RedStar = "<font size=\"-2\" color=\"red\"><b>* </b></font>";
f99 = "<font color=\"#990000\">";
f99x = "</font>";
TR1  = "<tr>";
TR2  = "</tr>";
TD1  = "<td>";
TDR1 = "<td align=\"right\" valign=\"top\">";
TD2  = "</td>";

document.writeln('<blockquote>');
document.writeln('<table>');
document.writeln('<form name="myForm" method="POST" action="guestbook.cgi">');

document.writeln(TR1,TDR1,RedStar,f99,'Name:',f99x,TD2);
document.writeln(TD1,'<input type="text" name="realname" size="30" maxlength="60">',TD2,TR2);

document.writeln(TR1,TDR1,'Email (optional):',TD2);
document.writeln(TD1,'<input type="text" name="username" size="40" maxlength="60">',' (We will not post or distribute your email address.)',TD2,TR2);

document.writeln(TR1,TDR1,'Occupation:',TD2);
document.writeln(TD1,'<select name="occupation" size="1">');
document.writeln('<option value="None Selected" selected>Pick One ---></option>');
document.writeln('<option value="Student">Student</option>');
document.writeln('<option value="Teacher">Teacher</option>');
document.writeln('<option value="Scientist">Scientist</option>');
document.writeln('<option value="Fisherman-Boater">Fisherman/Boater</option>');
document.writeln('<option value="Hobbyist">Hobbyist</option>');
document.writeln('<option value="Other">Other</option>');
document.writeln('</select>',TD2,TR2);

document.writeln(TR1,TDR1,'School / Lab / Company:',TD2);
document.writeln(TD1,'<input type="text" name="school" size="50" maxlength="60">',TD2,TR2);

document.writeln(TR1,TDR1,'City:',TD2);
document.writeln(TD1,'<input type="text" name="city" size="15" maxlength="60">',TD2,TR2);

document.writeln(TR1,TDR1,'State:',TD2);
document.writeln(TD1,'<input type="text" name="state" size="2" maxlength="15">',TD2,TR2);

document.writeln(TR1,TDR1,'Country:',TD2);
document.writeln(TD1,'<input type="text" name="country" size="15" value="USA" maxlength="15">',TD2,TR2);

// Captcha gimpy
document.writeln(TR1,TDR1,f99,'Code:',f99x,TD2);
document.writeln(TD1,'<img src="captcha.cgi">',TD2,TR2);
document.writeln(TR1,TDR1,RedStar,f99,'Verify:',f99x,TD2);
document.writeln(TD1,'<input type="text" name="verify" size="6" maxlength="6">','&nbsp;&nbsp;(Enter the values you see in the Code above.)',TD2,TR2);

document.writeln(TR1,TDR1,RedStar,f99,'Comments:',f99x,TD2);
document.writeln(TD1,'<textarea name="comments" cols="60" rows="4" wrap="virtual"></textarea>',TD2,TR2);

document.writeln(TR1,TDR1,TD2);
document.writeln(TD1,'<input type="hidden" name="hello" value="',document.referrer,'">',TD2,TR2);

document.writeln(TR1,TDR1,TD2);
document.writeln(TD1,'<input type="submit"> <input type="reset">',TD2,TR2);

document.writeln('</form>');
document.writeln('</table>');
document.writeln(RedStar,' are required fields.');
document.writeln('</blockquote>');