document.writeln("<div class=\"IndexSign\">");
document.writeln("  <div class=\"Top\"></div>");
document.writeln("  <div class=\"IndexSignContainer\">");
document.writeln("      <div class=\"Info\">");
document.writeln("         Get a <span>Free 1-on-1</span> live online lesson <span style=' font-family:Arial; color:#000;'>&</span> a free e- book now, complete the form below.");
document.writeln("      </div>");
document.writeln("      <div class=\"Regisiter\">");
document.writeln("          <p>");
document.writeln("             <label><span style='color:#f60'>*</span>Name:</label><input type=\"text\" id=\"txtSignName\" />");
document.writeln("          </p>");
document.writeln("          <p>");
document.writeln("             <label><span style='color:#f60'>*</span>Email:</label><input type=\"text\" id=\"txtSignEmail\" />");
document.writeln("          </p>");
document.writeln("          <p>");
document.writeln("             <label><span style='color:#f60'>*</span>Nationality:</label><select id=\"txtSignNationality\"></select>");
document.writeln("          </p>");
document.writeln("          <p>");
document.writeln("             <label><span style='color:#f60'>*</span>Phone:</label><input type=\"text\" style=\" width:40px;\" id=\"txtSignAreaCode\" /> <input type=\"text\" style=\" width:78px;\"  id=\"txtSignPhone\"/>");
document.writeln("          </p>");
document.writeln("     <p>&nbsp;&nbsp;&nbsp;Your learning aim:</p>");
document.writeln("       <p>");
document.writeln("         &nbsp;&nbsp;&nbsp;&nbsp;<label>");
document.writeln("         <textarea id=\"txtOccupationAim\" maxlength=50 rows='2'></textarea>");
document.writeln("         </label>");
document.writeln("      </p>");
document.writeln("          <p class=\"submit\">");
document.writeln("              <input type=\"hidden\" id=\"hidCountryID\" />");
document.writeln("             <img src=\"" + HostDefault + "/images/201006/home_signup_button.gif\" alt=\"\" id=\"SignSubmit\" />");
document.writeln("          </p>");
document.writeln("      </div>");
document.writeln("  </div>");
document.writeln("</div>");