/****************************************************************
*                                                               *
*	For use with ProChoiceAmerica.org and affiliated websites	*
*                                                               *
*	written by Michael Rathmann                                 *
*	(c)RathmannDesign.com. All rights reserved.                 *
*                                                               *
****************************************************************/

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	document.writeln('<TR><TD STYLE="padding-top:20px"><TABLE WIDTH="100%" BORDER="0" CELLSPACING="0" CELLPADDING="4">'
	+ '<TR><TD ID="sectTitle">* These fields are required</TD></TR>');

	document.writeln('<TR><TD ID="listTitle">Customize Your Communications - What You Want to Know About!</TD></TR>');
	document.writeln('<TR><TD ID="listEntry" STYLE="padding:0px"><TABLE BORDER="0" CELLSPACING="0" CELLPADDING="2">'
	+ '<TR><TD WIDTH="1%" ID="listTitleAlt"><INPUT TYPE="checkbox" NAME="contactOpt1" VALUE="checked" CHECKED></TD>'
		+ '<TD ID="listTitleAlt">Send Me Breaking News on Critical Choice Issues!</TD></TR>'
		+ '<TR><TD COLSPAN="2" STYLE="padding:4px 4px 10px 4px">Get periodic e-mail notifications with breaking news about reproductive freedom and efforts to prevent unintended or unwanted pregnancy in Colorado and nationally.</TD></TR>'
	+ '<TR><TD ID="listTitleAlt"><INPUT TYPE="checkbox" NAME="contactOpt2" VALUE="checked" CHECKED></TD>'
		+ '<TD ID="listTitleAlt">Sign Me Up for the <EM>Insider</EM> Update</TD></TR>'
		+ '<TR><TD COLSPAN="2" STYLE="padding:4px 4px 10px 4px">This monthly e-newsletter contains an overview of NARAL Pro-Choice\'s latest happenings, upcoming events, and more.</TD></TR>'
	+ '<TR><TD ID="listTitleAlt"><INPUT TYPE="checkbox" NAME="contactOpt3" VALUE="checked" CHECKED></TD>'
		+ '<TD ID="listTitleAlt">Sign Me Up as a Constituent Lobbyist</TD></TR>'
		+ '<TR><TD COLSPAN="2" STYLE="padding:4px 4px 10px 4px">Join the front lines of our grassroots advocacy efforts! As a Constituent Lobbyist, you\'ll receive urgent calls for action to notify your elected officials about critical legislation that affects Coloradans\' reproductive rights. You\'ll also be identified as a legislative leader in your community to write letters to the editor and be notified of opportunities to meet with your elected officials.</TD></TR>'
	+ '<TR><TD ID="listTitleAlt"><INPUT TYPE="checkbox" NAME="contactOpt4" VALUE="checked" CHECKED></TD>'
		+ '<TD ID="listTitleAlt">Tell Me About Upcoming Volunteer Activities!</TD></TR>'
		+ '<TR><TD COLSPAN="2" STYLE="padding:4px 4px 10px 4px">Join us during community festivals, help us coordinate our annual Choice Celebration Gala &amp; Auction, place calls to pro-choice voters in your community, or donate a few hours of your time to support our efforts to protect and promote reproductive rights in Colorado.</TD></TR>'
	+ '<TR><TD ID="listTitleAlt"><INPUT TYPE="checkbox" NAME="contactOpt5" VALUE="checked" CHECKED></TD>'
		+ '<TD ID="listTitleAlt">Tell Me How to Support Choice in My Community!</TD></TR>'
		+ '<TR><TD COLSPAN="2" STYLE="padding:4px 4px 10px 4px">Receive targeted e-mail notices of upcoming events in your community and learn how you can host house parties to educate your friends and neighbors about choice in Colorado.</TD></TR>'
	+ '<TR><TD ID="listTitleAlt"><INPUT TYPE="checkbox" NAME="contactOpt6" VALUE="checked" onClick="if (contactOpt6.checked) { clearOpt(form) } else { fillOpt(form) }"></TD>'
		+ '<TD ID="listTitleAlt">Remove me from your e-mail distribution lists.</TD></TR>'
	+ '</TABLE></TD></TR>');

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	+ '<TR><TD ID="listEntry" STYLE="padding:2px 2px 10px 2px"><TABLE WIDTH="100%" BORDER="0" CELLSPACING="0" CELLPADDING="2">'
	+ '<TR><TD><STRONG>*FULL NAME:</STRONG> <SPAN STYLE="font-size:10px">(First M Last)</SPAN></TD>'
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	+ '<TR><TD>BLDG, STE, APT:</TD>'
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	+ '<TR><TD>CITY/STATE/ZIP:</TD>'
		+ '<TD ALIGN="right"><TABLE BORDER="0" CELLSPACING="0" CELLPADDING="0">'
		+ '<TR><TD STYLE="padding-right:5px"><INPUT TYPE="text" NAME="contactCity" STYLE="'+midField+'" MAXLENGTH="50"'+dynaCode+'></TD>'
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		+ '</TABLE></TD></TR>'
	+ '<TR><TD>HOME PHONE #:</TD>'
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	+ '<TR><TD>MOBILE PHONE #:</TD>'
		+ '<TD ALIGN="right"><TABLE WIDTH="385" BORDER="0" CELLSPACING="0" CELLPADDING="0">'
		+ '<TR><TD><TABLE BORDER="0" CELLSPACING="0" CELLPADDING="0">'
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		+ '</TABLE></TD></TR>'
	+ '<TR><TD>WORK PHONE #:</TD>'
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	+ '<TR><TD><STRONG>*CONTACT PREFERENCE:</STRONG></TD>'
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	+ '<TR><TD ID="sectTitle">* Incompatible Browser</TD></TR>'
	+ '<TR><TD ID="listEntry"><P><STRONG>Sorry, this form is compatible with Microsoft Internet Explorer 5.0+higher, Netscape Navigator 6.0+higher, and Firefox 1.5+higher browsers only.</STRONG></P>'
	+ '<P>Please download one of these browsers if you wish to use this online form.<BR>We apologize for the inconvenience.</P>'
	+ '<P>If you are currently using the appropriate browser, please make sure that you have it set to be <B>JavaScript enabled</B>. After JavaScript has been enabled, simply reload this page and you will be taken to the form. Thank you.</P></TD></TR>'
	+ '</TABLE></TD></TR>');
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