document.writeln('		<!DOCTYPE style PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">');
document.writeln('<style type="text/css">');
document.writeln('			<!--');
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document.writeln('				text-align: left;');
document.writeln('				padding: 2px 4px 2px 4px;');
document.writeln('				margin: 0px;');
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document.writeln('				margin: 2px 8px 2px 8px;');
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document.writeln('			#sitemason_jFt94Y .sitemason_error {');
document.writeln('				color: #CC0000;');
document.writeln('				margin: 8px 8px 2px 8px;');
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document.writeln('			');
document.writeln('			#sitemason_jFt94Y .sitemason_notice {');
document.writeln('				font-weight: bold;');
document.writeln('				margin: 8px 8px 2px 8px;');
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document.writeln('		</style>');
document.writeln('		<form method="post" name="form1" enctype="multipart/form-data" action="http://www.sitemason.com/form/jFt94Y">');
document.writeln('<input type="hidden" name="referer" value="http://www.belmont.edu/prospectivestudents/visiting/schedule.html" />');
document.writeln('<input type="hidden" name="form__current_page" value="1" />		<table id="sitemason_jFt94Y" class="sitemason_form" border="0" cellspacing="0" cellpadding="0">			<tr>');
document.writeln('					<td class="sitemason_body">');
document.writeln('		');
document.writeln('		<div>');
document.writeln('  <div class="sitemason_body" style="width:350px; text-align:left; border-style:none; ">');
document.writeln('    <div><p><font color="#993300" size="4"><strong>Request a campus visit<br />');
document.writeln('</strong></font><br />');
document.writeln('We welcome visitors to our campus! The Office of Admissions is open Monday through Friday from 8 am until 4:30 pm, central time. If you would like to schedule a visit, please complete the form below and submit it to us. We will be in contact with you soon to complete the scheduling process.</p><br clear="all" />');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <div class="sitemason_body" style="width:350px; text-align:left; border-style:none; margin-bottom:14px; ">');
document.writeln('    <div>*required fields<br clear="all" />');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <div align="center" style="clear: both;" class="sitemason_body">');
document.writeln('				&nbsp;<br />');
document.writeln('  </div>');
document.writeln('  <div class="sitemason_body" style="width:350px; float:left; ">');
document.writeln('    <div style="text-align:left; width:150px; float:left;">');
document.writeln('      <label class="label" for="fname_2">*First Name:</label>');
document.writeln('    </div>');
document.writeln('    <div align="left" class="value" style="float:left; ">');
document.writeln('      <input type="text" style="width:150px; " name="fname_2" />');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <br clear="all" />');
document.writeln('  <div class="sitemason_body" style="width:350px; float:left; ">');
document.writeln('    <div style="text-align:left; width:150px; float:left;">');
document.writeln('      <label class="label" for="mi_2">Middle Initial:</label>');
document.writeln('    </div>');
document.writeln('    <div align="left" class="value" style="float:left; ">');
document.writeln('      <input type="text" style="width:25px; " name="mi_2" />');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <br clear="all" />');
document.writeln('  <div class="sitemason_body" style="width:350px; float:left; ">');
document.writeln('    <div style="text-align:left; width:150px; float:left;">');
document.writeln('      <label class="label" for="lname_2">*Last Name:</label>');
document.writeln('    </div>');
document.writeln('    <div align="left" class="value" style="float:left; ">');
document.writeln('      <input type="text" style="width:150px; " name="lname_2" />');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <br clear="all" />');
document.writeln('  <div align="center" style="clear: both;" class="sitemason_body">');
document.writeln('				&nbsp;<br />');
document.writeln('  </div>');
document.writeln('  <div class="sitemason_body" style="width:350px; float:left; ">');
document.writeln('    <div style="text-align:left; width:150px; float:left;">');
document.writeln('      <label class="label" for="address_2">*Street address:</label>');
document.writeln('    </div>');
document.writeln('    <div align="left" class="value" style="float:left; ">');
document.writeln('      <input type="text" style="width:150px; " name="address_2" />');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <br clear="all" />');
document.writeln('  <div class="sitemason_body" style="width:350px; float:left; ">');
document.writeln('    <div style="text-align:left; width:150px; float:left;">');
document.writeln('      <label class="label" for="city_2">*City:</label>');
document.writeln('    </div>');
document.writeln('    <div align="left" class="value" style="float:left; ">');
document.writeln('      <input type="text" style="width:150px; " name="city_2" />');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <br clear="all" />');
document.writeln('  <div class="sitemason_body" style="width:350px; float:left; ">');
document.writeln('    <div style="text-align:left; width:150px; float:left;">');
document.writeln('      <label class="label" for="state_2">*State:</label>');
document.writeln('    </div>');
document.writeln('    <div align="left" class="value" style="float:left; ">');
document.writeln('      <input type="text" style="width:50px; " name="state_2" />');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <br clear="all" />');
document.writeln('  <div class="sitemason_body" style="width:350px; float:left; ">');
document.writeln('    <div style="text-align:left; width:150px; float:left;">');
document.writeln('      <label class="label" for="zip_2">*Zip or postal code:</label>');
document.writeln('    </div>');
document.writeln('    <div align="left" class="value" style="float:left; ">');
document.writeln('      <input type="text" style="width:125px; " name="zip_2" />');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <br clear="all" />');
document.writeln('  <div class="sitemason_body" style="width:350px; float:left; ">');
document.writeln('    <div style="text-align:left; width:150px; float:left;">');
document.writeln('      <label class="label" for="country_2">Country:</label>');
document.writeln('    </div>');
document.writeln('    <div align="left" class="value" style="float:left; ">');
document.writeln('      <input type="text" style="width:150px; " name="country_2" />');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <br clear="all" />');
document.writeln('  <div align="center" style="clear: both;" class="sitemason_body">');
document.writeln('				&nbsp;<br />');
document.writeln('  </div>');
document.writeln('  <div class="sitemason_body" style="width:350px; float:left; ">');
document.writeln('    <div style="text-align:left; width:150px; float:left;">');
document.writeln('      <label class="label" for="home_phone">*Home phone number:            (format: xxx-xxx-xxxx)</label>');
document.writeln('    </div>');
document.writeln('    <div align="left" class="value" style="float:left; ">');
document.writeln('      <input type="text" style="width:150px; " name="home_phone" />');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <br clear="all" />');
document.writeln('  <div class="sitemason_body" style="width:350px; float:left; ">');
document.writeln('    <div style="text-align:left; width:150px; float:left;">');
document.writeln('      <label class="label" for="cell_phone">Cell phone number:             (format: xxx-xxx-xxxx)</label>');
document.writeln('    </div>');
document.writeln('    <div align="left" class="value" style="float:left; ">');
document.writeln('      <input type="text" style="width:150px; " name="cell_phone" />');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <br clear="all" />');
document.writeln('  <div class="sitemason_body" style="width:350px; float:left; ">');
document.writeln('    <div style="text-align:left; width:150px; float:left;">');
document.writeln('      <label class="label" for="email_student">*Student\'s email:</label>');
document.writeln('    </div>');
document.writeln('    <div align="left" class="value" style="float:left; ">');
document.writeln('      <input type="text" style="width:150px; " name="email_student" />');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <br clear="all" />');
document.writeln('  <div class="sitemason_body" style="width:350px; float:left; ">');
document.writeln('    <div style="text-align:left; width:150px; float:left;">');
document.writeln('      <label class="label" for="email_parent">*Parent\'s email:</label>');
document.writeln('    </div>');
document.writeln('    <div align="left" class="value" style="float:left; ">');
document.writeln('      <input type="text" style="width:150px; " name="email_parent" />');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <br clear="all" />');
document.writeln('  <div align="center" style="clear: both;" class="sitemason_body">');
document.writeln('				&nbsp;<br />');
document.writeln('  </div>');
document.writeln('  <div class="sitemason_body" style="text-align:left; width:350px; float:left; ">');
document.writeln('    <div style="text-align:left; width:150px; float:left;">');
document.writeln('      <label class="label" for="gender">Gender:</label>');
document.writeln('    </div>');
document.writeln('    <div align="left" class="value" style="float:left; ">');
document.writeln('      <input type="radio" name="gender" value="male" /><span class="sitemason_body">Male</span><input type="radio" name="gender" value="female" /><span class="sitemason_body">Female</span><input type="hidden" name="gender" />');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <br clear="all" />');
document.writeln('  <div class="sitemason_body" style="width:350px; float:left; ">');
document.writeln('    <div style="text-align:left; width:150px; ">');
document.writeln('      <label class="label" for="type_of_student">I am a:</label>');
document.writeln('    </div>');
document.writeln('    <div align="left" class="value" style="">');
document.writeln('      <div class="sitemason_body">');
document.writeln('        <input type="radio" name="type_of_student" value="hs_student" />high school student</div>');
document.writeln('      <div class="sitemason_body">');
document.writeln('        <input type="radio" name="type_of_student" value="college_student" />college student thinking of transferring to Belmont</div>');
document.writeln('      <div class="sitemason_body">');
document.writeln('        <input type="radio" name="type_of_student" value="graduate_student" />graduate student</div>');
document.writeln('      <div class="sitemason_body">');
document.writeln('        <input type="radio" name="type_of_student" value="adult_student" />adult student</div>');
document.writeln('      <div class="sitemason_body">');
document.writeln('        <input type="radio" name="type_of_student" value="non_degree_student" />non-degree student</div>');
document.writeln('      <input type="hidden" name="type_of_student" />');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <br clear="all" />');
document.writeln('  <div align="center" style="clear: both;" class="sitemason_body">');
document.writeln('				&nbsp;<br />');
document.writeln('  </div>');
document.writeln('  <div class="sitemason_body" style="width:350px; float:left; ">');
document.writeln('    <div style="margin-left:20px; text-align:left; width:150px; float:left;">');
document.writeln('      <label class="label" for="current_school">Current school attending, if applicable:</label>');
document.writeln('    </div>');
document.writeln('    <div align="left" class="value" style="float:left; ">');
document.writeln('      <input type="text" style="width:150px; " name="current_school" />');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <br clear="all" />');
document.writeln('  <div class="sitemason_body" style="width:350px; float:left; ">');
document.writeln('    <div style="margin-left:20px; text-align:left; width:150px; float:left;">');
document.writeln('      <label class="label" for="grad_or_xfer_date">Year of graduation/transfer:</label>');
document.writeln('    </div>');
document.writeln('    <div align="left" class="value" style="float:left; ">');
document.writeln('      <input type="text" style="width:100px; " name="grad_or_xfer_date" />');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <br clear="all" />');
document.writeln('  <div align="center" style="clear: both;" class="sitemason_body">');
document.writeln('				&nbsp;<br />');
document.writeln('  </div>');
document.writeln('  <div class="sitemason_body" style="width:350px; float:left; ">');
document.writeln('    <div style="text-align:left; width:160px; float:left;">');
document.writeln('      <label class="label" for="entryterm_2">*I plan to enroll in the</label>');
document.writeln('    </div>');
document.writeln('    <div align="left" class="value" style="float:left; ">');
document.writeln('      <div class="sitemason_body">');
document.writeln('        <input type="radio" name="entryterm_2" value="fall" checked="" />Fall</div>');
document.writeln('      <div class="sitemason_body">');
document.writeln('        <input type="radio" name="entryterm_2" value="spring" />Spring</div>');
document.writeln('      <input type="hidden" name="entryterm_2" />');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <div class="sitemason_body" style="width:350px; float:left; ">');
document.writeln('    <div style="margin-left:20px; text-align:left; width:25px; float:left;">');
document.writeln('      <label class="label" for="entry_year">of</label>');
document.writeln('    </div>');
document.writeln('    <div align="left" class="value" style="float:left; ">');
document.writeln('      <div class="sitemason_body">');
document.writeln('        <input type="radio" name="entry_year" value="2010" />2010</div>');
document.writeln('      <div class="sitemason_body">');
document.writeln('        <input type="radio" name="entry_year" value="2011" />2011</div>');
document.writeln('      <div class="sitemason_body">');
document.writeln('        <input type="radio" name="entry_year" value="2012" />2012</div>');
document.writeln('      <div class="sitemason_body">');
document.writeln('        <input type="radio" name="entry_year" value="2013" />2013</div>');
document.writeln('      <input type="hidden" name="entry_year" />');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <br clear="all" />');
document.writeln('  <div align="center" style="clear: both;" class="sitemason_body">');
document.writeln('				&nbsp;<br />');
document.writeln('  </div>');
document.writeln('  <div class="sitemason_body" style="width:350px; float:left; ">');
document.writeln('    <div style="text-align:left; width:275px; ">');
document.writeln('      <label class="label" for="visit_requests">While on campus I would like to: <br><em>Please check all that apply.</em></label>');
document.writeln('    </div>');
document.writeln('    <div align="left" class="value" style="margin-left:10px; ">');
document.writeln('      <div class="sitemason_body">');
document.writeln('        <input type="checkbox" name="visit_requests" value="meet_with_admissions" />attend an Admissions information session</div>');
document.writeln('      <div class="sitemason_body">');
document.writeln('        <input type="checkbox" name="visit_requests" value="campus_tour" />take a campus tour </div>');
document.writeln('      <div class="sitemason_body">');
document.writeln('        <input type="checkbox" name="visit_requests" value="lunch" />eat lunch on campus</div>');
document.writeln('      <input type="hidden" name="visit_requests" />');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <br clear="all" />');
document.writeln('  <div align="center" style="clear: both;" class="sitemason_body">');
document.writeln('				&nbsp;<br />');
document.writeln('  </div>');
document.writeln('  <div class="sitemason_body" style="width:350px; text-align:left; border-style:none; margin-bottom:14px; ">');
document.writeln('    <div>Several of Belmont\'s academic areas offer information sessions for prospective students.&nbsp; If you would like to attend one or more of these sessions, please check the appropriate box(es) below.&nbsp; If you have questions about which academic session would fit your interests, please refer to our <a target="_blank" href="http://www.belmont.edu/prospectivestudents/studying/programs.html">Programs of Study</a>.&nbsp;<br clear="all" />');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <div class="sitemason_body" style="width:350px; float:left; ">');
document.writeln('    <div style="text-align:left; ">');
document.writeln('      <label class="label" for="academic_info_session">I\'d like to attend the following academic session(s). <br><em>Please check all that apply.</em></label>');
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document.writeln('    <div align="left" class="value" style="margin-left:10px; ">');
document.writeln('      <div class="sitemason_body">');
document.writeln('        <input type="checkbox" name="academic_info_session" value="COBA" />College of Business Administration</div>');
document.writeln('      <div class="sitemason_body">');
document.writeln('        <input type="checkbox" name="academic_info_session" value="CEMB" />Curb College of Entertainment and Music Business </div>');
document.writeln('      <div class="sitemason_body">');
document.writeln('        <input type="checkbox" name="academic_info_session" value="SOM" />School of Music</div>');
document.writeln('      <div class="sitemason_body">');
document.writeln('        <input type="checkbox" name="academic_info_session" value="SON" />School of Nursing</div>');
document.writeln('      <div class="sitemason_body">');
document.writeln('        <input type="checkbox" name="academic_info_session" value="REL" />School of Religion</div>');
document.writeln('      <div class="sitemason_body">');
document.writeln('        <input type="checkbox" name="academic_info_session" value="ART" />Department of Art</div>');
document.writeln('      <div class="sitemason_body">');
document.writeln('        <input type="checkbox" name="academic_info_session" value="pre-health_sci" />Pre- Health Science <br><em>(Pre-Med, Pre-PT, Pre-OT, Pre-Pharmacy, etc.)</em></div>');
document.writeln('      <div class="sitemason_body">');
document.writeln('        <input type="checkbox" name="academic_info_session" value="other_acad_interest" />I have other academic area(s) of interest</div>');
document.writeln('      <input type="hidden" name="academic_info_session" />');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <br clear="all" />');
document.writeln('  <div class="sitemason_body" style="margin-left:20px; text-align:left; width:330px; float:left; ">');
document.writeln('    <div style="margin-left:15px; text-align:left; ">');
document.writeln('      <label class="label" for="additional_academic_interest_detail"><em>Please list your additional academic interest(s) below:</em></label>');
document.writeln('    </div>');
document.writeln('    <div align="left" class="value" style="margin-left:15px; ">');
document.writeln('      <input type="text" style="width:200px; " name="additional_academic_interest_detail" />');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <br clear="all" />');
document.writeln('  <div align="center" style="clear: both;" class="sitemason_body">');
document.writeln('				&nbsp;<br />');
document.writeln('  </div>');
document.writeln('  <div class="sitemason_body" style="width:350px; float:left; ">');
document.writeln('    <div style="text-align:left; width:150px; float:left;">');
document.writeln('      <label class="label" for="parents">My parents will accompany me:</label>');
document.writeln('    </div>');
document.writeln('    <div align="left" class="value" style="float:left; ">');
document.writeln('      <input type="radio" name="parents" value="yes" /><span class="sitemason_body">Yes</span><input type="radio" name="parents" value="no" /><span class="sitemason_body">No</span><input type="hidden" name="parents" />');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <br clear="all" />');
document.writeln('  <div align="center" style="clear: both;" class="sitemason_body">');
document.writeln('				&nbsp;<br />');
document.writeln('  </div>');
document.writeln('  <div class="sitemason_body" style="width:350px; float:left; ">');
document.writeln('    <div style="text-align:left; width:150px; float:left;">');
document.writeln('      <label class="label" for="visitor_number">Total number of visitors attending (including prospective student):</label>');
document.writeln('    </div>');
document.writeln('    <div align="left" class="value" style="float:left; ">');
document.writeln('      <input type="text" style="width:50px; " name="visitor_number" />');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <br clear="all" />');
document.writeln('  <div align="center" style="clear: both;" class="sitemason_body">');
document.writeln('				&nbsp;<br />');
document.writeln('  </div>');
document.writeln('  <div class="sitemason_body" style="width:350px; float:left; ">');
document.writeln('    <div style="text-align:left; width:150px; float:left;">');
document.writeln('      <label class="label" for="visit_dates">*Preferred visit date:          (format: mm/dd/yyyy)</label>');
document.writeln('    </div>');
document.writeln('    <div align="left" class="value" style="float:left; ">');
document.writeln('      <input type="text" style="width:150px; " name="visit_dates" />');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <br clear="all" />');
document.writeln('  <div class="sitemason_body" style="width:350px; float:left; ">');
document.writeln('    <div style="text-align:left; width:150px; float:left;">');
document.writeln('      <label class="label" for="visit_dates_1">Alternate visit date:          (format: mm/dd/yyyy)</label>');
document.writeln('    </div>');
document.writeln('    <div align="left" class="value" style="float:left; ">');
document.writeln('      <input type="text" style="width:150px; " name="visit_dates_1" />');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <br clear="all" />');
document.writeln('  <div class="sitemason_body" style="width:350px; float:left; ">');
document.writeln('    <div style="text-align:left; width:150px; float:left;">');
document.writeln('      <label class="label" for="visit_time">Preferred visit time:</label>');
document.writeln('    </div>');
document.writeln('    <div align="left" class="value" style="float:left; ">');
document.writeln('      <input type="radio" name="visit_time" value="AM" /><span class="sitemason_body">AM</span><input type="radio" name="visit_time" value="PM" /><span class="sitemason_body">PM</span><input type="hidden" name="visit_time" />');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <br clear="all" />');
document.writeln('  <div align="center" style="clear: both;" class="sitemason_body">');
document.writeln('				&nbsp;<br />');
document.writeln('  </div>');
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="first_visit_to_BU">Will this be your first visit to Belmont University?</label>');
document.writeln('    </div>');
document.writeln('    <div align="left" class="value" style="float:left; ">');
document.writeln('      <input type="radio" name="first_visit_to_BU" value="yes" /><span class="sitemason_body">Yes</span><input type="radio" name="first_visit_to_BU" value="no" /><span class="sitemason_body">No</span><input type="hidden" name="first_visit_to_BU" />');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <br clear="all" />');
document.writeln('  <div align="center" style="clear: both;" class="sitemason_body">');
document.writeln('				&nbsp;<br />');
document.writeln('  </div>');
document.writeln('  <div class="sitemason_body" align="center" style="text-align:center; width:75px; ">');
document.writeln('    <input type="submit" name="submit" value="Submit" style="width:75px;" />');
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>');
