name=\"revPQ3009\" style=\"color:Red;display:none;\">*</SPAN>Email*<br /><input type=\"text\" id=\"PQ3009\" name=\"PQ3009\" value=\"\" style=\" width: 200px; \" maxlength=\"500\" /></td></tr><tr><td style=\"\"><SPAN id=\"revPQ14872\" name=\"revPQ14872\" style=\"color:Red;display:none;\">*</SPAN>Company Phone<br /><input type=\"text\" id=\"PQ14872\" name=\"PQ14872\" 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=\"CQ1828\" type=\"checkbox\" name=\"CQ1828\" value=\"CA3150\">Corporate Golf Clinics &amp; Workshops</input><br /></td></tr><tr><td><input id=\"CQ1828\" type=\"checkbox\" name=\"CQ1828\" value=\"CA3151\">Executive Business Golf Coaching</input><br /></td></tr><tr><td><input id=\"CQ1828\" type=\"checkbox\" name=\"CQ1828\" value=\"CA3152\">Golf Instruction</input><br /></td></tr><tr><td><input id=\"CQ1828\" type=\"checkbox\" name=\"CQ1828\" value=\"CA3153\">Women\'s Golf</input><br /></td></tr><tr><td><input id=\"CQ1828\" type=\"checkbox\" name=\"CQ1828\" value=\"CA3154\">Beginner Golf</input><br /></td></tr><tr><td><input id=\"CQ1828\" type=\"checkbox\" name=\"CQ1828\" value=\"CA3155\">Junior Golf</input><br /></td></tr><tr><td><input id=\"CQ1828\" type=\"checkbox\" name=\"CQ1828\" value=\"CA3156\">Other</input><br /></td></tr></table></td></tr><tr><td style=\"\"><input id=\"IM180\" type=\"checkbox\" name=\"IM180\" value=\"true\" checked=\"true\">Would you like to join our mailing list?</input><br /></td></tr><tr><td style=\"\">Comments or Questions?<br /><input type=\"text\" id=\"CQ14873\" name=\"CQ14873\" value=\"\" style=\" width: 200px; \" maxlength=\"600\" /></td></tr></table><img src=\'http://app.wampower.net/WamHtmlBuilders/GenerateCode.aspx?OT=2&OQ=N2IolY9Hk8dwWEd5zdYE\' width=\'1\' height=\'1\' boder=\'0\'/>");
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