document.writeln('<tr><td colspan=2>* indicates a required field</td></tr>'
+ '<tr><td>* First Name </td><td><input maxLength=60 size=40 name=1 class="input_txt"></td></tr>'
+ '<tr><td>* Last Name </td><td><input maxLength=60 size=40 name=2 class="input_txt"></td></tr>'
+ '<tr><td>Job Title </td><td>');
/* Emergency Response forms */
if (document.form_1.ers) {
document.writeln('<select name="3" class="single">'
+ '<option value="" selected>Please Select</option>'
+ '<option value="Dispatcher">Dispatcher</option>'
+ '<option value="Incident Command Operator">Incident Command Operator</option>'
+ '<option value="Fire Inspector">Fire Inspector</option>'
+ '<option value="Firefighter">Firefighter</option>'
+ '<option value="Fire Chief">Fire Chief</option>'
+ '<option value="Battalion Chief">Battalion Chief</option>'
+ '<option value="Division Chief">Division Chief</option>'
+ '<option value="Emergency Operations Center Professional">Emergency Operations Center Professional</option>'
+ '<option value="Police Chief">Police Chief</option>'
+ '<option value="Other">Other (please indicate)</option></select><BR><INPUT maxLength=60 size=40 name=3other class="input_txt">'
+ '</td></tr><tr><td>* Organization/Department: </td><td><input maxLength=60 size=40 name=5 class="input_txt"></td></tr>');
}
/* Education forms */
else if (document.form_1.edu) { document.writeln('<input maxLength=60 size=40 name=3 class="input_txt">'
+ '</td></tr><tr><td>* Educational Institution </td><td><input maxLength=60 size=40 name=5 class="input_txt"></td></tr>'); }
/* Regular Aprimo forms */
else { document.writeln('<input maxLength=60 size=32 name=3 class="input_txt">'
+ '</td></tr><tr><td>* Company </td><td><input maxLength=60 size=40 name=5 class="input_txt"></td></tr>'); }
document.writeln('<tr><td>* Address 1 </td><td><input maxLength=60 size=40 name=6 class="input_txt"></td></tr>'
+ '<tr><td>Address 2 </td><td><input maxLength=60 size=40 name=7 class="input_txt"></td></tr>'
+ '<tr><td>* City </td><td><input maxLength=40 size=40 name=8 class="input_txt"></td></tr>'
+ '<tr><td>* Country </td><td>');
/* Country Select code */

	function country_iso_text(form_iso,zip,_num_forms) {
	
	var f = document.forms[_form_num];
	
	if(_num_forms > 0){_form_num = _num_forms - 1} else{_form_num = 0}
	/* document.charset = "iso-8859-1"; */
	
	var patternUS = /^[0-9]{5}.*/;
	var patternCAN = /([a-zA-Z][0-9]){3}.*/;	
	var patternDK = /^[0-9]{4}.*/;
	
		switch (form_iso.value)
		{
			case "US":
				zip_changed = zip.value.replace(/\s|[^a-z0-9]/gi,"");
				zip_changed = zip_changed.toUpperCase();
				if (zip_changed.match(patternUS)) {
					zip_changed = zip_changed.replace(/([0-9]{1,5})(.*)/,"$1");
					f.zip.value = zip_changed;
				} else {
					f.zip.value = "";
				}
			break			
			case "CA":
				zip_changed = zip.value.replace(/\s|[^a-z0-9]/gi,"");
				zip_changed = zip_changed.toUpperCase();
				if (zip_changed.match(patternCAN)) {
					zip_changed = zip_changed.replace(/([a-zA-Z][0-9][a-zA-Z])([0-9][a-zA-Z][0-9])(.*)/,"$1 $2");
					f.zip.value = zip_changed;
				} else {
					f.zip.value = "";
				}
			break		
			case "DK":
				zip_changed = zip.value.replace(/\s|[^a-z0-9]/gi,"");
				zip_changed = zip_changed.toUpperCase();
				if (zip_changed.match(patternDK) && (zip_changed.length == 4)) {
					zip_changed = zip_changed.replace(/([0-9]{1,4})(.*)/,"$1");
					f.zip.value = zip_changed;
				} else {
					f.zip.value = "";
					alert ('Missing Info: Postal Code - numbers only, no spaces. Please re-enter postal code in the form ####');
					f.zip.focus();
					return false;
				}
			break
			case "NO":
				zip_changed = zip.value.replace(/\s|[^a-z0-9]/gi,"");
				zip_changed = zip_changed.toUpperCase();
				if (zip_changed.match(patternDK) && (zip_changed.length == 4)) {
					zip_changed = zip_changed.replace(/([0-9]{1,4})(.*)/,"$1");
					f.zip.value = zip_changed;
				} else {
					f.zip.value = "";
					alert ('Missing Info: Postal Code - numbers only, no spaces. Please re-enter postal code in the form ####');
					f.zip.focus();
					return false;
				}
			break	
			case "FI":
				zip_changed = zip.value.replace(/\s|[^a-z0-9]/gi,"");
				zip_changed = zip_changed.toUpperCase();
				if (zip_changed.match(patternUS) && (zip_changed.length == 5)) {
					zip_changed = zip_changed.replace(/([0-9]{1,5})(.*)/,"$1");
					f.zip.value = zip_changed;
				} else {
					f.zip.value = "";
					alert ('Missing Info: Postal Code - numbers only, no spaces. Please re-enter postal code in the form #####');
					f.zip.focus();
					return false;
				}
			break	
			case "SE":
				zip_changed = zip.value.replace(/\s|[^a-z0-9]/gi,"");
				zip_changed = zip_changed.toUpperCase();
				if (zip_changed.match(patternUS) && (zip_changed.length == 5)) {
					zip_changed = zip_changed.replace(/([0-9]{1,5})(.*)/,"$1");
					f.zip.value = zip_changed;
				} else {
					f.zip.value = "";
					alert ('Missing Info: Postal Code - numbers only, no spaces. Please re-enter postal code in the form #####');
					f.zip.focus();
					return false;
				}
			break	
		}		
		
		switch (form_iso.value)
		{
		case "": f.country.value = "";  break
		case "US": f.country.value = "United States"; f.geo.value = "amer";  break
		case "CA": f.country.value = "Canada"; f.geo.value = "amer";  break
		case "AF": f.country.value = "Afghanistan"; f.geo.value = "emea_ec";  break
		case "AL": f.country.value = "Albania"; f.geo.value = "emea_ec";  break
		case "DZ": f.country.value = "Algeria"; f.geo.value = "emea_se";  break
		case "AD": f.country.value = "Andorra"; f.geo.value = "emea_se";  break
		case "AO": f.country.value = "Angola"; f.geo.value = "emea_ec";  break
		case "AI": f.country.value = "Anguilla"; f.geo.value = "la";  break
		case "AG": f.country.value = "Antigua and Barbuda"; f.geo.value = "la";  break
		case "AR": f.country.value = "Argentina"; f.geo.value = "la";  break
		case "AM": f.country.value = "Armenia"; f.geo.value = "emea_ec";  break
		case "AW": f.country.value = "Aruba"; f.geo.value = "la";  break
		case "AU": f.country.value = "Australia"; f.geo.value = "apac";  break
		case "AT": f.country.value = "Austria"; f.geo.value = "emea_ce";  break
		case "AZ": f.country.value = "Azerbaijan"; f.geo.value = "emea_ec";  break
		case "BS": f.country.value = "Bahamas"; f.geo.value = "la";  break
		case "BH": f.country.value = "Bahrain"; f.geo.value = "emea_ec";  break
		case "BD": f.country.value = "Bangladesh"; f.geo.value = "apac";  break
		case "BB": f.country.value = "Barbados"; f.geo.value = "la";  break
		case "BY": f.country.value = "Belarus"; f.geo.value = "emea_ec";  break
		case "BE": f.country.value = "Belgium"; f.geo.value = "emea_ne";  break
		case "BZ": f.country.value = "Belize"; f.geo.value = "la";  break
		case "BM": f.country.value = "Bermuda"; f.geo.value = "la";  break
		case "BT": f.country.value = "Bhutan"; f.geo.value = "apac";  break
		case "BO": f.country.value = "Bolivia"; f.geo.value = "la";  break
		case "BA": f.country.value = "Bosnia and Herzegovina"; f.geo.value = "emea_ec";  break
		case "BW": f.country.value = "Botswana"; f.geo.value = "emea_ec";  break
		case "BV": f.country.value = "Bouvet Island"; f.geo.value = "emea_ec";  break
		case "BR": f.country.value = "Brazil"; f.geo.value = "la";  break
		case "BN": f.country.value = "Brunei Darussalam"; f.geo.value = "apac";  break
		case "BG": f.country.value = "Bulgaria"; f.geo.value = "emea_ec";  break
		case "KH": f.country.value = "Cambodia"; f.geo.value = "apac";  break
		case "CM": f.country.value = "Cameroon"; f.geo.value = "emea_ec";  break
		case "KY": f.country.value = "Cayman Islands"; f.geo.value = "la";  break
		case "CF": f.country.value = "Central African Republic"; f.geo.value = "emea_ec";  break
		case "TD": f.country.value = "Chad"; f.geo.value = "emea_se";  break
		case "CL": f.country.value = "Chile"; f.geo.value = "la";  break
		case "CN": f.country.value = "China"; f.geo.value = "apac";  break
		case "CX": f.country.value = "Christmas Island"; f.geo.value = "apac";  break
		case "CO": f.country.value = "Colombia"; f.geo.value = "la";  break
		case "CG": f.country.value = "Congo"; f.geo.value = "emea_se";  break
		case "CR": f.country.value = "Costa Rica"; f.geo.value = "la";  break
		case "HR": f.country.value = "Croatia"; f.geo.value = "emea_ec";  break
		case "CY": f.country.value = "Cyprus"; f.geo.value = "emea_se";  break
		case "CZ": f.country.value = "Czech Republic"; f.geo.value = "emea_ec";  break
		case "KP": f.country.value = "Democratic Republic of Korea"; f.geo.value = "apac";  break
		case "CD": f.country.value = "Democratic Republic of the Congo"; f.geo.value = "emea_se";  break
		case "DK": f.country.value = "Denmark"; f.geo.value = "emea_ne";  break
		case "DJ": f.country.value = "Djibouti"; f.geo.value = "emea_ec";  break
		case "DM": f.country.value = "Dominica"; f.geo.value = "la";  break
		case "DO": f.country.value = "Dominican Republic"; f.geo.value = "la";  break
		case "EC": f.country.value = "Ecuador"; f.geo.value = "la";  break
		case "EG": f.country.value = "Egypt"; f.geo.value = "emea_ec";  break
		case "SV": f.country.value = "El Salvador"; f.geo.value = "la";  break
		case "EE": f.country.value = "Estonia"; f.geo.value = "emea_ne";  break
		case "ET": f.country.value = "Ethiopia"; f.geo.value = "emea_ec";  break
		case "FO": f.country.value = "Faeroe Islands"; f.geo.value = "emea_ne";  break
		case "FJ": f.country.value = "Fiji"; f.geo.value = "apac";  break
		case "FI": f.country.value = "Finland"; f.geo.value = "emea_ne";  break
		case "FR": f.country.value = "France"; f.geo.value = "emea_se";  break
		case "GA": f.country.value = "Gabon"; f.geo.value = "emea_se";  break
		case "GM": f.country.value = "Gambia"; f.geo.value = "emea_ec";  break
		case "GE": f.country.value = "Georgia"; f.geo.value = "emea_ec";  break
		case "DE": f.country.value = "Germany"; f.geo.value = "emea_ce";  break
		case "GH": f.country.value = "Ghana"; f.geo.value = "emea_ec";  break
		case "GI": f.country.value = "Gibraltar"; f.geo.value = "emea_se";  break
		case "GR": f.country.value = "Greece"; f.geo.value = "emea_se";  break
		case "GL": f.country.value = "Greenland"; f.geo.value = "emea_ne";  break
		case "GP": f.country.value = "Guadeloupe"; f.geo.value = "emea_se";  break
		case "GU": f.country.value = "Guam"; f.geo.value = "apac";  break
		case "GT": f.country.value = "Guatemala"; f.geo.value = "la";  break
		case "GY": f.country.value = "Guyana"; f.geo.value = "la";  break
		case "HT": f.country.value = "Haiti"; f.geo.value = "la";  break
		case "HN": f.country.value = "Honduras"; f.geo.value = "la";  break
		case "HK": f.country.value = "Hong Kong"; f.geo.value = "apac";  break
		case "HU": f.country.value = "Hungary"; f.geo.value = "emea_ec";  break
		case "IS": f.country.value = "Iceland"; f.geo.value = "emea_ne";  break
		case "IN": f.country.value = "India"; f.geo.value = "apac";  break
		case "ID": f.country.value = "Indonesia"; f.geo.value = "apac";  break
		case "IQ": f.country.value = "Iraq"; f.geo.value = "emea_ec";  break
		case "IE": f.country.value = "Ireland"; f.geo.value = "emea_ne";  break
		case "IL": f.country.value = "Israel"; f.geo.value = "emea_se";  break
		case "IT": f.country.value = "Italy"; f.geo.value = "emea_se";  break
		case "CI": f.country.value = "Ivory Coast"; f.geo.value = "emea_se";  break
		case "JM": f.country.value = "Jamaica"; f.geo.value = "la";  break
		case "JP": f.country.value = "Japan"; f.geo.value = "jp";  break
		case "JO": f.country.value = "Jordan"; f.geo.value = "emea_ec";  break
		case "KZ": f.country.value = "Kazakhstan"; f.geo.value = "emea_ec";  break
		case "KE": f.country.value = "Kenya"; f.geo.value = "emea_ec";  break
		case "KR": f.country.value = "Korea"; f.geo.value = "apac";  break
		case "KW": f.country.value = "Kuwait"; f.geo.value = "emea_ec";  break
		case "LV": f.country.value = "Latvia"; f.geo.value = "emea_ne";  break
		case "LB": f.country.value = "Lebanon"; f.geo.value = "emea_ec";  break
		case "LI": f.country.value = "Liechtenstein"; f.geo.value = "emea_ce";  break
		case "LT": f.country.value = "Lithuania"; f.geo.value = "emea_ne";  break
		case "LU": f.country.value = "Luxembourg"; f.geo.value = "emea_ne";  break
		case "MK": f.country.value = "Macedonia"; f.geo.value = "emea_ec";  break
		case "MG": f.country.value = "Madagascar"; f.geo.value = "emea_ec";  break
		case "MW": f.country.value = "Malawi"; f.geo.value = "emea_ec";  break
		case "MY": f.country.value = "Malaysia"; f.geo.value = "apac";  break
		case "MT": f.country.value = "Malta"; f.geo.value = "emea_ec";  break
		case "MQ": f.country.value = "Martinique"; f.geo.value = "emea_se";  break
		case "MR": f.country.value = "Mauritania"; f.geo.value = "emea_se";  break
		case "MU": f.country.value = "Mauritius"; f.geo.value = "emea_se";  break
		case "MX": f.country.value = "Mexico"; f.geo.value = "la";  break
		case "MD": f.country.value = "Moldova"; f.geo.value = "emea_ec";  break
		case "MC": f.country.value = "Monaco"; f.geo.value = "emea_se";  break
		case "MA": f.country.value = "Morocco"; f.geo.value = "emea_se";  break
		case "MZ": f.country.value = "Mozambique"; f.geo.value = "emea_ec";  break
		case "MM": f.country.value = "Myanmar"; f.geo.value = "apac";  break
		case "NA": f.country.value = "Namibia"; f.geo.value = "emea_ec";  break
		case "NP": f.country.value = "Nepal"; f.geo.value = "apac";  break
		case "NL": f.country.value = "Netherlands"; f.geo.value = "emea_ne";  break
		case "AN": f.country.value = "Netherlands Antilles"; f.geo.value = "la";  break
		case "NZ": f.country.value = "New Zealand"; f.geo.value = "apac";  break
		case "NI": f.country.value = "Nicaragua"; f.geo.value = "la";  break
		case "NE": f.country.value = "Niger"; f.geo.value = "emea_se";  break
		case "NG": f.country.value = "Nigeria"; f.geo.value = "emea_ec";  break
		case "NO": f.country.value = "Norway"; f.geo.value = "emea_ne";  break
		case "OM": f.country.value = "Oman"; f.geo.value = "emea_ec";  break
		case "PK": f.country.value = "Pakistan"; f.geo.value = "apac";  break
		case "PS": f.country.value = "Palestinian Territory, Occupied"; f.geo.value = "emea_ec";  break
		case "PA": f.country.value = "Panama"; f.geo.value = "la";  break
		case "PG": f.country.value = "Papua New Guinea"; f.geo.value = "apac";  break
		case "PY": f.country.value = "Paraguay"; f.geo.value = "la";  break
		case "PE": f.country.value = "Peru"; f.geo.value = "la";  break
		case "PH": f.country.value = "Philippines"; f.geo.value = "apac";  break
		case "PL": f.country.value = "Poland"; f.geo.value = "emea_ec";  break
		case "PT": f.country.value = "Portugal"; f.geo.value = "emea_se";  break
		case "PR": f.country.value = "Puerto Rico"; f.geo.value = "la";  break
		case "QA": f.country.value = "Qatar"; f.geo.value = "emea_ec";  break
		case "RE": f.country.value = "R&eacute;union"; f.geo.value = "emea_se";  break
		case "RO": f.country.value = "Romania"; f.geo.value = "emea_ec";  break
		case "RU": f.country.value = "Russian Federation"; f.geo.value = "emea_ec";  break
		case "RW": f.country.value = "Rwanda"; f.geo.value = "emea_ec";  break
		case "KN": f.country.value = "Saint Kitts and Nevis"; f.geo.value = "la";  break
		case "PM": f.country.value = "Saint Pierre and Miquelon"; f.geo.value = "emea_se";  break
		case "VC": f.country.value = "Saint Vincent and the Grenadines"; f.geo.value = "la";  break
		case "SM": f.country.value = "San Marino"; f.geo.value = "emea_se";  break
		case "SA": f.country.value = "Saudi Arabia"; f.geo.value = "emea_ec";  break
		case "SN": f.country.value = "Senegal"; f.geo.value = "emea_se";  break
		case "SG": f.country.value = "Singapore"; f.geo.value = "apac";  break
		case "SK": f.country.value = "Slovakia"; f.geo.value = "emea_ec";  break
		case "SI": f.country.value = "Slovenia"; f.geo.value = "emea_ec";  break
		case "SO": f.country.value = "Somalia"; f.geo.value = "emea_ec";  break
		case "ZA": f.country.value = "South Africa"; f.geo.value = "emea_ec";  break
		case "ES": f.country.value = "Spain"; f.geo.value = "emea_se";  break
		case "LK": f.country.value = "Sri Lanka"; f.geo.value = "apac";  break
		case "SZ": f.country.value = "Swaziland"; f.geo.value = "emea_ec";  break
		case "SE": f.country.value = "Sweden"; f.geo.value = "emea_ne";  break
		case "CH": f.country.value = "Switzerland"; f.geo.value = "emea_ce";  break
		case "TW": f.country.value = "Taiwan"; f.geo.value = "apac";  break
		case "TH": f.country.value = "Thailand"; f.geo.value = "apac";  break
		case "TN": f.country.value = "Tunisia"; f.geo.value = "emea_se";  break
		case "TR": f.country.value = "Turkey"; f.geo.value = "emea_se";  break
		case "UG": f.country.value = "Uganda"; f.geo.value = "emea_ec";  break
		case "UA": f.country.value = "Ukraine"; f.geo.value = "emea_ec";  break
		case "AE": f.country.value = "United Arab Emirates"; f.geo.value = "emea_ec";  break
		case "GB": f.country.value = "United Kingdom"; f.geo.value = "emea_ne";  break
		case "TZ": f.country.value = "United Republic of Tanzania"; f.geo.value = "emea_ec";  break
		case "UY": f.country.value = "Uruguay"; f.geo.value = "la";  break
		case "UZ": f.country.value = "Uzbekistan"; f.geo.value = "emea_ec";  break
		case "VA": f.country.value = "Vatican City State (Holy See)"; f.geo.value = "emea_se";  break
		case "VE": f.country.value = "Venezuela"; f.geo.value = "la";  break
		case "VN": f.country.value = "Vietnam"; f.geo.value = "apac";  break
		case "VG": f.country.value = "Virgin Islands (British)"; f.geo.value = "la";  break
		case "VI": f.country.value = "Virgin Islands (U.S.)"; f.geo.value = "la";  break
		case "YU": f.country.value = "Yugoslavia"; f.geo.value = "emea_ec";  break
		case "ZM": f.country.value = "Zambia"; f.geo.value = "emea_ec";  break
		case "ZW": f.country.value = "Zimbabwe"; f.geo.value = "emea_ec";  break
		}
	}
	
	
	document.writeln('<input type="hidden" name=country value="">'
	+ '<input type="hidden" name=geo value="">'
	+ '<select name=iso_country onchange="successPage()" class="single">'
	+ '<option value="" selected>Please Select</option>'
	+ '<option value=US>United States</option>'
	+ '<option value=CA>Canada</option>'
	+ '<option value=AF>Afghanistan</option>'
	+ '<option value=AL>Albania</option>'
	+ '<option value=DZ>Algeria</option>'
	+ '<option value=AD>Andorra</option>'
	+ '<option value=AO>Angola</option>'
	+ '<option value=AI>Anguilla</option>'
	+ '<option value=AG>Antigua and Barbuda</option>'
	+ '<option value=AR>Argentina</option>'
	+ '<option value=AM>Armenia</option>'
	+ '<option value=AW>Aruba</option>'
	+ '<option value=AU>Australia</option>'
	+ '<option value=AT>Austria</option>'
	+ '<option value=AZ>Azerbaijan</option>'
	+ '<option value=BS>Bahamas</option>'
	+ '<option value=BH>Bahrain</option>'
	+ '<option value=BD>Bangladesh</option>'
	+ '<option value=BB>Barbados</option>'
	+ '<option value=BY>Belarus</option>'
	+ '<option value=BE>Belgium</option>'
	+ '<option value=BZ>Belize</option>'
	+ '<option value=BM>Bermuda</option>'
	+ '<option value=BT>Bhutan</option>'
	+ '<option value=BO>Bolivia</option>'
	+ '<option value=BA>Bosnia and Herzegovina</option>'
	+ '<option value=BW>Botswana</option>'
	+ '<option value=BV>Bouvet Island</option>'
	+ '<option value=BR>Brazil</option>'
	+ '<option value=BN>Brunei Darussalam</option>'
	+ '<option value=BG>Bulgaria</option>'
	+ '<option value=KH>Cambodia</option>'
	+ '<option value=CM>Cameroon</option>'
	+ '<option value=KY>Cayman Islands</option>'
	+ '<option value=CF>Central African Republic</option>'
	+ '<option value=TD>Chad</option>'
	+ '<option value=CL>Chile</option>'
	+ '<option value=CN>China</option>'
	+ '<option value=CX>Christmas Island</option>'
	+ '<option value=CO>Colombia</option>'
	+ '<option value=CG>Congo</option>'
	+ '<option value=CR>Costa Rica</option>'
	+ '<option value=HR>Croatia</option>'
	+ '<option value=CY>Cyprus</option>'
	+ '<option value=CZ>Czech Republic</option>'
	+ '<option value=KP>Democratic Republic of Korea</option>'
	+ '<option value=CD>Democratic Republic of the Congo</option>'
	+ '<option value=DK>Denmark</option>'
	+ '<option value=DJ>Djibouti</option>'
	+ '<option value=DM>Dominica</option>'
	+ '<option value=DO>Dominican Republic</option>'
	+ '<option value=EC>Ecuador</option>'
	+ '<option value=EG>Egypt</option>'
	+ '<option value=SV>El Salvador</option>'
	+ '<option value=EE>Estonia</option>'
	+ '<option value=ET>Ethiopia</option>'
	+ '<option value=FO>Faeroe Islands</option>'
	+ '<option value=FJ>Fiji</option>'
	+ '<option value=FI>Finland</option>'
	+ '<option value=FR>France</option>'
	+ '<option value=GA>Gabon</option>'
	+ '<option value=GM>Gambia</option>'
	+ '<option value=GE>Georgia</option>'
	+ '<option value=DE>Germany</option>'
	+ '<option value=GH>Ghana</option>'
	+ '<option value=GI>Gibraltar</option>'
	+ '<option value=GR>Greece</option>'
	+ '<option value=GL>Greenland</option>'
	+ '<option value=GP>Guadeloupe</option>'
	+ '<option value=GU>Guam</option>'
	+ '<option value=GT>Guatemala</option>'
	+ '<option value=GY>Guyana</option>'
	+ '<option value=HT>Haiti</option>'
	+ '<option value=HN>Honduras</option>'
	+ '<option value=HK>Hong Kong</option>'
	+ '<option value=HU>Hungary</option>'
	+ '<option value=IS>Iceland</option>'
	+ '<option value=IN>India</option>'
	+ '<option value=ID>Indonesia</option>'
	+ '<option value=IQ>Iraq</option>'
	+ '<option value=IE>Ireland</option>'
	+ '<option value=IL>Israel</option>'
	+ '<option value=IT>Italy</option>'
	+ '<option value=CI>Ivory Coast</option>'
	+ '<option value=JM>Jamaica</option>'
	+ '<option value=JP>Japan</option>'
	+ '<option value=JO>Jordan</option>'
	+ '<option value=KZ>Kazakhstan</option>'
	+ '<option value=KE>Kenya</option>'
	+ '<option value=KR>Korea</option>'
	+ '<option value=KW>Kuwait</option>'
	+ '<option value=LV>Latvia</option>'
	+ '<option value=LB>Lebanon</option>'
	+ '<option value=LI>Liechtenstein</option>'
	+ '<option value=LT>Lithuania</option>'
	+ '<option value=LU>Luxembourg</option>'
	+ '<option value=MK>Macedonia</option>'
	+ '<option value=MG>Madagascar</option>'
	+ '<option value=MW>Malawi</option>'
	+ '<option value=MY>Malaysia</option>'
	+ '<option value=MT>Malta</option>'
	+ '<option value=MQ>Martinique</option>'
	+ '<option value=MR>Mauritania</option>'
	+ '<option value=MU>Mauritius</option>'
	+ '<option value=MX>Mexico</option>'
	+ '<option value=MD>Moldova</option>'
	+ '<option value=MC>Monaco</option>'
	+ '<option value=MA>Morocco</option>'
	+ '<option value=MZ>Mozambique</option>'
	+ '<option value=MM>Myanmar</option>'
	+ '<option value=NA>Namibia</option>'
	+ '<option value=NP>Nepal</option>'
	+ '<option value=NL>Netherlands</option>'
	+ '<option value=AN>Netherlands Antilles</option>'
	+ '<option value=NZ>New Zealand</option>'
	+ '<option value=NI>Nicaragua</option>'
	+ '<option value=NE>Niger</option>'
	+ '<option value=NG>Nigeria</option>'
	+ '<option value=NO>Norway</option>'
	+ '<option value=OM>Oman</option>'
	+ '<option value=PK>Pakistan</option>'
	+ '<option value=PS>Palestinian Territory, Occupied</option>'
	+ '<option value=PA>Panama</option>'
	+ '<option value=PG>Papua New Guinea</option>'
	+ '<option value=PY>Paraguay</option>'
	+ '<option value=PE>Peru</option>'
	+ '<option value=PH>Philippines</option>'
	+ '<option value=PL>Poland</option>'
	+ '<option value=PT>Portugal</option>'
	+ '<option value=PR>Puerto Rico</option>'
	+ '<option value=QA>Qatar</option>'
	+ '<option value=RE>R&eacute;union</option>'
	+ '<option value=RO>Romania</option>'
	+ '<option value=RU>Russian Federation</option>'
	+ '<option value=RW>Rwanda</option>'
	+ '<option value=KN>Saint Kitts and Nevis</option>'
	+ '<option value=PM>Saint Pierre and Miquelon</option>'
	+ '<option value=VC>Saint Vincent and the Grenadines</option>'
	+ '<option value=SM>San Marino</option>'
	+ '<option value=SA>Saudi Arabia</option>'
	+ '<option value=SN>Senegal</option>'
	+ '<option value=SG>Singapore</option>'
	+ '<option value=SK>Slovakia</option>'
	+ '<option value=SI>Slovenia</option>'
	+ '<option value=SO>Somalia</option>'
	+ '<option value=ZA>South Africa</option>'
	+ '<option value=ES>Spain</option>'
	+ '<option value=LK>Sri Lanka</option>'
	+ '<option value=SZ>Swaziland</option>'
	+ '<option value=SE>Sweden</option>'
	+ '<option value=CH>Switzerland</option>'
	+ '<option value=TW>Taiwan</option>'
	+ '<option value=TH>Thailand</option>'
	+ '<option value=TN>Tunisia</option>'
	+ '<option value=TR>Turkey</option>'
	+ '<option value=UG>Uganda</option>'
	+ '<option value=UA>Ukraine</option>'
	+ '<option value=AE>United Arab Emirates</option>'
	+ '<option value=GB>United Kingdom</option>'
	+ '<option value=TZ>United Republic of Tanzania</option>'
	+ '<option value=UY>Uruguay</option>'
	+ '<option value=UZ>Uzbekistan</option>'
	+ '<option value=VA>Vatican City State (Holy See)</option>'
	+ '<option value=VE>Venezuela</option>'
	+ '<option value=VN>Vietnam</option>'
	+ '<option value=VG>Virgin Islands (British)</option>'
	+ '<option value=VI>Virgin Islands (U.S.)</option>'
	+ '<option value=YU>Yugoslavia</option>'
	+ '<option value=ZM>Zambia</option>'
	+ '<option value=ZW>Zimbabwe</option>'
	+ '</select>');

/* End Country Select code */


document.writeln('</td></tr><tr><td>* State/Province </td><td><select name=state class="single"><option value="" selected="selected">Please Select</option><option value=AL>Alabama</option><option value=AK>Alaska</option><option value=AB>Alberta</option><option value=AZ>Arizona</option><option value=AR>Arkansas</option><option value=BC>British Columbia</option><option value=CA>California</option><option value=CO>Colorado</option><option value=CT>Connecticut</option><option value=DE>Delaware</option><option value=DC>District of Columbia</option><option value=FL>Florida</option><option value=GA>Georgia</option><option value=HI>Hawaii</option><option value=ID>Idaho</option><option value=IL>Illinois</option><option value=IN>Indiana</option><option value=IA>Iowa</option><option value=KS>Kansas</option><option value=KY>Kentucky</option><option value=LA>Louisiana</option><option value=ME>Maine</option><option value=MB>Manitoba</option><option value=MD>Maryland</option><option value=MA>Massachusetts</option><option value=MI>Michigan</option><option value=MN>Minnesota</option><option value=MS>Mississippi</option><option value=MO>Missouri</option><option value=MT>Montana</option><option value=NE>Nebraska</option><option value=NV>Nevada</option><option value=NB>New Brunswick</option><option value=NH>New Hampshire</option><option value=NJ>New Jersey</option><option value=NM>New Mexico</option><option value=NY>New York</option><option value=NF>Newfoundland</option><option value=NC>North Carolina</option><option value=ND>North Dakota</option><option value=NT>Northwest Territories</option><option value=NS>Nova Scotia</option><option value=OH>Ohio</option><option value=OK>Oklahoma</option><option value=ON>Ontario</option><option value=OR>Oregon</option><option value=PA>Pennsylvania</option><option value=PE>Prince Edward Island</option><option value=QC>Quebec</option><option value=RI>Rhode Island</option><option value=SK>Saskatchewan</option><option value=SC>South Carolina</option><option value=SD>South Dakota</option><option value=TN>Tennessee</option><option value=TX>Texas</option><option value=UT>Utah</option><option value=VT>Vermont</option><option value=VA>Virginia</option><option value=WA>Washington</option><option value=WV>West Virginia</option><option value=WI>Wisconsin</option><option value=WY>Wyoming</option><option value=YT>Yukon Territory</option><option value=Other>Other</option></select> </td>'
+ '<tr><td>* ZIP/Postal Code </td><td><input maxLength=10 size=16 name=zip class="input_txt"></td></tr>'




+ '<tr><td>* Work Phone </td><td><input maxLength=20 size=40 name=14 class="input_txt"></td></tr>'
+ '<tr><td>* E-mail Address </td><td><input maxLength=60 size=40 name=email class="input_txt"></td></tr>'
+ '<tr><td>* E-mail Address (confirm) </td><td><input maxLength=60 size=40 name=verifyemail onblur="verifyEmails()" class="input_txt" /></td></tr>');

/* interest_in placeholder code 
if (document.form_1.interest_in == null) {
	document.writeln('<input type=hidden value=placeholder name=interest_in>');
}
*/
var dis = 0;
/* success URL for Other country */	
function successPage(){

	if ((document.form_1.iso_country.value == 'US') || (document.form_1.iso_country.value == 'CA')) {
	
	if ((document.form_1.successurl_form) && (document.form_1.successurl_form_us_ca)){	
	document.form_1.successurl_form.value = document.form_1.successurl_form_us_ca.value;
	}
		if ( dis == 1 ) {
			window.document.form_1.state.disabled = false;
			window.document.form_1.state.focus();
			dis = 0;
		}
	}	
	else {
		  window.document.form_1.state.selectedIndex = 0;
		  window.document.form_1.state.disabled = true;
		  dis = 1;
	}
}

/* Verify Emails Function */	
function verifyEmails(){
var main_email=window.document.form_1.email.value;
var second_email=window.document.form_1.verifyemail.value;

if (main_email!=second_email) {
  	alert('The email addresses you provided do not match. \n  Please re-confirm your email address.');
	window.document.form_1.email.style.backgroundColor='#cccccc';
	window.document.form_1.verifyemail.style.backgroundColor='#cccccc'
	window.document.form_1.email.focus();
  	}
  	else{
  	window.document.form_1.email.style.backgroundColor='#FFFFFF';
	window.document.form_1.verifyemail.style.backgroundColor='#FFFFFF'  }
}