document.write('<form name="Membership" action="../cgi-bin/FormMail_mem.pl" method="post" style="font-size:0.95em;">');
document.write('<input type="hidden" name="recipient" value="saen@nfld.com">');
document.write('<input type="hidden" name="subject" value="SAEN Membership or Contribution">');
document.write('<input type="hidden" name="redirect" value="http://www.saen.org/redirect.html">');
document.write('<input type="hidden" name="required" value="realname, email, Address, CityProv, PostalCode, HomePhone">');
document.write('<input type="hidden" name="print_blank_fields" value="1">');
document.write('<input type="hidden" name="env_report" value="REMOTE_HOST,REMOTE_ADDR,HTTP_USER_AGENT,HTTP_REFERER">');
document.write('<input type="hidden" name="missing_fields_redirect" value="http://www.saen.org/error.html">');
document.write(' ');
document.write('<p>Please complete the form below to become a member of S.A.E.N or to make a separate contribution. We will be in');
document.write('touch with you shortly to make arrangements for your payment.</p>');
document.write(' ');
document.write('<table>');
document.write('<tr><td>Name:</td><td><input class="formstyle" type="text" name="realname" value="" size="12"></TD></TR>');
document.write('<tr><td>Address:</td><td><input class="formstyle" type="TEXT" name="Address" value="" size="12"></TD></TR>');
document.write('<tr><td>City, Prov:</td><td><input class="formstyle" type="TEXT" name="CityProv" value="" size="12"></TD></TR>');
document.write('<tr><td>Postal Code:</td><td><input class="formstyle" type="TEXT" name="PostalCode" value="" size="12"></TD></TR>');
document.write('<tr><td>Home Phone:</td><td><input class="formstyle" type="TEXT" name="HomePhone" value="" size="12"></TD></TR>');
document.write('<tr><td>Work Phone:</td><td><input class="formstyle" type="TEXT" name="WorkPhone" value="" size="12"></TD></TR>');
document.write('<tr><td>E-mail:</td><td><input class="formstyle" type="TEXT" name="email" value="" size="12"></TD></TR>');
document.write('<tr><td colspan=2><I>Do you want to receive all correspondence via email (i.e. newsletters, notice, etc.) Please indicate below.</I></td></tr>');
document.write('<tr><td colspan=2 align=center><INPUT TYPE=RADIO NAME="Correspondence" VALUE="Yes">&nbsp; Yes &nbsp; &nbsp; ');
document.write('                   <INPUT TYPE=RADIO NAME="Correspondence" VALUE="No">  No</td></tr>');
document.write('<tr><td colspan=2>&nbsp;</td></tr>');
document.write('<tr valign="top"><td>Membership:</td><td><input type="RADIO" name="Membership" value="Basic $20">Basic ($20)<br>');
document.write('<input type="radio" name="Membership" value="Corporate $50">Corporate ($50)</TD></TR>');
document.write('<tr valign="top"><td>or Contribute:</td><td><input type="CHECKBOX" name="Contribution" value="Yes">Additional Contribution:<br>');
document.write('Amount: <input class="formstyle" style="width:90px;" type="text" name="Additional Contribution:" value="" size="9"></TD></TR>');
document.write('<tr><td><input type="submit" name="submit" value="A Pledge to SAEN" ID="FormsButton3"></TD>');
document.write('<TD><input type="reset" name="Reset" value="Reset Form" id="FormsButton4"></TD></TR>');
document.write('</table>');
document.write('</form>');