document.writeln('		<!DOCTYPE html 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('			<!--');
document.writeln('			#sitemason_kQUXbG {');
document.writeln('				');
document.writeln('				border-color: #000000;');
document.writeln('				border-width: 1px;');
document.writeln('				border-style: solid;');
document.writeln('			}');
document.writeln('			');
document.writeln('			#sitemason_kQUXbG .sitemason_title {');
document.writeln('				background-color: #565656;');
document.writeln('				border-color: #000000;');
document.writeln('				border-width: 0 0 1px 0;');
document.writeln('				border-style: none none solid none;');
document.writeln('				color: #FFFFFF;');
document.writeln('				font-family: Verdana, Arial, Helvetica, sans-serif;');
document.writeln('				font-weight: normal;');
document.writeln('				text-align: left;');
document.writeln('				padding: 2px 4px 2px 4px;');
document.writeln('				margin: 0px;');
document.writeln('			}');
document.writeln('			');
document.writeln('			#sitemason_kQUXbG .sitemason_header {');
document.writeln('				background-color: #ADADAD;');
document.writeln('				color: #000000;');
document.writeln('				font-weight: normal;');
document.writeln('				padding: 2px 4px 2px 4px;');
document.writeln('				margin: 0px;');
document.writeln('				clear: both;');
document.writeln('			}');
document.writeln('			');
document.writeln('			#sitemason_kQUXbG .sitemason_body, #sitemason_kQUXbG .sitemason_error, #sitemason_kQUXbG .sitemason_notice {');
document.writeln('				background-color: #EEEEEE;');
document.writeln('				color: #000000;');
document.writeln('				margin: 2px 8px 2px 8px;');
document.writeln('				min-height: 1px;');
document.writeln('			}');
document.writeln('			');
document.writeln('			#sitemason_kQUXbG .sitemason_error {');
document.writeln('				color: #CC0000;');
document.writeln('				margin: 8px 8px 2px 8px;');
document.writeln('			}');
document.writeln('			');
document.writeln('			#sitemason_kQUXbG .sitemason_notice {');
document.writeln('				font-weight: bold;');
document.writeln('				margin: 8px 8px 2px 8px;');
document.writeln('			}');
document.writeln('			');
document.writeln('			#sitemason_kQUXbG .sitemason_match {');
document.writeln('				font-weight: bold;');
document.writeln('			}');
document.writeln('			');
document.writeln('			-->');
document.writeln('		</style>');
document.writeln('		<form method="post" name="form1" enctype="multipart/form-data" action="http://www.sitemason.com/form/kQUXbG">');
document.writeln('<input type="hidden" name="form__current_page" value="1">		<table id="sitemason_kQUXbG" 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="float:left; ">');
document.writeln('    <div style="text-align:right; width:150px; float:left;">');
document.writeln('      <label class="label" for="fieldname">Check to agree</label>');
document.writeln('    </div>');
document.writeln('    <div align="left" class="value" style="float:left; ">');
document.writeln('      <div class="sitemason_body">');
document.writeln('        <input type="checkbox" name="fieldname" value="Yes" checked>I PETITION FOR IMMEDIATE CHANGE IN THE CONDITIONS OF EXISTENCE!</div>');
document.writeln('      <input type="hidden" name="fieldname">');
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:right; width:100px; float:left;">');
document.writeln('      <label class="label" for="firstname">First Name</label>');
document.writeln('    </div>');
document.writeln('    <div align="left" class="value" style="float:left; ">');
document.writeln('      <input type="text" style="width:200px; " name="firstname">');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <br clear="all">');
document.writeln('  <div class="sitemason_body" style="float:left; ">');
document.writeln('    <div style="margin-left:0; text-align:right; width:100px; float:left;">');
document.writeln('      <label class="label" for="lastname">Last Name</label>');
document.writeln('    </div>');
document.writeln('    <div align="left" class="value" style="float:left; ">');
document.writeln('      <input type="text" style="width:200px; " name="lastname">');
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:right; width:100px; float:left;">');
document.writeln('      <label class="label" for="email">Email Address</label>');
document.writeln('    </div>');
document.writeln('    <div align="left" class="value" style="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" align="center" style="text-align:center; ">');
document.writeln('    <input type="submit" name="submit" 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>');
