document.write(" <tr> ");
document.write("   <td  >Pa&iacute;s</td>");
document.write("   <td  >");
document.write("     <select name='pais' >");
document.write("       <option value='' >Elija un pais</option>");
document.write("       <option value='' >------------------</option>");
document.write("       <option value='ESP' >ESPAnA</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='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' >Paraguay</option>");
document.write("       <option value='AND' >Andorra</option>");
document.write("       <option value='PUE' >Puerto Rico</option>");
document.write("       <option value='DOM' >Rep.Dom</option>");
document.write("       <option value='USA' >USA</option>");
document.write("       <option value='URU' >Uruguay</option>");
document.write("       <option value='' >------------------</option>");
document.write("       <option value='ZZZ' >OTROS</option>");
document.write("     </select>");
document.write("</td>");
document.write("       </tr>");
document.write("        ");
document.write("        ");
document.write("       <tr > ");
document.write("         <td   >Codigo Postal</strong></td>");
document.write("         <td  > ");
document.write("           <input type='text' name='cp' size='25' maxlength='60'  /><font size='1'>Solo para Espanoles</font> </td>");
document.write("       </tr>");
document.write("        ");
document.write("        ");
document.write("       <tr > ");
document.write("                              <td   >Edad</strong></td>");
document.write("                              <td  >");
document.write("                                <select name='fec_ncto'>");
document.write("                                  <option value='' >Selecciona</option>");
document.write("                                  <option value='01-01-1990' >Posterior a 1990</option>");
document.write("                                  <option value='01-01-1989' >1989</option>");
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("                                  <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("                                  <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("                                  <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("                                  <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("                                  <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("                                  <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("                                  <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("                             ");
document.write("                             ");
document.write("                            <tr >");
document.write("                              <td    >Sexo</strong></td>");
document.write("                              <td   >");
document.write("                                <select name='sexo' >");
document.write("                                  <option value='' >Elige tu sexo</option>");
document.write("                                  <option value='H' >Hombre</option>");
document.write("                                  <option value='M' >Mujer </option>");
document.write("                                </select>");
document.write("                                </td>");
document.write("                           </tr>");
document.write("                            ");
document.write("                            ");
document.write("             <tr > ");
document.write("    <td   >Sector</strong></td>");
document.write("    <td  >");
document.write("      <select name='sector' >");
document.write("        <option value='15' >Publicidad/Comunicaciones</option>");
document.write("        <option value='2' >Informatica (IS, MIS, DP)</option>");
document.write("        <option value='3' >Informatica (Internet)</option>");
document.write("        <option value='4' >Informatica (Desarrollo de Software)</option>");
document.write("        <option value='5' >Consultoria</option>");
document.write("        <option value='6' >Educacion</option>");
document.write("        <option value='7' >Arquitectura/Ingenieria/Contruccion</option>");
document.write("        <option value='8' >Gobierno/Ejercito</option>");
document.write("        <option value='9' >Servicios juridicos</option>");
document.write("        <option value='10' >Fabricacion/Produccion/Operaciones</option>");
document.write("        <option value='11' >Servicios medicos</option>");
document.write("        <option value='12' >Investigacion y desarrollo</option>");
document.write("        <option value='13' >Ventas/Comercializacion</option>");
document.write("        <option value='14' >Otros</option>");
document.write("        <option value='1' >Contabilidad/Finanzas</option>");
document.write("        <option value='' selected>Tu Sector</option>");
document.write("      </select>");
document.write("    </td>");
document.write("  </tr>");
document.write("     ");
document.write(" <tr> ");
document.write("  <td   >");
document.write("     Ocupaci&oacute;n  </td>");
document.write("  <td  > ");
document.write("      <select name='ocupacion'>");
document.write("        <option value='6' >Estudiante / Universitario</option>");
document.write("        <option value='1' >Ejecutivo / Empresario</option>");
document.write("        <option value='3' >Empleado por cuenta ajena</option>");
document.write("        <option value='5' >Ama de Casa</option>");
document.write("        <option value='9' >Jubilado</option>");
document.write("        <option value='12' >Autonomo / Profesional liberal</option>");
document.write("        <option value='' selected>Tu ocupacion</option>");
document.write("      </select>");
document.write("</td>");
document.write(" </tr>");
document.write("  <tr > ");
document.write("    <td  valign='top' >Intereses</td>");
document.write("    <td  align='center' > ");
document.write("     <font size='1' face='Verdana' >Selecciona lo que te interesa y recibir&aacute;s la Newsletter de <a href='http://www.canalmail.com' target='_blank'><img src='http://promociones.canalmail.com/pruebas/canalmailpastilla.gif' align='texttop' border='0'></a> relacionada con tus gustos. Adem&aacute;s te enviaremos las mejores promociones a tu email. Y s&oacute;lo por registrarte podr&aacute;s ganar alguno de estos <a href='http://sorteos.canalmail.com' target='_blank'><b>Premios</b></a>.</font></td>");
document.write("  <tr> ");
document.write("    <td colspan='2'> ");
document.write("   <table border='0' cellpadding='0' cellspacing='0'  >");
document.write("    <tr>	    ");
document.write("	    <td height='22'  ><font size='1'><b> ");
document.write("	      <input type='checkbox' name='listas' value='1'  >");
document.write("	      <b>Ocio</b></b> ");
document.write("	      </font></td>");
document.write("	    <td  > ");
document.write("	      <font size='1'><b> ");
document.write("	      <input type='checkbox' name='listas' value='8'  >");
document.write("          <b>Ofertas</b></b></font></td>");
document.write("	    <td  > ");
document.write("	      <font size='1'><b> ");
document.write("	      <input type='checkbox' name='listas' value='30'  >");
document.write("          <b>Bancos</b></b></font></td>");
document.write("	    <td  ><font size='1'><b> ");
document.write("	      <input type='checkbox' name='listas' value='90'  >");
document.write("          <b>Empleo</b></b></font></td>");
document.write("      </tr>");
document.write("      <tr> ");
document.write("	    <td height='22'  ><font size='1'><b> ");
document.write("	      <input type='checkbox' name='listas' value='41'  >");
document.write("	      <b>Coches</b></b></font></td>");
document.write("	    <td  > ");
document.write("	      <font size='1'><b> ");
document.write("	      <input type='checkbox' name='listas' value='7'  >");
document.write("	      <b>Musica</b></b>	      </font></td>");
document.write("	    <td  > ");
document.write("	      <font size='1'><b>  ");
document.write("	      <input type='checkbox' name='listas' value='2418'  >");
document.write("	      Compras</b></font></td>");
document.write("	    <td  ><font size='1'><b> ");
document.write("	      <input type='checkbox' name='listas' value='9'  >");
document.write("	      <b>Deportes</b></b></font></td>");
document.write("     </tr> ");
document.write("     <tr>");
document.write("	    <td height='22'  ><font size='1'><b> ");
document.write("	      <input type='checkbox' name='listas' value='13'  >");
document.write("	      <b>Cursos</b></b></font></td>");
document.write("	    <td  > ");
document.write("	      <font size='1'><b> ");
document.write("	      <input type='checkbox' name='listas' value='690'  >");
document.write("	      <b>Caballero</b></b></font></td>");
document.write("	    <td  > ");
document.write("	      <font size='1'><b> ");
document.write("	      <input type='checkbox' name='listas' value='11'  >");
document.write("	      <b>Viajes</b></b></font></td>");
document.write("	    <td  ><font size='1'><b> ");
document.write("	      <input type='checkbox' name='listas' value='1133'  >");
document.write("	      <b>Inform&aacute;tica</b></b></font></td>");
document.write("      </tr>");
document.write("     <tr > ");
document.write("	    <td height='22'  ><font size='1'><b> ");
document.write("	      <input type='checkbox' name='listas' value='691'  >");
document.write("	      <b>Hijos</b></b></font></td>");
document.write("	    <td  > ");
document.write("	      <font size='1'><b> ");
document.write("	      <input type='checkbox' name='listas' value='5'  >");
document.write("	      <b>Salud</b></b></font></td>");
document.write("	    <td  > ");
document.write("	      <font size='1'><b> ");
document.write("	      <input type='checkbox' name='listas' value='25'  >");
document.write("	      <b>Mujer</b></b>	      </font></td>");
document.write("	    <td  ><font size='1'><b> ");
document.write("	      <input type='checkbox' name='listas' value='2420'  >");
document.write("	      <b>Noticias</b></b></font></td>");
document.write("      </tr>");
document.write("       </table>    ");
document.write("       </td>");
document.write("</tr>");
document.write("</tr>");