document.write("<script src=\'http://app.wampower.net/WamHtmlBuilders/Scripts/prototype.js\' type=\'text/javascript\'  language=\'javascript\' ></script>");
document.write("<script src=\'http://wam.bmacarolinas.org/WamHtmlBuilders/Scripts/Validation.js\' type=\'text/javascript\'  language=\'javascript\' ></script>");
document.write("<style type=\'text/css\'>");
document.write("DIV#SocketContainer341 { font-family:Arial;font-size:12px;color:#000000;width:100%; }");
document.write("DIV#SocketContainer341 TD { font-family:Arial;font-size:12px;color:#000000; } ");
document.write("</style>");
document.write("<div id=\'SocketContainer341\' ><p><font size=\"3\"><br />");
document.write("</font></p>");
document.write("<p><font size=\"3\">Please register here for the&nbsp;BMA email newsletter</font></p><form method=\"post\" action=\"http://wam.bmacarolinas.org/WamHtmlBuilders/GenerateCode.aspx?OT=2&OQ=N2IolY9Hk8ZwWEd5yN8H\" onsubmit=\"javascript:return FormSubmit413();\"><table style=\"\"><tr><td style=\"\"><SPAN id=\"rfvPQ8042\" name=\"rfvPQ8042\" style=\"color:Red;display:none;\">*</SPAN>First Name*<br /><input type=\"text\" id=\"PQ8042\" name=\"PQ8042\" value=\"\" style=\" width: 200px; \" maxlength=\"500\" /></td></tr><tr><td style=\"\">Last Name<br /><input type=\"text\" id=\"PQ8043\" name=\"PQ8043\" value=\"\" style=\" width: 200px; \" maxlength=\"500\" /></td></tr><tr><td style=\"\"><SPAN id=\"rfvPQ8044\" name=\"rfvPQ8044\" style=\"color:Red;display:none;\">*</SPAN><SPAN id=\"revPQ8044\" name=\"revPQ8044\" style=\"color:Red;display:none;\">*</SPAN>Email*<br /><input type=\"text\" id=\"PQ8044\" name=\"PQ8044\" value=\"\" style=\" width: 200px; \" maxlength=\"500\" /></td></tr><tr><td style=\"\"><SPAN id=\"revPQ8046\" name=\"revPQ8046\" style=\"color:Red;display:none;\">*</SPAN>Phone<br /><input type=\"text\" id=\"PQ8046\" name=\"PQ8046\" value=\"\" style=\" width: 200px; \" onblur=\"formatphones(this)\" maxlength=\"500\" /></td></tr><tr><td style=\"\">Company<br /><input type=\"text\" id=\"PQ8045\" name=\"PQ8045\" value=\"\" style=\" width: 200px; \" maxlength=\"500\" /></td></tr><tr><td style=\"\">Title<br /><input type=\"text\" id=\"PQ8048\" name=\"PQ8048\" value=\"\" style=\" width: 200px; \" maxlength=\"500\" /></td></tr><tr><td style=\"\">Address<br /><input type=\"text\" id=\"PQ8049\" name=\"PQ8049\" value=\"\" style=\" width: 200px; \" maxlength=\"500\" /></td></tr><tr><td style=\"\">Address 2<br /><input type=\"text\" id=\"PQ8050\" name=\"PQ8050\" value=\"\" style=\" width: 200px; \" maxlength=\"500\" /></td></tr><tr><td style=\"\">City<br /><input type=\"text\" id=\"PQ8051\" name=\"PQ8051\" value=\"\" style=\" width: 200px; \" maxlength=\"500\" /></td></tr><tr><td style=\"\">State<br /><select id=\"PQ8052\" name=\"PQ8052\" style=\"\"><option value=\"Default\">-- Select answer --</option><option value=\"PA12\">Alabama</option><option value=\"PA13\">Alaska</option><option value=\"PA14\">Arizona</option><option value=\"PA15\">Arkansas</option><option value=\"PA16\">California</option><option value=\"PA17\">Colorado</option><option value=\"PA18\">Connecticut</option><option value=\"PA19\">Delaware</option><option value=\"PA20\">District of Columbia</option><option value=\"PA21\">Florida</option><option value=\"PA22\">Georgia</option><option value=\"PA23\">Hawaii</option><option value=\"PA24\">Idaho</option><option value=\"PA25\">Illinois</option><option value=\"PA26\">Indiana</option><option value=\"PA27\">Iowa</option><option value=\"PA28\">Kansas</option><option value=\"PA29\">Kentucky</option><option value=\"PA30\">Louisiana</option><option value=\"PA31\">Maine</option><option value=\"PA32\">Maryland</option><option value=\"PA33\">Massachusetts</option><option value=\"PA34\">Michigan</option><option value=\"PA35\">Minnesota</option><option value=\"PA36\">Mississippi</option><option value=\"PA37\">Missouri</option><option value=\"PA38\">Montana</option><option value=\"PA39\">Nebraska</option><option value=\"PA40\">Nevada</option><option value=\"PA41\">New Hampshire</option><option value=\"PA42\">New Jersey</option><option value=\"PA43\">New Mexico</option><option value=\"PA44\">New York</option><option value=\"PA45\">North Carolina</option><option value=\"PA46\">North Dakota</option><option value=\"PA47\">Ohio</option><option value=\"PA48\">Oklahoma</option><option value=\"PA49\">Oregon</option><option value=\"PA50\">Pennsylvania</option><option value=\"PA51\">Rhode Island</option><option value=\"PA52\">South Carolina</option><option value=\"PA53\">South Dakota</option><option value=\"PA54\">Tennessee</option><option value=\"PA55\">Texas</option><option value=\"PA56\">Utah</option><option value=\"PA57\">Vermont</option><option value=\"PA58\">Virginia</option><option value=\"PA59\">Washington</option><option value=\"PA60\">West Virginia</option><option value=\"PA61\">West Virginia</option><option value=\"PA62\">Wisconsin</option><option value=\"PA63\">Wyoming</option></select></td></tr><tr><td style=\"\"><SPAN id=\"revPQ8053\" name=\"revPQ8053\" style=\"color:Red;display:none;\">*</SPAN>Zip<br /><input type=\"text\" id=\"PQ8053\" name=\"PQ8053\" value=\"\" style=\" width: 200px; \" maxlength=\"500\" /></td></tr><tr><td style=\"\">Web site<br /><input type=\"text\" id=\"PQ8054\" name=\"PQ8054\" value=\"\" style=\" width: 200px; \" maxlength=\"500\" /></td></tr><tr><td style=\"\"><input id=\"IM413\" type=\"checkbox\" name=\"IM413\" value=\"true\" checked=\"true\">Please confirm my registration.</input><br /></td></tr></table><img src=\'http://app.wampower.net/WamHtmlBuilders/GenerateCode.aspx?OT=2&OQ=N2IolY9Hk8dwWEd5yN8H\' width=\'1\' height=\'1\' boder=\'0\'/>");
document.write("<input type=\"submit\" value=\"Submit\" style=\"color:black;\" /></form></div>");
document.write("<script type=\"text/javascript\" language=\"javascript\">");
document.write("var Form_ValidatorList413 = new Array(");
document.write("document.getElementById(\"rfvPQ8042\"),");
document.write("document.getElementById(\"rfvPQ8044\"),");
document.write("document.getElementById(\"revPQ8044\"),");
document.write("document.getElementById(\"revPQ8046\"),");
document.write("document.getElementById(\"revPQ8053\"));var rfvPQ8042 = document.all ? document.all[\"rfvPQ8042\"] : document.getElementById(\"rfvPQ8042\");");
document.write("rfvPQ8042.controltovalidate = \"PQ8042\";");
document.write("rfvPQ8042.evaluationfunction = \"RequiredFieldValidatorEvaluateIsValid\";");
document.write("rfvPQ8042.initialvalue = \"\";");
document.write("var rfvPQ8044 = document.all ? document.all[\"rfvPQ8044\"] : document.getElementById(\"rfvPQ8044\");");
document.write("rfvPQ8044.controltovalidate = \"PQ8044\";");
document.write("rfvPQ8044.evaluationfunction = \"RequiredFieldValidatorEvaluateIsValid\";");
document.write("rfvPQ8044.initialvalue = \"\";");
document.write("var revPQ8044 = document.all ? document.all[\"revPQ8044\"] : document.getElementById(\"revPQ8044\");");
document.write("revPQ8044.controltovalidate = \"PQ8044\";");
document.write("revPQ8044.evaluationfunction = \"RegularExpressionValidatorEvaluateIsValid\";");
document.write("revPQ8044.validationexpression = \"^\\\\S+@\\\\S+\\\\.\\\\S+$\";");
document.write("var revPQ8046 = document.all ? document.all[\"revPQ8046\"] : document.getElementById(\"revPQ8046\");");
document.write("revPQ8046.controltovalidate = \"PQ8046\";");
document.write("revPQ8046.evaluationfunction = \"RegularExpressionValidatorEvaluateIsValid\";");
document.write("revPQ8046.validationexpression = \"((\\\\(\\\\d{3}\\\\) ?)|(\\\\d{3}-))?\\\\d{3}-\\\\d{4}\";");
document.write("var revPQ8053 = document.all ? document.all[\"revPQ8053\"] : document.getElementById(\"revPQ8053\");");
document.write("revPQ8053.controltovalidate = \"PQ8053\";");
document.write("revPQ8053.evaluationfunction = \"RegularExpressionValidatorEvaluateIsValid\";");
document.write("revPQ8053.validationexpression = \"\\\\d{5}(-\\\\d{4})?\";");
document.write("function FormSubmit413() {");
document.write("if (typeof(ValidateControls) == \"function\" && ValidateControls(Form_ValidatorList413) == false) ");
document.write(" return false;");
document.write("}");
document.write("</script>");
