document.write(" <table width='100%' border='0' cellspacing='3' cellpadding='2'> ");
document.write("   <tr> ");
document.write("     <td align='center' colspan='2'><a target='_blank' href='http://www.canalmail.com.br'><img border='0' align='texttop' src='http://promociones.canalmail.com/pruebas/canalmailpastilla.gif'/></a></td> ");
document.write("   </tr> ");
document.write("   <tr> ");
document.write(" <table>");
document.write("     <td><label>Pa&iacute;s<br/> ");
document.write("         <select class='input' name='pais' onchange='CargaProvincias()' style='border: 1px solid rgb(221, 221, 221); background-color: rgb(251, 251, 251); color: rgb(85, 85, 85);'> ");
document.write("           <option selected='' value=''>Selecione</option> ");
document.write("           <option value=''>------------------</option> ");
document.write("           <option value='BRA'>Brasil</option> ");
document.write("           <option value=''>------------------</option> ");
document.write("           <option value='POR'>Portugal</option> ");
document.write("           <option value='ESP'>Espanha</option> ");
document.write("           <option value='MEX'>M&eacute;xico</option> ");
document.write("           <option value='ARG'>Argentina</option> ");
document.write("           <option value='CHL'>Chile</option> ");
document.write("           <option value='PER'>Per&uacute;</option> ");
document.write("           <option value='COL'>Col&ocirc;mbia</option> ");
document.write("           <option value='VEN'>Venezuela</option> ");
document.write("           <option value=''>------------------</option> ");
document.write("           <option value='BOL'>Bol&iacute;via</option> ");
document.write("           <option value='BRA'>Brasil</option> ");
document.write("           <option value='CAB'>Cabo Verde</option> ");
document.write("           <option value='CRI'>Costa Rica</option> ");
document.write("           <option value='CUB'>Cuba</option> ");
document.write("           <option value='ECU'>Equador</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'>Nicar&aacute;gua</option> ");
document.write("           <option value='PAN'>Panam&aacute;</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("      </label></td> ");
document.write("  </tr> ");
document.write("  <tr> ");
document.write("    <td><label>Estado<br/> ");
document.write("        <select class='input' name='provincia' id='provincia' style='border: 1px solid rgb(221, 221, 221); background-color: rgb(251, 251, 251); color: rgb(85, 85, 85);'> ");
document.write("          <option value=''>Selecione</option> ");
document.write("          <option value=''>------------------</option> ");
document.write("        </select> ");
document.write("     </label></td> ");
document.write("  </tr> ");
document.write("  <tr> ");
document.write("    <td><p> ");
document.write("        <label>CEP<br/> ");
document.write("          <input type='text' maxlength='60' size='20' name='cp'  /> ");
document.write("           <a onclick=\"window.open('http://includes.canalmail.com/bra/busca_cep.htm', '', 'STATUS=NO, TOOLBAR=NO, LOCATION=NO, DIRECTORIES=NO, RESISABLE=NO, SCROLLBARS=YES, TOP=50, LEFT=50, WIDTH=360, HEIGHT=320');\" style='cursor: pointer;'><b>N&atilde;o sei o CEP</b></a></td> ");
document.write("        </label> ");
document.write("      </p></td> ");
document.write("  </tr> ");
document.write("  <tr> ");
document.write("    <td><p> ");
document.write("        <label>Celular<br/> ");
document.write("          <input type='text' maxlength='12' size='20' name='movil' /> ");
document.write("        </label> ");
document.write("      </p></td> ");
document.write("  </tr> ");
document.write("  <tr> ");
document.write("    <td><p> ");
document.write("        <label>Idade<br/> ");
document.write("          <select class='input' name='fec_ncto' style='border: 1px solid rgb(221, 221, 221); background-color: rgb(251, 251, 251); color: rgb(85, 85, 85);'> ");
document.write("            <option value=''>Selecione</option> ");
document.write("            <option value='01-01-1946'>Maior de 62</option> ");
document.write("            <option value='01-01-1947'>62</option> ");
document.write("            <option value='01-01-1948'>61</option> ");
document.write("            <option value='01-01-1949'>60</option> ");
document.write("            <option value='01-01-1950'>59</option> ");
document.write("            <option value='01-01-1951'>58</option> ");
document.write("            <option value='01-01-1952'>57</option> ");
document.write("            <option value='01-01-1953'>56</option> ");
document.write("            <option value='01-01-1954'>55</option> ");
document.write("            <option value='01-01-1955'>54</option> ");
document.write("            <option value='01-01-1956'>53</option> ");
document.write("            <option value='01-01-1957'>52</option> ");
document.write("            <option value='01-01-1958'>51</option> ");
document.write("            <option value='01-01-1959'>50</option> ");
document.write("            <option value='01-01-1960'>49</option> ");
document.write("            <option value='01-01-1961'>48</option> ");
document.write("            <option value='01-01-1962'>47</option> ");
document.write("            <option value='01-01-1963'>46</option> ");
document.write("            <option value='01-01-1964'>45</option> ");
document.write("            <option value='01-01-1965'>44</option> ");
document.write("            <option value='01-01-1966'>43</option> ");
document.write("            <option value='01-01-1967'>42</option> ");
document.write("            <option value='01-01-1968'>41</option> ");
document.write("            <option value='01-01-1969'>40</option> ");
document.write("            <option value='01-01-1970'>39</option> ");
document.write("            <option value='01-01-1971'>38</option> ");
document.write("            <option value='01-01-1972'>37</option> ");
document.write("            <option value='01-01-1973'>36</option> ");
document.write("            <option value='01-01-1974'>35</option> ");
document.write("            <option value='01-01-1975'>34</option> ");
document.write("            <option value='01-01-1976'>33</option> ");
document.write("            <option value='01-01-1977'>32</option> ");
document.write("            <option value='01-01-1978'>31</option> ");
document.write("            <option value='01-01-1979'>30</option> ");
document.write("            <option value='01-01-1980'>29</option> ");
document.write("            <option value='01-01-1981'>28</option> ");
document.write("            <option value='01-01-1982'>27</option> ");
document.write("            <option value='01-01-1983'>26</option> ");
document.write("            <option value='01-01-1984'>25</option> ");
document.write("            <option value='01-01-1985'>24</option> ");
document.write("            <option value='01-01-1986'>23</option> ");
document.write("            <option value='01-01-1987'>22</option> ");
document.write("            <option value='01-01-1988'>21</option> ");
document.write("            <option value='01-01-1989'>20</option> ");
document.write("            <option value='01-01-1990'>19</option> ");
document.write("            <option value='01-01-1991'>18</option> ");
document.write("            <option value='01-01-1992'>17</option> ");
document.write("            <option value='01-01-1993'>16</option> ");
document.write("            <option value='01-01-1994'>15</option> ");
document.write("            <option value='01-01-1995'>Menor de 15</option> ");
document.write("          </select> ");
document.write("        </label> ");
document.write("      </p></td> ");
document.write("  </tr> ");
document.write("  <tr> ");
document.write("    <td><p> ");
document.write("        <label>Sexo<br/> ");
document.write("          <select class='input' name='sexo' style='border: 1px solid rgb(221, 221, 221); background-color: rgb(251, 251, 251); color: rgb(85, 85, 85);'> ");
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("        </label> ");
document.write("      </p></td> ");
document.write("  </tr> ");
document.write("  <tr> ");
document.write("    <td><p> ");
document.write("        <label>Ocupa&ccedil;&atilde;o<br/> ");
document.write("          <select class='input' name='ocupacion' style='border: 1px solid rgb(221, 221, 221); background-color: rgb(251, 251, 251); color: rgb(85, 85, 85);'> ");
document.write("            <option selected='' value=''>Selecione</option> ");
document.write("            <option value='9'>Aposentado</option> ");
document.write("            <option value='12'>Aut&ocirc;nomo / Profissional liberal</option> ");
document.write("            <option value='97'>Diretor / Presidente</option> ");
document.write("            <option value='5'>Dona de Casa</option> ");
document.write("            <option value='98'>Empres&aacute;rio</option> ");
document.write("            <option value='6'>Estudante / Universit&aacute;rio</option> ");
document.write("            <option value='1'>Executivo</option> ");
document.write("            <option value='3'>Funcion&aacute;rio Registrado</option> ");
document.write("            <option value='8'>Funcion&aacute;rio P&uacute;blico</option> ");
document.write("			<option value='7' >Prestador de Servi&ccedil;o</option> ");
document.write("            <option value='99'>Outros</option> ");
document.write("          </select> ");
document.write("        </label> ");
document.write("      </p></td> ");
document.write(" </tr> ");
document.write("  <tr> ");
document.write("    <td><p> ");
document.write("        <label>&Aacute;rea de Atua&ccedil;&atilde;o<br/> ");
document.write("          <select class='input' name='sector' style='border: 1px solid rgb(221, 221, 221); background-color: rgb(251, 251, 251); color: rgb(85, 85, 85);'> ");
document.write("            <option value=''>Selecione</option> ");
document.write("            <option value='1' >Administra&ccedil;&atilde;o / Finan&ccedil;as</option> ");
document.write("            <option value='18'>Agroneg&oacute;cio</option> ");
document.write("            <option value='19'>Alimentos e Bebidas</option> ");
document.write("            <option value='7' >Arquitetura / Engenharia</option> ");
document.write("            <option value='15'>Publicidade / Comunica&ccedil;&atilde;o / Marketing</option> ");
document.write("            <option value='7' >Constru&ccedil;&atilde;o</option> ");
document.write("            <option value='6' >Educa&ccedil;&atilde;o</option> ");
document.write("            <option value='10'>Ind&uacute;stria - Produ&ccedil;&atilde;o / Fabrica&ccedil;&atilde;o</option> ");
document.write("            <option value='2,3,4'>Inform&aacute;tica / Internet</option> ");
document.write("            <option value='16'>Log&iacute;stica / Transportes</option> ");
document.write("            <option value='5'>Recursos Humanos</option> ");
document.write("            <option value='11'>Sa&uacute;de</option> ");
document.write("            <option value='9'>Servi&ccedil;os jur&iacute;dicos</option> ");
document.write("            <option value='8' >Setor P&uacute;blico / Governo</option> ");
document.write("            <option value='17'>Turismo</option> ");
document.write("            <option value='13'>Vendas / Com&eacute;rcio</option> ");            
document.write("            <option value='14'>Outras</option> ");
document.write("          </select> ");
document.write("        </label> ");
document.write("      </p></td> ");
document.write("  </tr> ");
document.write("  <tr> ");
document.write("    <td><label>&Aacute;reas de Interesses:</label> ");
document.write("      <br /> ");
document.write("      <table cellspacing='0' cellpadding='0' border='0' align='center' width='300px'> ");
document.write("        <tbody> ");
document.write("          <tr> ");
document.write("            <td><input type='checkbox' value='1160,1158,17' name='listas'/> ");
document.write("              <a name='1'><b><font size='1' face='Arial, Helvetica, sans-serif' color='#21759b'>Alimentos e Bebidas</font></b></a></td> ");
document.write("            <td><input type='checkbox' value='1295,57,1254,691,1256' name='listas'/> ");
document.write("              <a name='13'><b><font size='1' face='Arial, Helvetica, sans-serif' color='#21759b'>Filhos</font></b></a></td> ");
document.write("          </tr> ");
document.write("          <tr> ");
document.write("            <td><input type='checkbox' value='25,123,1210,28,489,1217' name='listas'/> ");
document.write("              <a name='30'><b><font size='1' face='Arial, Helvetica, sans-serif' color='#21759b'>Artigos Femininos</font></b></a></td> ");
document.write("            <td><input type='checkbox' value='1133,4,4340,377' name='listas'/> ");
document.write("              <a name='41'><b><font size='1' face='Arial, Helvetica, sans-serif' color='#21759b'>Inform&aacute;tica</font></b></a></td> ");
document.write("          </tr> ");
document.write("          <tr> ");
document.write("            <td><input type='checkbox' value='690,124,1249,1247,1251' name='listas'/> ");
document.write("              <a name='90'><b><font size='1' face='Arial, Helvetica, sans-serif' color='#21759b'>Artigos Masculinos</font></b></a></td> ");
document.write("            <td><input type='checkbox' value='39,38,7378,7' name='listas'/> ");
document.write("              <a name='7'><b><font size='1' face='Arial, Helvetica, sans-serif' color='#21759b'>M&uacute;sica e Livros</font></b></a></td> ");
document.write("          </tr> ");
document.write("          <tr> ");
document.write("            <td><input type='checkbox' value='41,615,107,4359,69,1195,614,56,14' name='listas'/> ");
document.write("              <a name='8'><b><font size='1' face='Arial, Helvetica, sans-serif' color='#21759b'>Automotivos</font></b></a></td> ");             
document.write("            <td><input type='checkbox' value='30,1395,1184,1391,1389,530,1186' name='listas'/> ");
document.write("              <a name='7'><b><font size='1' face='Arial, Helvetica, sans-serif' color='#21759b'>Neg&oacute;cios e Finan&ccedil;as</font></b></a></td> ");
document.write("          </tr> ");
document.write("          <tr> ");
document.write("            <td><input type='checkbox' value='1164' name='listas'/> ");
document.write("              <a name='690'><b><font size='1' face='Arial, Helvetica, sans-serif' color='#21759b'>Casa e Constru&ccedil;&atilde;o</font></b></a></td> ");  
document.write("            <td><input type='checkbox' value='90' name='listas'/> ");
document.write("              <a name='11'><b><font size='1' face='Arial, Helvetica, sans-serif' color='#21759b'>Ofertas de Emprego</font></b></a></td> ");
document.write("          </tr> ");
document.write("          <tr> ");
document.write("            <td><input type='checkbox' value='13,1241,1243' name='listas'/> ");
document.write("              <a name='690'><b><font size='1' face='Arial, Helvetica, sans-serif' color='#21759b'>Educa&ccedil;&atilde;o e Forma&ccedil;&atilde;o</font></b></a></td> ");  
document.write("            <td><input type='checkbox' value='8,2418,1165,1166' name='listas'/> ");
document.write("              <a name='5'><b><font size='1' face='Arial, Helvetica, sans-serif' color='#21759b'>Promo&ccedil;&otilde;es</font></b></a></td> ");
document.write("          </tr> ");
document.write("          <tr> ");
document.write("            <td><input type='checkbox' value='1169,37' name='listas'/> ");
document.write("              <a name='690'><b><font size='1' face='Arial, Helvetica, sans-serif' color='#21759b'>Empr&eacute;stimos</font></b></a></td> ");  
document.write("            <td><input type='checkbox' value='78' name='listas'/> ");
document.write("              <a name='2418'><b><font size='1' face='Arial, Helvetica, sans-serif' color='#21759b'>Sa&uacute;de e Bem Estar</font></b></a></td> ");
document.write("          </tr> ");
document.write("          <tr> ");
document.write("            <td><input type='checkbox' value='21,23,8755,4418,24,4338,71,22,1,887' name='listas'/> ");
document.write("              <a name='1133'><b><font size='1' face='Arial, Helvetica, sans-serif' color='#21759b'>Entretenimento</font></b></a></td> ");
document.write("            <td><input type='checkbox' value='1154,1148,1150,2618,393' name='listas'/> ");
document.write("              <a name='9'><b><font size='1' face='Arial, Helvetica, sans-serif' color='#21759b'>Tecnologia e Multim&iacute;dia</font></b></a></td> ");
document.write("          </tr> ");
document.write("          <tr> ");
document.write("            <td><input type='checkbox' value='1273,18,9,357,449,363,1266,4358,365' name='listas'/> ");
document.write("              <a name='41'><b><font size='1' face='Arial, Helvetica, sans-serif' color='#21759b'>Esportes</font></b></a></td> ");
document.write("            <td><input type='checkbox' value='62,64,89,63,61,11,431' name='listas'/> ");
document.write("              <a name='2420'><b><font size='1' face='Arial, Helvetica, sans-serif' color='#21759b'>Viagem e Turismo</font></b></a></td> ");
document.write("          </tr> ");
document.write("        </tbody> ");
document.write("      </table></td> ");
document.write("  </tr> ");
document.write("</table> ");