//<script type="text/javascript" language="javascript">

	document.writeln('	<fieldset>');
	document.writeln('		<legend></legend>');
	
		document.writeln('	<form name="customForm30693" action="/CustomFormProcess.asp" method="post" onsubmit="return ValidateCustomForm(this,0)">');
		document.writeln('  <input type="hidden" name="Title" value="Hot 8 @ 8 " />');
		document.writeln('	<input type="hidden" name="ID" value="30693" />');
		document.writeln('	<input type="hidden" name="nConfirmationNum" value="561" />');
		document.writeln('	<input type="hidden" name="NumQuestions" value="2" />');
	
	

//</script>


		document.writeln('		<div class="formRow">');
		document.write('			<label for="Question0answer" style="margin-top:0px;" >Song Title');
		
		document.write('</label>\r\n');
		document.writeln('			<input type="hidden" name="Question0" value="Song Title" />');
		document.writeln('			<input type="hidden" name="QuestionRequired0" value="0" />');
		
	document.writeln('		<input class="textbox medium" type="text" name="Question0answer" id="Question0answer" value="" />');document.writeln('		</div>');
		document.writeln('		<div class="formRow">');
		document.write('			<label for="Question1answer" style="margin-top:0px;" >Artist');
		
		document.write('</label>\r\n');
		document.writeln('			<input type="hidden" name="Question1" value="Artist" />');
		document.writeln('			<input type="hidden" name="QuestionRequired1" value="0" />');
		
	document.writeln('		<input class="textbox medium" type="text" name="Question1answer" id="Question1answer" value="" />');document.writeln('		</div>');
		document.writeln('		<div class="formRow">');
		document.write('			<label for="Question2answer" style="margin-top:0px;" >Shout Out');
		
		document.write('</label>\r\n');
		document.writeln('			<input type="hidden" name="Question2" value="Shout Out" />');
		document.writeln('			<input type="hidden" name="QuestionRequired2" value="0" />');
		
	document.writeln('		<textarea name="Question2answer" id="Question2answer" rows="5" cols="30" class="medium"></textarea>');document.writeln('		</div>');
			//document.writeln('		<div class="formRow">');
			//document.writeln('			<p>Log-in to HOT 106 and you can have forms like this filled out for you.');
			//document.writeln('			To join HOT 106, just fill out the information below.</p>');
			//document.writeln('		</div>');
		
			
			document.writeln('		<div class="formRow">');
			document.writeln('			<input type="checkbox" checked="checked" name="bJoinClub" value="yes" id="yesClub" />');
			document.writeln('			<label for="yesClub" class="inline">It is ok for Hot 106, #1 for hip-hop to email me periodically.</label>');
			document.writeln('		</div>');

			
			document.writeln('		<div class="formRow">');
			document.writeln('			<input type="checkbox" checked="checked" name="nMailType" value="1" id="yesHTML" />');
			document.writeln('			<label for="yesHTML" class="inline">Send email in HTML format (when available)</label>');
			document.writeln('		</div>');
	
		document.writeln('		<div class="formRow">');
document.writeln('			<!--Separator--><img src="/images/trans.gif" height="10" width="1" border="0" />');
document.writeln('		</div>');
document.writeln('	<div class="formRow">');document.write('		<label for="FirstName">First Name:');document.write(' <span class="Headline">*</span>');document.write('</label>\r\n');document.writeln('		<input class="textbox medium" type="text" name="FirstName" id="FirstName" maxlength="50" />');document.writeln('	</div>');document.writeln('	<div class="formRow">');document.write('		<label for="LastName">Last Name:');document.write(' <span class="Headline">*</span><input type="hidden" name="NameRequired" value="" />');document.write('</label>\r\n');document.writeln('		<input class="textbox medium" type="text" name="LastName" id="LastName" maxlength="50" />');document.writeln('	</div>');document.writeln('	<div class="formRow">');document.write('		<label for="City">City:');document.write(' <span class="Headline">*</span><input type="hidden" name="CityRequired" value="" />');document.write('</label>\r\n');document.writeln('		<input class="textbox medium" type="text" name="City" id="City" maxlength="50" />');document.writeln('	</div>');document.writeln('	<div class="formRow">');document.writeln('	<label for="txtUFCaptchaUserCode">Validation Code</label>');document.writeln('	<img id="imgCaptcha" name="imgCaptcha" src="http://captcha.fimc.net/JpegImage.aspx?code=9DFBC93483C646018FFE57089D86EEA4" />');document.writeln('	</div>');document.writeln('	<div class="formRow" title="You must enter the validation code above to submit this event. The code is case insensitive.">');document.writeln('	<label for="txtUFCaptchaUserCode">Enter Validation Code*</label>');document.writeln('	<input type="text" name="txtUFCaptchaUserCode" id="txtUFCaptchaUserCode" maxlength="20" class="textbox medium" />');document.writeln('	<input type="hidden" name="hdnUFCaptchaLookupKey" value="9DFBC93483C646018FFE57089D86EEA4" />');document.writeln('	<input type="hidden" name="txtUserShouldEnterCustom" value="6M732" />');
document.writeln('	</div>');document.writeln('		<div id="formRowSubmit">');document.writeln('		<p class="Headline">* Required Fields.</p>');document.writeln('			<input type="submit" name="Submit" id="Submit" value="Submit" />');document.writeln('		</div>');document.writeln('	</fieldset>');document.writeln('	</form>');