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document.write('  <table align="center">');
document.write('    <tr>');
document.write('      <td colspan="2"><b>&quot;Newsletterservice des LSM&quot;');
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document.write('Bitte senden Sie mir die aktuellen');
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document.write('bis auf Widerruf automatisch zu.</b></td>');
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document.write('      <td colspan="2">die mit * gekennzeichneten Felder müssen ausgefüllt werden</td>');
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document.write('    <tr>');
document.write('      <td>Vorname, Name *</td>');
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document.write('        <input type="text" name="user_input[id4]" value="" size="40">');
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document.write('      <td>Meine E-Mail *</td>');
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document.write('        <input type="text" name="email" value="" size="40">');
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document.write('          <option value="0">LSM');
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document.write('          <option value="1">BSM');
document.write('</option>');
document.write('          <option value="2">BLV');
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document.write('          <option value="3">Andere');
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document.write('          <option value="4">Nein</option>');
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document.write('      <td>Hinweis:<br>Diese Angabe ist nur für unsere Statistik');
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document.write('Newsletter erhalten Sie auch als Nichtmitglied</td>');
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document.write('    <tr>');
document.write('      <td colspan="2" align="center" valign="middle">');
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document.write('      <td colspan="2" align="center"><font size="-2">Powered by <a href="http://www.onetwomax.de" target="_blank">OneTwoMax</a> Newsletter Script</font></td>');
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