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document.writeln('		<form method="post" name="form1" enctype="multipart/form-data" action="http://www.sitemason.com/form/cgP7Ms">');
document.writeln('<input type="hidden" name="referer" value="http://www.belmont.edu/uc/information_sessions/index.html">');
document.writeln('<input type="hidden" name="form_session_id" value="3067575">');
document.writeln('<input type="hidden" name="form__current_page" value="1">		<table id="sitemason_cgP7Ms" class="sitemason_form" border="0" cellspacing="0" cellpadding="0" style="width:525px;" align="center">			<tr>');
document.writeln('					<td class="sitemason_body">');
document.writeln('		');
document.writeln('		<div>');
document.writeln('  <h2 class="sitemason_header" style="width:98%; border-style:none; padding-top:1px; padding-bottom:1px; padding-right:5px; padding-left:5px; ">');
document.writeln('    <a name="Adult_Degree_Programs"></a><p style="text-align: left;"><strong><span style="font-size: large;">Adult Degree Programs</span></strong><span style="font-size: large;"><br />');
document.writeln('&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span><strong><span style="font-size: large;"> </span></strong><span style="font-size: large;">&gt;&gt;info session registration</span></p></h2>');
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document.writeln('    <div><p><span style="color: rgb(102, 0, 0);"><em>* Denotes a required field</em></span></p><br clear="all">');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <div class="sitemason_body" style="float:left; ">');
document.writeln('    <div style="text-align:left; width:100px; float:left;">');
document.writeln('      <label class="label" for="fname">*  <b>First Name:</b></label>');
document.writeln('    </div>');
document.writeln('    <div align="left" class="value" style="margin-left:0; float:left; ">');
document.writeln('      <input type="text" style="width:100px; " name="fname">');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <div class="sitemason_body" style="float:left; ">');
document.writeln('    <div style="text-align:left; width:100px; float:left;">');
document.writeln('      <label class="label" for="lname">* <b> Last Name:</b></label>');
document.writeln('    </div>');
document.writeln('    <div align="left" class="value" style="margin-left:0; float:left; ">');
document.writeln('      <input type="text" style="width:100px; " name="lname">');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <br clear="all">');
document.writeln('  <div class="sitemason_body" style="float:left; ">');
document.writeln('    <div style="text-align:left; width:100px; float:left;">');
document.writeln('      <label class="label" for="address">* <b> Address:</b></label>');
document.writeln('    </div>');
document.writeln('    <div align="left" class="value" style="margin-left:0; float:left; ">');
document.writeln('      <input type="text" style="width:200px; " name="address">');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <div class="sitemason_body" style="float:left; ">');
document.writeln('    <div style="text-align:left; width:100px; float:left;">');
document.writeln('      <label class="label" for="city">* <b>City:</b></label>');
document.writeln('    </div>');
document.writeln('    <div align="left" class="value" style="margin-left:0; float:left; ">');
document.writeln('      <input type="text" style="width:100px; " name="city">');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <div class="sitemason_body" style="float:left; ">');
document.writeln('    <div style="text-align:left; width:55px; float:left;">');
document.writeln('      <label class="label" for="state">* <b>State:</b></label>');
document.writeln('    </div>');
document.writeln('    <div class="value" align="left" style="margin-left:0; float:left; ">');
document.writeln('      <select name="state">');
document.writeln('        <option value="">--</option>');
document.writeln('        <option value="AL">AL</option>');
document.writeln('        <option value="AK">AK</option>');
document.writeln('        <option value="AZ">AZ</option>');
document.writeln('        <option value="AR">AR</option>');
document.writeln('        <option value="CA">CA</option>');
document.writeln('        <option value="CO">CO</option>');
document.writeln('        <option value="CT">CT</option>');
document.writeln('        <option value="DE">DE</option>');
document.writeln('        <option value="DC">DC</option>');
document.writeln('        <option value="FL">FL</option>');
document.writeln('        <option value="GA">GA</option>');
document.writeln('        <option value="HI">HI</option>');
document.writeln('        <option value="ID">ID</option>');
document.writeln('        <option value="IL">IL</option>');
document.writeln('        <option value="IN">IN</option>');
document.writeln('        <option value="IA">IA</option>');
document.writeln('        <option value="KS">KS</option>');
document.writeln('        <option value="KY">KY</option>');
document.writeln('        <option value="LA">LA</option>');
document.writeln('        <option value="ME">ME</option>');
document.writeln('        <option value="MD">MD</option>');
document.writeln('        <option value="MA">MA</option>');
document.writeln('        <option value="MI">MI</option>');
document.writeln('        <option value="MN">MN</option>');
document.writeln('        <option value="MS">MS</option>');
document.writeln('        <option value="MO">MO</option>');
document.writeln('        <option value="MT">MT</option>');
document.writeln('        <option value="NE">NE</option>');
document.writeln('        <option value="NV">NV</option>');
document.writeln('        <option value="NH">NH</option>');
document.writeln('        <option value="NJ">NJ</option>');
document.writeln('        <option value="NM">NM</option>');
document.writeln('        <option value="NY">NY</option>');
document.writeln('        <option value="NC">NC</option>');
document.writeln('        <option value="ND">ND</option>');
document.writeln('        <option value="OH">OH</option>');
document.writeln('        <option value="OK">OK</option>');
document.writeln('        <option value="OR">OR</option>');
document.writeln('        <option value="PA">PA</option>');
document.writeln('        <option value="RI">RI</option>');
document.writeln('        <option value="SC">SC</option>');
document.writeln('        <option value="SD">SD</option>');
document.writeln('        <option value="TN">TN</option>');
document.writeln('        <option value="TX">TX</option>');
document.writeln('        <option value="UT">UT</option>');
document.writeln('        <option value="VT">VT</option>');
document.writeln('        <option value="VA">VA</option>');
document.writeln('        <option value="WA">WA</option>');
document.writeln('        <option value="WV">WV</option>');
document.writeln('        <option value="WI">WI</option>');
document.writeln('        <option value="WY">WY</option>');
document.writeln('        <option value="AS">AS</option>');
document.writeln('        <option value="FM">FM</option>');
document.writeln('        <option value="GU">GU</option>');
document.writeln('        <option value="MH">MH</option>');
document.writeln('        <option value="MP">MP</option>');
document.writeln('        <option value="PW">PW</option>');
document.writeln('        <option value="PR">PR</option>');
document.writeln('        <option value="VI">VI</option>');
document.writeln('        <option value="AE">AE</option>');
document.writeln('        <option value="AA">AA</option>');
document.writeln('        <option value="AE">AE</option>');
document.writeln('        <option value="AE">AE</option>');
document.writeln('        <option value="AE">AE</option>');
document.writeln('        <option value="AP">AP</option>');
document.writeln('        <option value="INTL">INTL</option>');
document.writeln('      </select>');
document.writeln('    </div>');
document.writeln('    <input type="hidden" name="fieldname">');
document.writeln('  </div>');
document.writeln('  <div class="sitemason_body" style="float:left; ">');
document.writeln('    <div style="text-align:left; width:50px; float:left;">');
document.writeln('      <label class="label" for="zipcode">* <b>Zip:</b></label>');
document.writeln('    </div>');
document.writeln('    <div align="left" class="value" style="margin-left:0; float:left; ">');
document.writeln('      <input type="text" style="width:50px; " name="zipcode">');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <br clear="all">');
document.writeln('  <div class="sitemason_body" style="float:left; ">');
document.writeln('    <div style="text-align:left; width:200px; float:left;">');
document.writeln('      <label class="label" for="Dates"><b>Info Session Date Selection:</b></label>');
document.writeln('    </div>');
document.writeln('    <div class="value" align="left" style="width:400px; float:left; ">');
document.writeln('      <select name="Dates">');
document.writeln('        <option value="Choose one from below:">Choose one from below:</option>');
document.writeln('        <option value="2/18/10 MC Info Session Evening">2/18/10 Main Campus Info Session 4:30-6:30p.m.</option>');
document.writeln('      </select>');
document.writeln('    </div>');
document.writeln('    <input type="hidden" name="fieldname">');
document.writeln('  </div>');
document.writeln('  <br clear="all">');
document.writeln('  <div class="sitemason_body" style="float:left; ">');
document.writeln('    <div style="text-align:left; width:300px; float:left;">');
document.writeln('      <label class="label" for="people">* <b> Number of people attending (<i>including yourself</i>):</b></label>');
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document.writeln('    <div align="left" class="value" style="margin-left:0; float:left; ">');
document.writeln('      <input type="text" style="width:25px; " name="people">');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <br clear="all">');
document.writeln('  <div class="sitemason_body" style="float:left; ">');
document.writeln('    <div style="text-align:left; width:100px; float:left;">');
document.writeln('      <label class="label" for="phone"><b>Phone:</b></label>');
document.writeln('    </div>');
document.writeln('    <div align="left" class="value" style="margin-left:0; float:left; ">');
document.writeln('      <input type="text" style="width:100px; " name="phone">');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <br clear="all">');
document.writeln('  <div class="sitemason_body" style="float:left; ">');
document.writeln('    <div style="text-align:left; width:110px; float:left;">');
document.writeln('      <label class="label" for="Email">* <b>E-mail Address:</b></label>');
document.writeln('    </div>');
document.writeln('    <div align="left" class="value" style="margin-left:0; float:left; ">');
document.writeln('      <input type="text" style="width:200px; " name="Email">');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <br clear="all">');
document.writeln('  <div class="sitemason_body" style="text-align:left; border-style:none; ">');
document.writeln('    <div><p>&nbsp;<strong><em>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</em></strong><span style="color: rgb(102, 0, 0);"><strong><em>&nbsp; We will send you a reminder of your event and driving directions&nbsp;via email.</em></strong>&nbsp;</span></p><br clear="all">');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <div class="sitemason_body" style="float:left; ">');
document.writeln('    <div style="text-align:left; width:200px; ">');
document.writeln('      <label class="label" for="program_interest"><b>What is your area of interest?</b></label>');
document.writeln('    </div>');
document.writeln('    <div align="left" class="value" style="margin-left:10px; ">');
document.writeln('      <table border="0" cellpadding="2" cellspacing="1" class="body">');
document.writeln('        <tr>');
document.writeln('          <td valign="top">');
document.writeln('            <input type="checkbox" name="program_interest" value="LIS"><span class="sitemason_body">Liberal Studies</span></td>');
document.writeln('          <td valign="top">');
document.writeln('            <input type="checkbox" name="program_interest" value="Ministry"><span class="sitemason_body">Ministry</span></td>');
document.writeln('										</tr>');
document.writeln('										<tr>');
document.writeln('									<td valign="top">');
document.writeln('            <input type="checkbox" name="program_interest" value="Accounting"><span class="sitemason_body">Accounting</span></td>');
document.writeln('          <td valign="top">');
document.writeln('            <input type="checkbox" name="program_interest" value="RN/BSN"><span class="sitemason_body">RN to BSN (bridge program)</span></td>');
document.writeln('										</tr>');
document.writeln('										<tr>');
document.writeln('									<td valign="top">');
document.writeln('            <input type="checkbox" name="program_interest" value="Public Relations Management"><span class="sitemason_body">Public Relations Management</span></td>');
document.writeln('          <td valign="top">');
document.writeln('            <input type="checkbox" name="program_interest" value="PBBA"><span class="sitemason_body">Business</span></td>');
document.writeln('										</tr>');
document.writeln('										<tr>');
document.writeln('									<td valign="top">');
document.writeln('            <input type="checkbox" name="program_interest" value="Other"><span class="sitemason_body">Other area not on this list (please enter below)</span></td>');
document.writeln('        </tr>');
document.writeln('      </table>');
document.writeln('      <input type="hidden" name="program_interest">');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <br clear="all">');
document.writeln('  <div class="sitemason_body" style="margin-left:150px; float:left; ">');
document.writeln('    <div align="left" class="value" style="float:left; ">');
document.writeln('      <input type="text" style="width:200px; " name="Other">');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <br clear="all">');
document.writeln('  <div class="sitemason_body" style="float:left; ">');
document.writeln('    <div style="text-align:left; width:500px; ">');
document.writeln('      <label class="label" for="comments_or_ques"><b>Are there any specific topics you would like to discuss or questions/comments you may have?  If so, feel free to type them below:</b></label>');
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document.writeln('    <div align="left" class="value" style="margin-left:0; ">');
document.writeln('      <textarea rows="3" style="width:500px; " name="comments_or_ques"></textarea>');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <br clear="all">');
document.writeln('  <div class="sitemason_body" align="center" style="text-align:center; ">');
document.writeln('    <input type="submit" name="button" value="Submit">');
document.writeln('  </div>');
document.writeln('  <br clear="all">');
document.writeln('</div>');
document.writeln('');
document.writeln('				</td>');
document.writeln('			</tr>');
document.writeln('			</table>');
document.writeln('		</form>');
