document.write('<form method="post" action="http://29411.newsletter.onetwomax.de/">');
document.write('  <table align="center" bgcolor="#ffffff" style="border: 1px solid #000000">');
document.write('    <tr>');
document.write('      <td colspan="2"><font face="verdana" size="2"><b>mit * gekennzeichnete Felder müssen ausgefüllt werden</b></font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="verdana" size="1"><b>E-Mail *</b></font></td>');
document.write('      <td><font face="verdana" size="1"><b>');
document.write('        <input style=" font-family: verdana; font-weight: bold;" type="text" name="email" value="" size="20">');
document.write('      </b></font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="verdana" size="1"><b>Name *</b></font></td>');
document.write('      <td><font face="verdana" size="1"><b>');
document.write('        <input style=" font-family: verana; font-weight: bold;" type="text" name="user_input[id4]" value="" size="20">');
document.write('      </b></font></td>');
document.write('    </tr>');
document.write('    <tr bgcolor="#Ffffff">');
document.write('      <td><font color="#000000" face="verdana" size="1"><b>Verein</b></font></td>');
document.write('      <td><font face="verdana">');
document.write('        <input style=" font-family: verdana; font-weight: bold;" type="text" name="user_input[id5]" value="" size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr bgcolor="#FFFFff">');
document.write('      <td><font color="#000000" face="verdana" size="1"><b>Bundesland*</b></font></td>');
document.write('      <td><font face="verdana">');
document.write('        <input style=" font-family: verdana; font-weight: bold;" type="text" name="user_input[id6]" value="" size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td colspan="2" align="center" valign="middle">');
document.write('        <input type="hidden" name="mq" value="\'">');
document.write('        <input type="hidden" name="action" value="add">');
document.write('        <input type="hidden" name="entry" value="29411">');
document.write('        <input type="submit" name="submit" value="Abschicken">');
document.write('      </td>');
document.write('    </tr>');
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document.write('');