document.write("<form name=\"myform\" method=\"post\" action=\"http://www.bandcentric.net/rss/optin/frm_submitsubscription_leki.asp\" onSubmit='return submitmyform(this)'><table border=\"0\" cellspacing=\"0\" cellpadding=\"0\"><tr><td width=\"400\" align=\"right\"><span class=\"BC_optin_text\">Join the Leki World&nbsp;</span><span class=\"BC_optin_text\"></span></td><td align=\"left\"><input name=\"sExplFirstname\" type=\"text\" class=\"BC_optin_input\" id=\"sExplFirstname\" size=\"20\" maxlength=\"200\" value=\"\"><br/><span class=\"BC_optin_text\"></span><input name=\"sExplLastname\" type=\"text\" class=\"BC_optin_input\" id=\"sExplLastname\" size=\"25\" maxlength=\"200\" value=\"\"></td></tr><tr><td class=\"BC_optin_text\" align=\"right\"></td><td align=\"left\"><input name=\"sExplEmail\" type=\"text\" class=\"BC_optin_input\" id=\"sExplEmail\" size=\"35\" maxlength=\"200\" value=\"\"><br/><input name=\"Submit\" type=\"submit\" class=\"BC_optin_button\" value=\"send\"></td></tr></table><input type=\"hidden\" name=\"sband\" value=\"leki\"><input type=\"hidden\" name=\"sRedirectURL\" value=\"\"></form>")