document.writeln(" <script src=\"/scripts/holidaysValidation.js\" type=\"text/javascript\"></script>");
document.writeln("	  ");
document.writeln("	 <p>(<img src=\"images/required.gif\" width=\"3\" height=\"4\" hspace=\"1\" vspace=\"3\" /> Please note \'Holidays\' are only available from Qatar.)</p>");
document.writeln("<form id=\"requestQuote\" name=\"requestQuote\" action=\"/modules/holidaysMailer.php\" method=\"post\" class=\"partnership\">");
document.writeln("<input id=\"requestType\" name=\"requestType\" type=\"hidden\" value=\"requestQuote\" ");
document.writeln("	 ");
document.writeln("	");
document.writeln("		<ul>");
document.writeln("			<li class=\"label\"><label>Title:</label></li>");
document.writeln("			<li><select id=\"pax1title\" style=\"WIDTH: 60px\" name=\"pax1title\">");
document.writeln("				<option value=\"Mr\" selected>Mr</option>");
document.writeln("				<option value=\"Mrs\">Mrs</option>");
document.writeln("				<option value=\"Ms\">Ms</option>");
document.writeln("				<option value=\"Miss\">Miss</option>");
document.writeln("				</select>");
document.writeln("			</li>");
document.writeln("			<li class=\"label required\"><img src=\"images/required.gif\" width=\"3\" height=\"4\" hspace=\"1\" vspace=\"3\" /><label>First name:</label></li>");
document.writeln("			<li><input id=\"pax1firstname\" name=\"pax1firstname\" /></li>");
document.writeln("			<li class=\"label required\"><img src=\"images/required.gif\" width=\"3\" height=\"4\" hspace=\"1\" vspace=\"3\" /><label>Last name:</label></li>");
document.writeln("			<li><input id=\"pax1lastname\" name=\"pax1lastname\" /></li>");
document.writeln("			<li class=\"label required\"><img src=\"images/required.gif\" width=\"3\" height=\"4\" hspace=\"1\" vspace=\"3\" /><label>Telephone:</label></li>");
document.writeln("			<li><input id=\"pax1telephone\" name=\"pax1telephone\" /></li>");
document.writeln("			<li class=\"label required\"><label>Fax:</label></li>");
document.writeln("			<li><input id=\"pax1fax\" name=\"pax1fax\" /></li>");
document.writeln("			<li class=\"label required\"><img src=\"images/required.gif\" width=\"3\" height=\"4\" hspace=\"1\" vspace=\"3\" /><label>Email:</label></li>");
document.writeln("			<li><input id=\"email\" name=\"email\" /></li>");
document.writeln("			<li class=\"label required\"><img src=\"images/required.gif\" width=\"3\" height=\"4\" hspace=\"1\" vspace=\"3\" /><label>Country:</label></li>");
document.writeln("			<li><select id=\"Country\" name=\"Country\">");
document.writeln("				<option value=\"Qatar\" selected>Qatar</option>");
document.writeln("				<option value=\"Kuwait\">Kuwait</option>");
document.writeln("				<option value=\"Saudi Arabia\">Saudi Arabia</option>");
document.writeln("				<option value=\"Oman\">Oman</option>");
document.writeln("				<option value=\"Bahrain\">Bahrain</option>");
document.writeln("				<option value=\"UAE\">UAE</option>");
document.writeln("				</select>");
document.writeln("			</li>");
document.writeln("		</ul>");
document.writeln("  		<fieldset>");
document.writeln("			<ul class=\"second\">");
document.writeln("				<h5>Travel Details</h5>");
document.writeln("				Details of other people traveling with you: (please provide age if below 12)<br />");
document.writeln("				  ");
document.writeln("			  ");
document.writeln("				<li class=\"label\"><label>Title:</label></li>");
document.writeln("				<li><select id=\"pax2title\" name=\"pax2title\">");
document.writeln("					<option value=\"Mr\" selected>Mr</option>");
document.writeln("					<option value=\"Mrs\">Mrs</option>");
document.writeln("					<option value=\"Ms\">Ms</option>");
document.writeln("					<option value=\"Miss\">Miss</option>");
document.writeln("					</select>");
document.writeln("				</li>");
document.writeln("				<li class=\"label\"><label>First Name</label></li>");
document.writeln("				<li><input id=\"pax2firstname\"name=\"pax2firstname\" /></li>");
document.writeln("				<li class=\"label\"><label>Last Name</label></li>");
document.writeln("				<li><input id=\"pax2lastname\" name=\"pax2lastname\" /></li>");
document.writeln("				<li class=\"label\"><label>Age</label></li>");
document.writeln("				<li><input id=\"pax2age\" name=\"pax2age\" maxlength=\"2\" style=\" width:50px\" /></li>");
document.writeln("		  </ul>");
document.writeln("		 </fieldset>");
document.writeln("		 <fieldset>");
document.writeln("				<ul class=\"second\">");
document.writeln("				<li class=\"label\"><label>Title:</label></li>");
document.writeln("				<li><select id=\"pax3title\" name=\"pax3title\">");
document.writeln("					<option value=\"Mr\" selected>Mr</option>");
document.writeln("					<option value=\"Mrs\">Mrs</option>");
document.writeln("					<option value=\"Ms\">Ms</option>");
document.writeln("					<option value=\"Miss\">Miss</option>");
document.writeln("					</select>");
document.writeln("				</li>");
document.writeln("				<li class=\"label\"><label>First Name</label></li>");
document.writeln("				<li><input id=\"pax3firstname\"name=\"pax3firstname\" /></li>");
document.writeln("				<li class=\"label\"><label>Last Name</label></li>");
document.writeln("				<li><input id=\"pax3lastname\" name=\"pax3lastname\" /></li>");
document.writeln("				<li class=\"label\"><label>Age</label></li>");
document.writeln("				<li><input id=\"pax3age\" name=\"pax3age\" maxlength=\"2\" style=\" width:50px\" /></li>");
document.writeln("			</ul>");
document.writeln("		</fieldset>");
document.writeln("		 <fieldset>");
document.writeln("				<ul class=\"second\">");
document.writeln("				<li class=\"label\"><label>Title:</label></li>");
document.writeln("				<li><select id=\"pax4title\" name=\"pax4title\">");
document.writeln("					<option value=\"Mr\" selected>Mr</option>");
document.writeln("					<option value=\"Mrs\">Mrs</option>");
document.writeln("					<option value=\"Ms\">Ms</option>");
document.writeln("					<option value=\"Miss\">Miss</option>");
document.writeln("					</select>");
document.writeln("				</li>");
document.writeln("				<li class=\"label\"><label>First Name</label></li>");
document.writeln("				<li><input id=\"pax4firstname\"name=\"pax4firstname\" /></li>");
document.writeln("				<li class=\"label\"><label>Last Name</label></li>");
document.writeln("				<li><input id=\"pax4lastname\" name=\"pax4lastname\" /></li>");
document.writeln("				<li class=\"label\"><label>Age</label></li>");
document.writeln("				<li><input id=\"pax4age\" name=\"pax4age\" maxlength=\"2\" style=\" width:50px\" /></li>");
document.writeln("			</ul>");
document.writeln("		</fieldset>");
document.writeln("		<fieldset>");
document.writeln("				<ul class=\"second\">");
document.writeln("				<li class=\"label\"><label>Title:</label></li>");
document.writeln("				<li><select id=\"pax5title\" name=\"pax2title\">");
document.writeln("					<option value=\"Mr\" selected>Mr</option>");
document.writeln("					<option value=\"Mrs\">Mrs</option>");
document.writeln("					<option value=\"Ms\">Ms</option>");
document.writeln("					<option value=\"Miss\">Miss</option>");
document.writeln("					</select>");
document.writeln("				</li>");
document.writeln("				<li class=\"label\"><label>First Name</label></li>");
document.writeln("				<li><input id=\"pax5firstname\"name=\"pax5firstname\" /></li>");
document.writeln("				<li class=\"label\"><label>Last Name</label></li>");
document.writeln("				<li><input id=\"pax5lastname\" name=\"pax5lastname\" /></li>");
document.writeln("				<li class=\"label\"><label>Age</label></li>");
document.writeln("				<li><input id=\"pax5age\" name=\"pax5age\" maxlength=\"2\" style=\" width:50px\" /></li>");
document.writeln("			</ul>");
document.writeln("		</fieldset>");
document.writeln("		<fieldset>");
document.writeln("				<ul class=\"second\">");
document.writeln("				<li class=\"label\"><label>Title:</label></li>");
document.writeln("				<li><select id=\"pax6title\" name=\"pax2title\">");
document.writeln("					<option value=\"Mr\" selected>Mr</option>");
document.writeln("					<option value=\"Mrs\">Mrs</option>");
document.writeln("					<option value=\"Ms\">Ms</option>");
document.writeln("					<option value=\"Miss\">Miss</option>");
document.writeln("					</select>");
document.writeln("				</li>");
document.writeln("				<li class=\"label\"><label>First Name</label></li>");
document.writeln("				<li><input id=\"pax6firstname\"name=\"pax6firstname\" /></li>");
document.writeln("				<li class=\"label\"><label>Last Name</label></li>");
document.writeln("				<li><input id=\"pax6lastname\" name=\"pax6lastname\" /></li>");
document.writeln("				<li class=\"label\"><label>Age</label></li>");
document.writeln("				<li><input id=\"pax6age\" name=\"pax6age\" maxlength=\"2\" style=\" width:50px\" /></li>");
document.writeln("			</ul>");
document.writeln("		</fieldset>");
document.writeln("		<fieldset>");
document.writeln("		<ul class=\"second\">");
document.writeln("				<li class=\"label\"><label><img src=\"images/required.gif\" width=\"3\" height=\"4\" hspace=\"1\" vspace=\"3\" />Destination:</label></li>");
document.writeln("				<li><select id=\"countrycitydest\" name=\"countrycitydest\">");
document.writeln("						<option value=\"\" selected=\"selected\">-- Select --</option>");
document.writeln("						<option value=\"Austria (Blumau)\" >Austria (Blumau)</option>");
document.writeln("						<option value=\"Austria (Igls)\">Austria (Igls)</option>");
document.writeln("						<option value=\"Austria (Innsbruck)\">Austria (Innsbruck)</option>");
document.writeln("						<option value=\"Austria (Salzburg)\">Austria (Salzburg)</option>");
document.writeln("						<option value=\"Austria (Vienna)\">Austria (Vienna)</option>");
document.writeln("						<option value=\"Bahrain\">Bahrain</option>");
document.writeln("						<option value=\"China (Shanghai)\">China (Shanghai)</option>");
document.writeln("						<option value=\"Czech Republic (Prague)\">Czech Republic (Prague)</option>");
document.writeln("						<option value=\"Egypt (Cairo)\">Egypt (Cairo)</option>");
document.writeln("						<option value=\"Egypt (Hurghada)\">Egypt (Hurghada)</option>");
document.writeln("						<option value=\"Egypt (Luxor)\">Egypt (Luxor)</option>");
document.writeln("						<option value=\"Egypt (Sharm El Shaikh)\">Egypt (Sharm El Shaikh)</option>");
document.writeln("						<option value=\"France (Cannes)\">France (Cannes)</option>");
document.writeln("						<option value=\"France (Monaco)\">France (Monaco)</option>");
document.writeln("						<option value=\"France (Nice)\">France (Nice)</option>");
document.writeln("						<option value=\"France (Paris)\">France (Paris)</option>");
document.writeln("						<option value=\"Germany (Franfurt)\">Germany (Franfurt)</option>");
document.writeln("						<option value=\"Germany (Munich)\">Germany (Munich)</option>");
document.writeln("						<option value=\"Hongkong\">Hongkong</option>");
document.writeln("						<option value=\"Hongkong (Kowloon)\">Hongkong (Kowloon)</option>");
document.writeln("						<option value=\"India (Cochin)\">India (Cochin)</option>");
document.writeln("						<option value=\"India (Delhi)\">India (Delhi)</option>");
document.writeln("						<option value=\"India (Goa)\">India (Goa)</option>");
document.writeln("						<option value=\"India (Hyderabad)\">India (Hyderabad)</option>");
document.writeln("						<option value=\"India (Mumbai)\">India (Mumbai)</option>");
document.writeln("						<option value=\"India (Thiruvanathapuram)\">India (Thiruvanathapuram)</option>");
document.writeln("						<option value=\"Indonesia (Bali)\">Indonesia (Bali)</option>");
document.writeln("						<option value=\"Indonesia (Jakarta)\">Indonesia (Jakarta)</option>");
document.writeln("						<option value=\"Ireland (Cork)\">Ireland (Cork)</option>");
document.writeln("						<option value=\"Ireland (Dublin)\">Ireland (Dublin)</option>");
document.writeln("						<option value=\"Italy (Florence)\">Italy (Florence)</option>");
document.writeln("						<option value=\"Italy (Milan)\">Italy (Milan)</option>");
document.writeln("						<option value=\"Italy (Rome)\">Italy (Rome)</option>");
document.writeln("						<option value=\"Italy (Venice)\">Italy (Venice)</option>");
document.writeln("						<option value=\"Jordan (Amman)\">Jordan (Amman)</option>");
document.writeln("						<option value=\"Jordan (Aqaba)\">Jordan (Aqaba)</option>");
document.writeln("						<option value=\"Jordan (Dead Sea)\">Jordan (Dead Sea)</option>");
document.writeln("						<option value=\"Jordan (Petra)\">Jordan (Petra)</option>");
document.writeln("						<option value=\"Lebanon (Beirut)\">Lebanon (Beirut)</option>");
document.writeln("						<option value=\"Lebanon (Mazzar)\">Lebanon (Mazzar)</option>");
document.writeln("						<option value=\"Malaysia (Genting)\">Malaysia (Genting)</option>");
document.writeln("						<option value=\"Malaysia (Kuala Lumpur)\">Malaysia (Kuala Lumpur)</option>");
document.writeln("						<option value=\"Malaysia (Langkawi)\">Malaysia (Langkawi)</option>");
document.writeln("						<option value=\"Malaysia (Penang)\">Malaysia (Penang)</option>");
document.writeln("						<option value=\"Maldives\">Maldives</option>");
document.writeln("						<option value=\"Morocco (Agadir)\">Morocco (Agadir)</option>");
document.writeln("						<option value=\"Morocco (Casablanca)\">Morocco (Casablanca)</option>");
document.writeln("						<option value=\"Morocco (Fez)\">Morocco (Fez)</option>");
document.writeln("						<option value=\"Morocco (Marrakesh)\">Morocco (Marrakesh)</option>");
document.writeln("						<option value=\"Nepal (Jomsom)\">Nepal (Jomsom)</option>");
document.writeln("						<option value=\"Nepal (Kathmandu)\">Nepal (Kathmandu)</option>");
document.writeln("						<option value=\"Nepal (Pokhara)\">Nepal (Pokhara)</option>");
document.writeln("						<option value=\"Oman (Barka)\">Oman (Barka)</option>");
document.writeln("						<option value=\"Oman (Muscat)\">Oman (Muscat)</option>");
document.writeln("						<option value=\"Oman (Nizwa)\">Oman (Nizwa)</option>");
document.writeln("						<option value=\"Oman (Salalah)\">Oman (Salalah)</option>");
document.writeln("						<option value=\"Oman (Sur)\">Oman (Sur)</option>");
document.writeln("						<option value=\"Phillipines (Cebu)\">Phillipines (Cebu)</option>");
document.writeln("						<option value=\"Phillipines (Manila)\">Phillipines (Manila)</option>");
document.writeln("						<option value=\"Russia (Moscow)\">Russia (Moscow)</option>");
document.writeln("						<option value=\"Singapore (Sentosa)\">Singapore (Sentosa)</option>");
document.writeln("						<option value=\"Singapore City\">Singapore City</option>");
document.writeln("						<option value=\"Spain (Barcelona)\">Spain (Barcelona)</option>");
document.writeln("						<option value=\"Spain (Madrid)\">Spain (Madrid)</option>");
document.writeln("						<option value=\"Sri Lanka (Bentota)\">Sri Lanka (Bentota)</option>");
document.writeln("						<option value=\"Sri Lanka (Colombo)\">Sri Lanka (Colombo)</option>");
document.writeln("						<option value=\"Sri Lanka (Galle)\">Sri Lanka (Galle)</option>");
document.writeln("						<option value=\"Sri Lanka (Kandy)\">Sri Lanka (Kandy)</option>");
document.writeln("						<option value=\"Switzerland (Geneva)\">Switzerland (Geneva)</option>");
document.writeln("						<option value=\"Switzerland (Zurich)\">Switzerland (Zurich)</option>");
document.writeln("						<option value=\"Syria (Aleppo)\">Syria (Aleppo)</option>");
document.writeln("						<option value=\"Syria (Damascus)\">Syria (Damascus)</option>");
document.writeln("						<option value=\"Syria (Palmyra)\">Syria (Palmyra)</option>");
document.writeln("						<option value=\"Thailand (Bangkok)\">Thailand (Bangkok)</option>");
document.writeln("						<option value=\"Thailand (Hua Hin)\">Thailand (Hua Hin)</option>");
document.writeln("						<option value=\"Thailand (Pattaya)\">Thailand (Pattaya)</option>");
document.writeln("						<option value=\"UAE (Abu Dhabi)\">UAE (Abu Dhabi)</option>");
document.writeln("						<option value=\"UAE (Ajman)\">UAE (Ajman)</option>");
document.writeln("						<option value=\"UAE (Dubai)\">UAE (Dubai)</option>");
document.writeln("						<option value=\"UAU (Sharjah)\">UAU (Sharjah)</option>");
document.writeln("						<option value=\"UK (London)\">UK (London)</option>");
document.writeln("						<option value=\"UK (Manchester)\">UK (Manchester)</option>");
document.writeln("					</select></li>");
document.writeln("				<li class=\"label\"><label><img src=\"images/required.gif\" width=\"3\" height=\"4\" hspace=\"1\" vspace=\"3\" />Date of Departure:</label></li>");
document.writeln("				<li><input name=\"departuredate\" id=\"departuredate\" value=\"MM/DD/YYYY\" maxlength=\"10\" style=\"width:100px\" /></li>");
document.writeln("				<li class=\"label\"><label><img src=\"images/required.gif\" width=\"3\" height=\"4\" hspace=\"1\" vspace=\"3\" />Date of Return:</label></li>");
document.writeln("				<li><input name=\"returndate\" id=\"returndate\" value=\"MM/DD/YYYY\" maxlength=\"10\" style=\"width:100px\" /></li>");
document.writeln("				<li class=\"label\"><label><img src=\"images/required.gif\" width=\"3\" height=\"4\" hspace=\"1\" vspace=\"3\" />Book Flight ex-Doha?</label></li>");
document.writeln("				<li><table cellspacing=\"0\" cellpadding=\"0\" border=\"0\" width=\"115\">");
document.writeln("						<tr>");
document.writeln("						<td><input type=\"radio\" value=\"YES\" name=\"book_exdohatype\" style=\"width:20px\"></td>");
document.writeln("						<td width=\"50\">Yes</td>");
document.writeln("						<td><input type=\"radio\" value=\"NO\" name=\"book_exdohatype\" style=\"width:20px\"></td>");
document.writeln("						<td  >No</td>");
document.writeln("						</tr>");
document.writeln("					</table>");
document.writeln("				</li>");
document.writeln("				</ul>");
document.writeln("				<ul>");
document.writeln("				<li class=\"label\" ><label><img src=\"images/required.gif\" width=\"3\" height=\"4\" hspace=\"1\" vspace=\"3\" />Flight Class?</label></li>");
document.writeln("				<li>");
document.writeln("					<table cellspacing=\"0\" cellpadding=\"0\" border=\"0\" width=\"250\">");
document.writeln("						<tr>");
document.writeln("						<td><input class=\"radio\" type=\"radio\" value=\"FIRST\" name=\"flightclass\" style=\"width:20px; \"></td>");
document.writeln("						<td  width=\"50\">First</td>");
document.writeln("						<td><input type=\"radio\" value=\"BUSINESS\" name=\"flightclass\" style=\"width:20px\"></td>");
document.writeln("						<td  width=\"60\">Business</td>");
document.writeln("						");
document.writeln("						<td><input type=\"radio\" value=\"ECONOMY\" name=\"flightclass\" style=\"width:20px\"></td>");
document.writeln("						<td  width=\"60\">Economy</td>");
document.writeln("						</tr>");
document.writeln("				  </table>");
document.writeln("				</li>	");
document.writeln("				</ul>");
document.writeln("				<ul>					");
document.writeln("				<li class=\"label\" ><label><img src=\"images/required.gif\" width=\"3\" height=\"4\" hspace=\"1\" vspace=\"3\" />Number of nights:</label></li>");
document.writeln("				<li><input cid=\"nights\" name=\"nights\" style=\"width:50px\"></li>");
document.writeln("				<li class=\"label\" ><label><img src=\"images/required.gif\" width=\"3\" height=\"4\" hspace=\"1\" vspace=\"3\" />Room Type:</label></li>");
document.writeln("				<li><select id=\"roomtype\" name=\"roomtype\">");
document.writeln("						<option value=\"\" selected>-- Select --</option>");
document.writeln("						<option value=\"TRIPLE\">Triple Room</option>");
document.writeln("						<option value=\"DOUBLE\">Double Room</option>");
document.writeln("						<option value=\"SINGLE\">Single Room</option>");
document.writeln("					</select>");
document.writeln("				</li>");
document.writeln("				<li class=\"label\" ><label><img src=\"images/required.gif\" width=\"3\" height=\"4\" hspace=\"1\" vspace=\"3\" />Number of rooms:</label></li>");
document.writeln("				<li><select id=\"no_of_rooms\" name=\"no_of_rooms\">");
document.writeln("						<option value=\"1\" selected>1</option>");
document.writeln("						<option value=\"2\">2</option>");
document.writeln("						<option value=\"3\">3</option>");
document.writeln("						<option value=\"4\">4</option>");
document.writeln("						<option value=\"5\">5</option>");
document.writeln("					</select>");
document.writeln("				</li>");
document.writeln("				<li class=\"label\" ><label>Special Requests&nbsp;&nbsp;<br>(not guaranteed):&nbsp;</label></li>");
document.writeln("				<li><textarea id=\"special_request\" name=\"special_request\" cols=\"50\" rows=\"5\" wrap=\"virtual\"></textarea></li>");
document.writeln("				<li class=\"label\" ><label>Book car hire:</label></li>");
document.writeln("				<li><table cellspacing=\"0\" cellpadding=\"0\" border=\"0\" width=\"115\">");
document.writeln("						<tr>");
document.writeln("						<td><input type=\"radio\" value=\"YES\" name=\"book_car\" style=\"width:20px\"></td>");
document.writeln("						<td  width=\"50\">Yes</td>");
document.writeln("						<td><input type=\"radio\" value=\"NO\" name=\"book_car\" style=\"width:20px\"></td>");
document.writeln("						<td  width=\"50\">No</td>");
document.writeln("						</tr>");
document.writeln("					</table></li>");
document.writeln("					</ul>");
document.writeln("				<ul>	");
document.writeln("				<li class=\"label\" ><label>Book sightseeing tours:</label></li>");
document.writeln("					<li><table cellspacing=\"0\" cellpadding=\"0\" border=\"0\" width=\"115\">");
document.writeln("						<tr>");
document.writeln("						<td><input type=\"radio\" value=\"YES\" name=\"book_tours\" style=\"width:20px\"></td>");
document.writeln("						<td  width=\"50\">Yes</td>");
document.writeln("						<td><input type=\"radio\" value=\"NO\" name=\"book_tours\" style=\"width:20px\"></td>");
document.writeln("						<td width=\"50\" >No</td>");
document.writeln("						</tr>");
document.writeln("					</table></li>");
document.writeln("					</ul>");
document.writeln("				<ul>	");
document.writeln("					<li class=\"label\" ><label>Require Travel Insurance:</label></li>");
document.writeln("					<li><table cellspacing=\"0\" cellpadding=\"0\" border=\"0\" width=\"115\">");
document.writeln("						<tr>");
document.writeln("						<td><input type=\"radio\" value=\"YES\" name=\"require_travelinsurance\" style=\"width:20px\"></td>");
document.writeln("						<td  width=\"50\">Yes</td>");
document.writeln("						<td><input type=\"radio\" value=\"NO\" name=\"require_travelinsurance\" style=\"width:20px\"></td>");
document.writeln("						<td  width=\"50\">No</td>");
document.writeln("						</tr>");
document.writeln("					</table></li>");
document.writeln("					</ul>");
document.writeln("				<ul>	");
document.writeln("				<li class=\"label\" ><label>Privilege Club Member:</label></li>");
document.writeln("					<li><input  id=\"priv_club_no\"   name=\"priv_club_no\"></li>");
document.writeln("				");
document.writeln("		  </ul>");
document.writeln("		  </fieldset>");
document.writeln("		");
document.writeln("				<input type=\"image\" src=\"images/btn-submit-w.gif\" alt=\"submit\" class=\"submit\" />");
document.writeln("		");
document.writeln("	  </form>");