document.write("			<fieldset class='fieldset'>");
document.write("				<legend>Informacion necesaria</legend>");
document.write("				<table cellpadding='0' cellspacing='$stylevar[formspacer]' border='0' width='400'>");
document.write("				  <!--  Canalmail -->");
document.write("          <tr> ");
document.write("            <td ><b>Pa&iacute;s:</b></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' >ESPAŅA</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("          <tr> ");
document.write("            <td ><b>C&oacute;digo Postal:</b></td>");
document.write("            <td > ");
document.write("              <input type='text' name='cp' size='10' maxlength='5'  />");
document.write("            </td>");
document.write("          </tr>");
document.write("          ");
document.write("          <tr> ");
document.write("            <td ><b>Edad:</b></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("					");
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='' >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("          <tr> ");
document.write("            <td ><b>Sector:</b></td>");
document.write("            <td > ");
document.write("              <select  class='searchBox'  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>[Elija un sector]</option>");
document.write("              </select>");
document.write("            </td>");
document.write("          </tr>");
document.write("          <tr> ");
document.write("            <td ><b>Ocupaci&oacute;n:</b></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>[Elija una ocupacion]</option>");
document.write("              </select>");
document.write("            </td>");
document.write("          </tr>");
document.write("          <tr> ");
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("          <tr> ");
document.write("            <td  colspan='2'>");
document.write("              <table width='370' 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' name='listas' value='1' >");
document.write("      <a name='1'><b><font size='1'>Ocio</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' name='listas' value='8' >");
document.write("      <a name='8'><b><font size='1'>Ofertas</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='30'  >");
document.write("      <a name='30'><b><font size='1'>Bancos</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='90'  >");
document.write("      <a name='90'><b><font size='1'>Empleo</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='41'  >");
document.write("      <a name='41'><b><font size='1'>Coches</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='7'  >");
document.write("      <a name='7'><b><font size='1'>Musica</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='2418' >");
document.write("      <a name='2418' ></a>Compras</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='9'  >");
document.write("      <a name='9'><b><font size='1'>Deportes</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='13'  >");
document.write("      <a name='13'><b><font size='1'>Cursos</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='690'  >");
document.write("      <a name='690'><b><font size='1'>El</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='11'  >");
document.write("      <a name='11'><b><font size='1'>Viajes</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='1133' >");
document.write("      <a name='1133'><b><font size='1'>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='691'><b><font size='1'>Hijos</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='5'  >");
document.write("      <a name='5'><b><font size='1'>Salud</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='692'  >");
document.write("      <a name='692'><b><font size='1'>Mujer</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' name='listas' value='2420'  >");
document.write("      <a name='2420'><b><font size='1'>Noticias</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>");