document.write("<tr>");
document.write("    <td class='row1'><p><font size='1' face='Verdana'><a target='_blank' href='http://www.canalmail.com'><img border='0' align='texttop' src='http://promociones.canalmail.com/pruebas/canalmailpastilla.gif'/></a></font></p></td>");
document.write("    <td class='row2'></td>");
document.write("<tr>");
document.write("    <td class='row1'><span class='gen'>Ocupa&ccedil;&atilde;o: *</span></td>");
document.write("    <td class='row2'><select name='ocupacion' style='width:150px' >");
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></td>");
document.write("  </tr>");
document.write("  <tr>");
document.write("    <td class='row1'><span class='gen'>Pa&iacute;s: *</span></td>");
document.write("    <td class='row2'><select name='pais' style='width:150px'>");
document.write("      <option value=''>Selecione</option>");
document.write("      <option value='NULL'>------------------</option>");
document.write("      <option value='BRA' selected >Brasil</option>");
document.write("      <option value='NULL'>------------------</option>");
document.write("      <option value='POR'>Portugal</option>");
document.write("      <option value='ESP'>Espanha</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'>Per&uacute;</option>");
document.write("      <option value='COL'>Colombia</option>");
document.write("      <option value='VEN'>Venezuela</option>");
document.write("      <option value='NULL'>------------------</option>");
document.write("      <option value='BOL'>Bolivia</option>");
document.write("      <option value='BRA'>Brasil</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='NULL'>------------------</option>");
document.write("      <option value='ZZZ'>OTROS</option>");
document.write("    </select></td>");
document.write("  </tr>");
document.write("  <tr>");
document.write("    <td class='row1'><span class='gen'>CEP: *</span></td>");
document.write("    <td class='row2'><input type='text' maxlength='60' size='25' name='cp' style='width:150px'/></td>");
document.write("  </tr>");
document.write("  <tr>");
document.write("    <td class='row1'><span class='gen'>Idade: *</span></td>");
document.write("    <td class='row2'><select name='fec_ncto' style='width:150px'>");
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></td>");
document.write("  </tr>");
document.write("  <tr>");
document.write("    <td class='row1'><span class='gen'>Sexo: *</span></td>");
document.write("    <td class='row2'><select name='sexo' style='width:150px'>");
document.write("      <option value=''>Selecione</option>");
document.write("      <option value='H'>Masculino</option>");
document.write("      <option value='M'>Feminino </option>");
document.write("    </select></td>");
document.write("  </tr>");
document.write("  <tr>");
document.write("    <td class='row1'><span class='gen'>&Aacute;rea de Atua&ccedil;&atilde;o: *</span></td>");
document.write("    <td class='row2'><select name='sector' style='width:150px'>");
document.write("      <option value='15'>Publicidade / Comunica&ccedil;&atilde;o</option>");
document.write("      <option value='2'>Informática (Is, Mis, Dp)</option>");
document.write("      <option value='3'>Informática (Internet)</option>");
document.write("      <option value='4'>Informática (Desenvolvimento de Software)</option>");
document.write("      <option value='5'>Consultoría</option>");
document.write("      <option value='6'>Educação</option>");
document.write("      <option value='7'>Arquitetura / Engenharia / Construção</option>");
document.write("      <option value='8'>Governo / Exercito</option>");
document.write("      <option value='9'>Serviços juridicos</option>");
document.write("      <option value='10'>Fabrica&ccedil;&atilde;o / Produ&ccedil;&atilde;o / Opera&ccedil;&otilde;es</option>");
document.write("      <option value='11'>Medicina</option>");
document.write("      <option value='12'>Pesquisa e Desenvolvimento</option>");
document.write("      <option value='13'>Vendas / Comercializa&ccedil;&atilde;o</option>");
document.write("      <option value='14'>Outros</option>");
document.write("      <option value='1'>Contabilidade / Finan&ccedil;as</option>");
document.write("      <option selected='' value=''>Selecione</option>");
document.write("    </select></td>");
document.write("  </tr>");
document.write("  <tr>");
document.write("    <td valign='top' class='row1'><span class='gen'>&Aacute;reas de Interesse: </span>");
document.write("    <td class='row2'>");
document.write("      <table cellspacing='0' cellpadding='0' border='0' width='350'>");
document.write("        <tbody>");
document.write("          <tr>");
document.write("            <td height='22' width='78' valign='top'><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' value='41' name='listas'/>");
document.write("              <a name='8' id='8'><b><font size='1'>Automotivo</font></b></a></b></font></font></font></td>");
document.write("            </tr>");

document.write("          <tr>");
document.write("            <td height='22' width='78' valign='top'><font face='Arial, Helvetica, sans-serif'><font size='1'><font size='2'><b>");
document.write("              <input type='checkbox' value='25' name='listas'/>");
document.write("              <a name='41' id='41'><b><font size='1'>Conte&uacute;do Feminino</font></b></a></b></font></font></font></td>");
document.write("            </tr>");

document.write("          <tr>");
document.write("            <td height='22' width='78' valign='top'><font face='Arial, Helvetica, sans-serif'><font size='1'><font size='2'><b>");
document.write("              <input type='checkbox' value='30' name='listas'/>");
document.write("              <a name='690' id='690'><b><font size='1'>Neg&oacute;cios e Finan&ccedil;as</font></b></a></b></font></font></font></td>");
document.write("            </tr>");

document.write("          <tr>");
document.write("            <td height='22' width='78' valign='top'><font face='Arial, Helvetica, sans-serif'><font size='1'><font size='2'><b>");
document.write("              <input type='checkbox' value='5' name='listas'/>");
document.write("              <a name='691' id='691'><b><font size='1'>Sa&uacute;de/Beleza/Bem Estar</font></b></a></b></font></font></font></td>");
document.write("            </tr>");

document.write("          <tr>");
document.write("            <td height='22' valign='top'><font face='Arial, Helvetica, sans-serif'><font size='1'> <font size='1'><font size='2'><b> <font size='1'>");
document.write("              <input type='checkbox' value='13' name='listas'/>");
document.write("              <a name='2418' id='2418'/></a>Emprego e Forma&ccedil;&atilde;o</font></b></font></font></font></font></td>");
document.write("            </tr>");

document.write("          <tr>");
document.write("            <td height='22' valign='top'><font face='Arial, Helvetica, sans-serif'><font size='1'> <font size='1'><font size='2'><b>");
document.write("              <input type='checkbox' value='11' name='listas'/>");
document.write("              <a name='2420' id='2420'><b><font size='1'>Viagem e Turismo</font></b></a></b></font></font></font></td>");
document.write("            </tr>");

document.write("        </tbody>");
document.write("      </table>");
document.write("      </td>");
document.write("  </tr>");
document.write("</tbody>");


