document.write('<form id=form name=form method=post action=http://www.cityy.cn/vip/bm_add.asp onSubmit=javascript:return checktheform();>');document.write('<table width="100%" border="0" align="center" cellpadding="0" cellspacing="0" bgcolor="#E7EEFB" style="margin-bottom:5px;border:1px solid #E7EEFB;">');document.write('<tr><td height="34" background="http://www.cityy.cn/images/bmkc.png"><div align="left" style="margin-left:130px; text-align:right; color="blue""><a title="服务时间：早9:00到晚18:00,敬请来电。">如遇问题请咨询：0755-83692700</a></div></td>');document.write('</tr>');document.write('<tr><td height="26"><div align="right">');document.write('	<table width="100%"  border="0" cellpadding="1" cellspacing="1">');document.write('		<tr>');document.write('			<td height="25" colspan="2">');document.write('			<div align="center" class="STYLE3">');document.write('<span>【预约登门】<input type="radio" name="lei" value="预约登门" /></span>');document.write('<span>【网上咨询】<input type="radio" name="lei" value="网上咨询" /></span>');document.write('<span>【订座试听】<input type="radio" name="lei" value=订座试听" /></span>');document.write('<span>【现在报名】<input type="radio" name="lei" value="现在报名" checked="checked"/></span>');document.write('</div></td>');document.write('</tr>');document.write('<tr>');document.write('<td width="17%"><div align="center" class="STYLE3"><strong>课程名称</strong></div></td>');document.write('<td height="25" class="linkRed02"><div align=left class=STYLE3>鏂颁笢鏂规捣澶栫敓瀛樼敓娲荤瘒璧拌鐝紙鐣欏琛屽墠棰勫钀ワ級</div></td>');document.write('</tr>');document.write('<tr>');document.write('<td width="17%"><div align="center" class="STYLE3"><strong>真实姓名</strong></div></td>');document.write('<td height="25"><div align="left">');document.write('<input name="name" type="text" id="name" size="18" />');document.write('<span class="style8">*</span><span class="STYLE3"> 性 别');document.write('<label> : 男');document.write('<input name="sex" type="radio" value="1" checked="checked" />');document.write('</label>');document.write('女');document.write('<input type="radio" name="sex" value="2" />');document.write('<input type="hidden" name="course_id" value="93727"/>');document.write('<input type="hidden" name="flag" value="0"/>');document.write('<input type="hidden" name="cname" value="szxdf"/>');document.write('</span></div></td>');document.write('</tr>');document.write('<tr>');document.write('<td class="STYLE3"><div align="center"><strong>联系电话</strong></div></td>');document.write('<td height="25"><div align=left>');document.write('<input name="tel" type="text" id="tel" size=18 />');document.write('<span class="STYLE3">* Ｅ-mail:');document.write('<input name="email" type="text" id="email" size="24" maxlength="40" />');document.write('</span> </div></td></tr>');document.write('<tr>');document.write('<td valign="top" class="STYLE3"><div align="center"><strong>所在地区</strong></div></td>');document.write('<td><div align="left"> <span class="STYLE3">');document.write('<input name="diqu" type="text" id="diqu" size="18" />');document.write('</span></div></td>');document.write('</tr>');document.write('<tr>');document.write('<td valign="top" class="STYLE3"><div align="center"><strong>咨询内容</strong></div></td>');document.write('<td><div align="left">');document.write('<textarea name="content" cols="52" rows="4" id="content"></textarea>');document.write('</div></td>');document.write('</tr>');document.write('<tr>');document.write('<td></td>');document.write('<td height="20"><div align="left">');document.write('<input type="submit" name="" value="提  交  信  息" />');document.write('</div></td>');document.write('</tr>');document.write('</table>');document.write('<br />');document.write('</div></td>');document.write('</tr>');document.write('</table>');document.write('</form>');