document.write('<form action="./../listmessenger/public/listmessenger.php" onSubmit="return ValidateForm()" name="nlForm" method="post">');
document.write('<table cellspacing="1" cellpadding="1" border="0">');
document.write('<tr><td class="nl">Free Newsletter</td></tr>');
document.write('<tr>');
document.write('<td><input class="inputfield" onClick="return remove()" onBlur="return add()" type="text" name="email_address" value="email"></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td class="text"><input type="radio" name="action" value="subscribe" CHECKED>&nbsp;subscribe</td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td class="text"><input type="radio" name="action" value="unsubscribe">&nbsp;unsubscribe</td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td align="left">');
document.write('<input class="inputfield" type="hidden" name="group_ids[]" value="1">');
document.write('<input type="submit" name="submit" value="submit">');
document.write('</td>');
document.write('</tr>');
document.write('</table>');
document.write('</form>');