// JavaScript Document
document.write ('<form id="jraform" action="http://www.jillrogersassociates.co.uk/cgi-bin/FormMail.cgi" method=\'POST\'>');
document.write ('<input type="hidden" name="subject" value="JRA - Web Customer Contact Form">');
document.write ('<input type="hidden" name="recipient" value="jra@jillrogersassociates.co.uk">');
document.write ('<input type="hidden" name="redirect" value="http://www.jillrogersassociates.co.uk/thankyou.htm">');
document.write ('<input type="hidden" name="required" value="surname,firstname,jobtitle,organisation,address,postcode,telephone,email,conference">');
document.write ('<table width="90%" border="0" cellpadding="2">');
document.write ('<tr>');
document.write ('<td width="40%" valign="middle"><div align="left">Title:</div></td>');
document.write ('<td width="60%"><div align="left"><input name="title" type="text" id="title" size="30" /></div></td></tr>');
document.write ('<tr>');
document.write ('<td valign="middle"><div align="left">Surname:*</div></td>');
document.write ('<td><div align="left"><input name="surname" type="text" id="surname" size="30" /></div></td></tr>');
document.write ('<tr>');
document.write ('<td valign="middle"><div align="left">First name:*</div></td>');
document.write ('<td><div align="left"><input name="firstname" type="text" id="firstname" size="30" /></div></td></tr>');
document.write ('<tr>');
document.write ('<td valign="middle"><div align="left">Job title/Position:*</div></td>');
document.write ('<td><div align="left"><input name="jobtitle" type="text" id="jobtitle" size="30" /></div></td></tr>');
document.write ('<tr>');
document.write ('<td valign="middle"><div align="left">Organisation/Place of work:*</div></td>');
document.write ('<td><div align="left"><input name="organisation" type="text" id="organisation" size="30" /></div></td></tr>');
document.write ('<tr>');
document.write ('<td valign="middle"><div align="left">Mailing Address:*</div></td>');
document.write ('<td><div align="left"><textarea name="address" cols="25" rows="5" id="comments"></textarea></div></td></tr>');
document.write ('<tr>');
document.write ('<td valign="middle"><div align="left">Postcode:*</div></td>');
document.write ('<td><div align="left"><input name="postcode" type="text" id="postcode" size="30" /></div></td></tr>');
document.write ('<tr>');
document.write ('<td valign="middle"><div align="left">Telephone:* </div></td>');
document.write ('<td><div align="left"><input name="telephone" type="text" id="telephone" size="30" /></div></td></tr>');
document.write ('<tr>');
document.write ('<td valign="middle"><div align="left">Fax:</div></td>');
document.write ('<td><div align="left"><input name="fax" type="text" id="fax" size="30" /></div></td></tr>');
document.write ('<tr>');
document.write ('<td valign="middle"><div align="left">Email:*</div></td>');
document.write ('<td><div align="left"><input name="email" type="text" id="email" size="30" /></div></td></tr>');
document.write ('<tr>');
document.write ('<td valign="middle"><div align="left">Register for Conference:*</div></td>');
document.write ('<td><div align="left">');
document.write ('<select name="conference" id="conference">');
document.write ('<option value="Please Select">---Please Select---</option>');
document.write ('<option value="NET10">Net Conference 2010</option>');
document.write ('<option value="Chester10">Chester Conference 2010</option>');
document.write ('<option value="Other">Other</option>');
document.write ('</select>');
document.write ('</div></td></tr>');
document.write ('<tr>');
document.write ('<td valign="middle"><div align="left">Comments:</div></td>');
document.write ('<td><div align="left"><textarea name="comments" cols="25" rows="5" id="comments"></textarea></div></td></tr>');
document.write ('<td><div align="left"></td><td class="_text" style="margin-left:10px; margin-top:8px;"><img alt="" border="0" src="images/a.gif" style="margin-right:7px"><a href="#" class="l1_text" onclick="document.getElementById(\'jraform\').reset()">reset</a><img alt="" border="0" src="images/a.gif" style="margin-right:7px; margin-left:33px"><a href="#" class="l1_text" onclick="document.getElementById(\'jraform\').submit()">send</a></div></td>');
document.write ('</tr>');
document.write ('</table>');
document.write ('</form>');