document.write('<style type="text/css">\r\n<!--\r\n   #webFrmID { font-family: "Lucida Sans Unicode", "Lucida Grande", sans-serif; font-size: 12px; color: #666;  }\r\n   #webFrmID .cntBox { position: relative; left: 50%; width: auto; float: left; clear: both; text-align: left; margin: 5px 0 12px 0; }\r\n   #webFrmID .cntBox .box { position: relative; left: -50%; float: left; padding: 0; }\r\n  #webFrmID .chikLet { margin: 0 0 5px 0; padding: 0; height: 24px; }\r\n  #webFrmID .chikLet li, .chikLet li span { background: url(http://www.getresponse.com/images/core/icons/gr_chicklet.png) left top no-repeat; display: block; height: 24px; }\r\n  #webFrmID .chikLet li { margin: 0; padding: 0 0 0 24px; float: left; line-height: 24px; }\r\n  #webFrmID .chikLet li span { background-position: right bottom; padding: 0 8px 0 4px; float: left; }\r\n  #webFrmID .clearer { width: 100%; height: 0.1px; font-size: 0.1px; clear: both; line-height: 0.1px; }\r\n-->\r\n</style>\r\n<div id="webFrmID"> \r\n<form accept-charset="utf-8" action="http://www.getresponse.com/cgi-bin/add.cgi" style="width: 241px; margin: 10px;"><input type="hidden" name="custom_http_referer" id="custom_http_referer" value=""/>\r\n    <div style="width: 241px; font-family: tahoma;">\r\n        <div style="height: 19px; background-image: url(http://www.getresponse.com/images/common/templates/webforms/brown_top.png); background-repeat: no-repeat;"></div>\r\n        <div style="background-image: url(http://www.getresponse.com/images/common/templates/webforms/brown_middle.png); background-repeat: repeat-y; padding: 0 9px 0 9px;">\r\n            <div id="webform_title" style="line-height:21px; color: #0240A7; font-size: 20px; padding-left: 10px;">Get It Now!</div>\r\n            <div style="font-size: 12px; color: #5A5A42; background-color: #E2DEC1; border: 1px solid #B1AF98; padding: 20px 13px 34px 7px; margin: 12px 0 12px 0;">\r\n                <ul id="fields" style="list-style: none; padding: 0; margin: 0;">\r\n                    <li id="subscriber_name-field" style="list-style: inherit; background: none; float: none; height: 20px; width: 181px; padding: 0; margin-bottom: 10px; margin-left: 20px;">\r\n    <label style="float: left;" for="subscriber_name">Name</label>\r\n    <input id="subscriber_name" name="subscriber_name" value="" type="text" style=" float: right;width: 120px; border: 1px solid #AAAAB6;"/>\r\n    <div style="clear: both;"></div>\r\n</li>\r\n<li id="subscriber_email-field" style="list-style: inherit; background: none; float: none; height: 20px; width: 181px; padding: 0; margin-bottom: 10px; margin-left: 20px;">\r\n    <label style="float: left;" for="subscriber_email">Email</label>\r\n    <input id="subscriber_email" name="subscriber_email" value="" type="text" style=" float: right;width: 120px; border: 1px solid #AAAAB6;"/>\r\n    <div style="clear: both;"></div>\r\n</li>\r\n\r\n                </ul>\r\n            </div>\r\n           \r\n            <input type="hidden" name="confirmation_url" id="confirmation_url" value="http://www.17minasthmaandallergysecrets.com/secrets/index2.html"/>\r\n            <input type="hidden" name="error_url" id="error_url" value="http://www.17minasthmaandallergysecrets.com/secrets/index2.html"/>\r\n            <input type="hidden" name="campaign_name" id="campaign_name" value="getrid_asthma_subscribers"/>\r\n            <input type="hidden" name="custom_ref" id="custom_ref" value=""/>\r\n            <div style="padding-bottom: 3px; padding-top: 20px; text-align: center;">\r\n                <input id="webform_submit" style="cursor: hand; font-size: 14px; font-weight: bold; color: #FFFFFF; background: url(http://www.getresponse.com/images/common/templates/webforms/orange_button.png) 0 0 no-repeat; border: 0; width: 150px; height: 25px;" type="submit" value="Get Instant Access!"/>\r\n            </div>\r\n            <div style="text-align: center; font-size: 12px;">\r\n                \r\n                \r\n            <div class="clearer"></div>\r\n            </div>\r\n        </div>\r\n        <div style="height: 9px; background-image: url(http://www.getresponse.com/images/common/templates/webforms/brown_bottom.png); background-repeat: no-repeat;"></div>\r\n    </div>\r\n</form>\r\n</div><script type="text/javascript">var el=document.getElementById("custom_http_referer");if(el != null){el.value = document.location};</script>');