document.write("			<fieldset class='fieldset'>");
document.write("				<legend>Informa&ccedil;&otilde;es necess&aacute;rias</legend>");
document.write("				<table cellpadding='0' cellspacing='$stylevar[formspacer]' border='0' width='400'>");
document.write("				  <!--  Canalmail -->");
document.write("             <tr> ");
document.write("               <td align='right' colspan='2'><a target='_blank' href='http://www.canalmail.com'><img border='0' align='texttop' src='http://promociones.canalmail.com/pruebas/canalmailpastilla.gif'/></a></td> ");
document.write("             </tr> ");
document.write("          <tr> ");
document.write("            <td ><b>Pa&iacute;s:</b></td>");
document.write("            <td > ");
document.write("              <select   name='pais' onchange='CargaProvincias()'>");
document.write("                <option value=''    >Escolha um pa&iacute;s</option>");
document.write("                <option value='' >------------------</option>");
document.write("                <option value='BRA' selected>Brasil</option>");
document.write("                <option value='' >------------------</option>");
document.write("                <option value='POR' >Portugal</option>");
document.write("                <option value='MEX' >Mexico</option>");
document.write("                <option value='ARG' >Argentina</option>");
document.write("                <option value='CHL' >Chile</option>");
document.write("                <option value='PER' >Peru</option>");
document.write("                <option value='COL' >Colombia</option>");
document.write("                <option value='VEN' >Venezuela</option>");
document.write("                <option value='' >------------------</option>");
document.write("                <option value='BOL' >Bolivia</option>");
document.write("                <option value='ESP' >Espanha</option>");
document.write("                <option value='CAB' >C.Verde</option>");
document.write("                <option value='CRI' >Costa Rica</option>");
document.write("                <option value='CUB' >Cuba</option>");
document.write("                <option value='ECU' >Ecuador</option>");
document.write("                <option value='ESA' >Salvador</option>");
document.write("                <option value='FIL' >Filipinas</option>");
document.write("                <option value='GUA' >Guatemala</option>");
document.write("                <option value='HON' >Honduras</option>");
document.write("                <option value='NIC' >Nicaragua</option>");
document.write("                <option value='PAN' >Panama</option>");
document.write("                <option value='PAR' >Paraguai</option>");
document.write("                <option value='AND' >Andorra</option>");
document.write("                <option value='PUE' >Porto Rico</option>");
document.write("                <option value='DOM' >Rep.Dom</option>");
document.write("                <option value='USA' >USA</option>");
document.write("                <option value='URU' >Uruguai</option>");
document.write("                <option value='' >------------------</option>");
document.write("                <option value='ZZZ' >Outros</option>");
document.write("              </select>");
document.write("            </td>");
document.write("          </tr>");
document.write("          <tr> ");
document.write("            <td><b>Estado:</b></td>");
document.write("            <td> ");
document.write("              <select name='provincia' id='provincia'>");
document.write("                <option value='' selected>Selecione</option>");
document.write("                <option value=''>------------------</option>");
document.write("                <option value=''>Escolha um Estado</option>");
document.write("                <option value=''>------------------</option>");
document.write("                           <option value='ACR'>Acre</option>");
document.write("                           <option value='ALA'>Alagoas</option>");
document.write("                           <option value='AMA'>Amapa</option>");
document.write("                           <option value='AZ'>Amazonas</option>");
document.write("                           <option value='BH'>Bahia</option>");
document.write("                           <option value='CEA'>Ceara</option>");
document.write("                           <option value='DF'>Distrito Federal</option>");
document.write("                           <option value='ES'>Espirito Santo</option>");
document.write("                           <option value='GL'>Goias</option>");
document.write("                           <option value='MG'>Mato Grosso</option>");
document.write("                           <option value='MGS'>Mato G. do Sul</option>");
document.write("                           <option value='MA'>Maranh&atilde;o</option>");
document.write("                           <option value='MN'>Minas Gerais</option>");
document.write("                           <option value='PAA'>Para</option>");
document.write("                           <option value='PRB'>Paraiba</option>");
document.write("                           <option value='PRN'>Parana</option>");
document.write("                           <option value='PEA'>Pernambuco</option>");
document.write("                           <option value='PI'>Piaui</option>");
document.write("                           <option value='RJ'>Rio de Janeiro</option>");
document.write("                           <option value='RG'>Rio Grande do Norte</option>");
document.write("                           <option value='RGS'>Rio Grande do Sul</option>");
document.write("                           <option value='RO'>Rondonia</option>");
document.write("                           <option value='ROR'>Roraima</option>");
document.write("                           <option value='STC'>Santa Catarina</option>");
document.write("                           <option value='SPA'>Sao Paulo</option>");
document.write("                           <option value='SER'>Sergipe</option>");
document.write("                           <option value='TOC'>Tocantins</option>");
document.write("              </select>");
document.write("            </td>");
document.write("          </tr>");
document.write("          <tr> ");
document.write("            <td ><b>CEP:</b></td>");
document.write("            <td > ");
document.write("              <input type='text' name='cp' size='10' maxlength='8' />");
document.write("            </td>");
document.write("          </tr>");
document.write("          <tr> ");
document.write("            <td><b>Celular:</b></td>");
document.write("            <td> ");
document.write("              <input type='text' name='movil' size='10' maxlength='12' />");
document.write("            </td>");
document.write("          </tr>");
document.write("          ");
document.write("          <tr> ");
document.write("            <td ><b>Idade:</b></td>");
document.write("            <td > ");
document.write("              <select name='fec_ncto'>");
document.write(" 						  <option value='' >Selecione</option>");
document.write("						  <option value='01-01-1990' >Posterior a 1990</option>");
document.write("						  <option value='01-01-1989' >1989</option>");
document.write("					");
document.write("						  <option value='01-01-1988' >1988</option>");
document.write("						  <option value='01-01-1987' >1987 </option>");
document.write("						  <option value='01-01-1986' >1986 </option>");
document.write("						  <option value='01-01-1985' >1985  </option>");
document.write("						  <option value='01-01-1984' >1984 </option>");
document.write("						  <option value='01-01-1983' >1983 </option>");
document.write("					");
document.write("						  <option value='01-01-1982' >1982 </option>");
document.write("						  <option value='01-01-1981' >1981 </option>");
document.write("						  <option value='01-01-1980' >1980 </option>");
document.write("						  <option value='01-01-1979' >1979 </option>");
document.write("						  <option value='01-01-1978' >1978 </option>");
document.write("						  <option value='01-01-1977' >1977 </option>");
document.write("					");
document.write("						  <option value='01-01-1976' >1976 </option>");
document.write("						  <option value='01-01-1975' >1975 </option>");
document.write("						  <option value='01-01-1974' >1974 </option>");
document.write("						  <option value='01-01-1973' >1973 </option>");
document.write("						  <option value='01-01-1972' >1972 </option>");
document.write("						  <option value='01-01-1971' >1971 </option>");
document.write("					");
document.write("						  <option value='01-01-1970' >1970 </option>");
document.write("						  <option value='01-01-1969' >1969 </option>");
document.write("						  <option value='01-01-1968' >1968 </option>");
document.write("						  <option value='01-01-1967' >1967 </option>");
document.write("						  <option value='01-01-1966' >1966 </option>");
document.write("						  <option value='01-01-1965' >1965 </option>");
document.write("					");
document.write("						  <option value='01-01-1964' >1964 </option>");
document.write("						  <option value='01-01-1963' >1963 </option>");
document.write("						  <option value='01-01-1962' >1962 </option>");
document.write("						  <option value='01-01-1961' >1961 </option>");
document.write("						  <option value='01-01-1960' >1960 </option>");
document.write("						  <option value='01-01-1959' >1959 </option>");
document.write("					");
document.write("						  <option value='01-01-1958' >1958 </option>");
document.write("						  <option value='01-01-1957' >1957 </option>");
document.write("						  <option value='01-01-1956' >1956 </option>");
document.write("						  <option value='01-01-1955' >1955 </option>");
document.write("						  <option value='01-01-1954' >1954 </option>");
document.write("						  <option value='01-01-1953' >1953 </option>");
document.write("					");
document.write("						  <option value='01-01-1952' >1952 </option>");
document.write("						  <option value='01-01-1951' >1951 </option>");
document.write("						  <option value='01-01-1950' >1950 </option>");
document.write("						  <option value='01-01-1949' >1949 </option>");
document.write("						  <option value='01-01-1948' >1948 </option>");
document.write("						  <option value='01-01-1947' >1947 </option>");
document.write("					");
document.write("						  <option value='01-01-1946' >1946 </option>");
document.write("						  <option value='01-01-1945' >1945 </option>");
document.write("						  <option value='01-01-1944' >1944 </option>");
document.write("						  <option value='01-01-1943' >1943 </option>");
document.write("						  <option value='01-01-1942' >1942 </option>");
document.write("						  <option value='01-01-1941' >Anterior a 1941 </option>");
document.write("              </select>");
document.write("            </td>");
document.write("          </tr>");
document.write("          <tr valign='top'>");
document.write("		<td><b> Sexo:</b> </td>");
document.write("	        <td>");
document.write("             <select name='sexo' >");
document.write("               <option value='' >Selecione</option>");
document.write("               <option value='H' >Masculino</option>");
document.write("               <option value='M' >Feminino </option>");
document.write("             </select>");
document.write("	        </td>");
document.write("	  </tr>");
document.write("          <tr> ");
document.write("            <td ><b>Area:</b></td>");
document.write("            <td > ");
document.write("              <select name='sector' >");
document.write("				 <option value='' selected>Selecione</option>");
document.write("         <option value='15'>Publicidade/Comunica&ccedil;&otilde;es</option>");
document.write(" 				 <option value='2'>Inform&aacute;tica (IS, MIS, DP)</option>");
document.write("         <option value='3'>Inform&aacute;tica (Internet)</option>");
document.write("         <option value='4'>Inform&aacute;tica (Desenv.de Software)</option>");
document.write("         <option value='5'>Consultoria</option>");
document.write("         <option value='6'>Educa&ccedil;&atilde;o</option>");
document.write("         <option value='7'>Arquitectura/Constru&ccedil;&atilde;o</option>");
document.write("         <option value='7'>Engenharia</option>");
document.write("         <option value='8'>Governo/Ex&eacute;rcito</option>");
document.write("         <option value='9'>Servi&ccedil;os Jur&iacute;dicos</option>");
document.write("         <option value='10'>Produ&ccedil;&atilde;o/Fabrica&ccedil;&atilde;o</option>");
document.write("         <option value='11'>Servi&ccedil;os M&eacute;dicos</option>");
document.write("         <option value='12'>Investiga&ccedil;&atilde;o e Desenvolvimento</option>");
document.write("         <option value='13'>Vendas/Com&eacute;rcio</option>");
document.write("         <option value='1'>Contabilidade e Finan&ccedil;as</option>");
document.write("         <option value='14'>Outros</option>");
document.write("              </select>");
document.write("            </td>");
document.write("          </tr>");
document.write("          <tr> ");
document.write("            <td ><b>Ocupa&ccedil;&atilde;o:</b></td>");
document.write("            <td > ");
document.write("              <select name='ocupacion'>");
document.write("   		<option value='' selected>Selecione</option>");
document.write("		<option value='5'>Do Lar</option>");
document.write("        	<option value='6'>Estudante / Universit&aacute;rio</option>");
document.write("        	<option value='1'>Executivo / Empres&aacute;rio</option>");
document.write("        	<option value='3'>Estagi&aacute;rio</option>");
document.write("        	<option value='12'>Profissional liberal/Aut&oacute;nomo</option>");
document.write("		<option value='9'>Funcion&aacute;rio Registrado</option>");
document.write("              </select>");
document.write("            </td>");
document.write("          </tr>");
document.write("          <tr> ");
document.write("            <td ><b>&Aacute;reas de Interesse:</b></td>");
document.write("          </tr>");
document.write("          <tr> ");
document.write("            <td  colspan='2'>");
document.write(" <table width='580' border='0' cellpadding='0' cellspacing='0' align='center' >");
document.write("                 <tr>");
document.write(" <td height='22' valign='top' width='78'><font face='Arial, Helvetica, sans-serif' ><font size='1'><font size='1'><font size='1'><font size='1'><font size='2'><b>");
document.write("       <input type='checkbox' checked='checked' name='listas' value='17' >");
document.write("       <a name='1'><b><font size='1'>Alimentos e Bebidas</font></b></a></b></font></font><font size='2'><b>");
document.write("       </b></font></font></font></font></font></td>");
document.write("     <td valign='top' width='83'><font face='Arial, Helvetica, sans-serif' ><font size='1'>");
document.write("       <font size='2'><b>");
document.write("       <input type='checkbox' checked='checked' name='listas' value='41' >");
document.write("       <a name='8'><b><font size='1'>Automotivo</font></b></a></b></font></font></font></td>");
document.write("     <td valign='top' width='90'><font face='Arial, Helvetica, sans-serif' ><font size='1'>");
document.write("       <font size='2'><b>");
document.write("       <input type='checkbox' name='listas' value='25'  >");
document.write("       <a name='30'><b><font size='1'>Conte&uacute;do Feminino</font></b></a></b></font></font></font></td>");
document.write("     <td valign='top' width='105'><font face='Arial, Helvetica, sans-serif' ><font size='1'><font size='2'><b>");
document.write("       <input type='checkbox' name='listas' value='690'  >");
document.write("       <a name='90'><b><font size='1'>Conte&uacute;do Masculino</font></b></a></b></font></font></font></td>");
document.write("   </tr>");
document.write("   <tr>");
document.write("     <td height='22' valign='top' width='78'><font face='Arial, Helvetica, sans-serif' ><font size='1'><font size='2'><b>");
document.write("       <input type='checkbox' name='listas' value='9'  >");
document.write("       <a name='41'><b><font size='1'>Esportes e Lazer</font></b></a></b></font></font></font></td>");
document.write("     <td valign='top' width='83'><font face='Arial, Helvetica, sans-serif' ><font size='1'>");
document.write("       <font size='1'><font size='2'><b>");
document.write("       <input type='checkbox' name='listas' value='30'  >");
document.write("       <a name='7'><b><font size='1'>Neg&oacute;cios e Finan&ccedil;as</font></b></a></b></font></font><font size='2'><b>");
document.write("       </b></font></font></font></td>");
document.write("     <td valign='top' width='90'><font face='Arial, Helvetica, sans-serif' ><font size='1'>");
document.write("       <font size='1'><font size='2'><b> <font size='1'>");
document.write("       <input type='checkbox' name='listas' value='5' >");
document.write("       <a name='2418' ></a>Sa&uacute;de/Beleza/Bem Estar</font></b></font></font></font></font></td>");
document.write("     <td valign='top' width='105'><font face='Arial, Helvetica, sans-serif' ><font size='1'><font size='2'><b>");
document.write("       <input type='checkbox' name='listas' value='1133'  >");
document.write("       <a name='9'><b><font size='1'>Tecnologia e Inform&aacute;tica</font></b></a></b></font></font></font></td>");
document.write("   </tr>");
document.write("   <tr>");
document.write("     <td height='22' valign='top' width='78'><font face='Arial, Helvetica, sans-serif' ><font size='1'><font size='2'><b>");
document.write("       <input type='checkbox' name='listas' value='691'  >");
document.write("       <a name='13'><b><font size='1'>Bebe & Cia</font></b></a></b></font></font></font></td>");
document.write("     <td valign='top' width='83'><font face='Arial, Helvetica, sans-serif' ><font size='1'>");
document.write("       <font size='2'><b>");
document.write("       <input type='checkbox' name='listas' value='1164'  >");
document.write("       <a name='690'><b><font size='1'>Casa e Jardim</font></b></a></b></font></font></font></td>");
document.write("     <td valign='top' width='90'><font face='Arial, Helvetica, sans-serif' ><font size='1'>");
document.write("       <font size='2'><b>");
document.write("       <input type='checkbox' name='listas' value='13'  >");
document.write("       <a name='11'><b><font size='1'>Emprego e Forma&ccedil;&atilde;o</font></b></a></b></font></font></font></td>");
document.write("     <td valign='top' width='105'><font face='Arial, Helvetica, sans-serif' ><font size='1'><font size='2'><b>");
document.write("       <input type='checkbox' checked='checked' name='listas' value='8' >");
document.write("       <a name='1133'><b><font size='1'>Entretenimento</font></b></a></b></font></font></font></td>");
document.write("   </tr>");
document.write("   <tr >");
document.write("     <td height='22' valign='top' width='78'><font face='Arial, Helvetica, sans-serif' ><font size='1'><font size='2'><b>");
document.write("       <input type='checkbox' name='listas' value='2420'  >");
document.write("       <a name='691'><b><font size='1'>Not&iacute;cias</font></b></a></b></font></font></font></td>");
document.write("     <td valign='top' width='83'><font face='Arial, Helvetica, sans-serif' ><font size='1'>");
document.write("       <font size='2'><b>");
document.write("       <input type='checkbox' name='listas' value='1165'  >");
document.write("       <a name='5'><b><font size='1'>Ofertas e Promo&ccedil;&otilde;es</font></b></a></b></font></font></font></td>");
document.write("     <td valign='top' width='90'><font face='Arial, Helvetica, sans-serif' ><font size='1'>");
document.write("       <font size='1'><font size='2'><b> ");
document.write("      <input type='checkbox' name='listas' value='1150'  >");
document.write(" <a name='692'><b><font size='1'>Telefonia & Celular</font></b></a></b></font></font>");
document.write(" </font></font></td>");
document.write(" <td valign='top' width='105'><font face='Arial, Helvetica, sans-serif' ><font size='1'><font size='2'><b>");
document.write(" <input type='checkbox' checked='checked' name='listas' value='11'  >");
document.write(" <a name='2420'><b><font size='1'>Viagem e Turismo</font></b></a></b></font></font></font></td>");
document.write(" </tr>");
document.write(" </table>");
document.write("            </td>");
document.write("          </tr>");
document.write("          </table>");
document.write("</fieldset>");

