document.write("<!-- Web Form Generator 2.0 --><center><form method=\"post\" action=\"http://clients.profollow.com/scripts/addlead.pl\" target=\"_new\"><input type=\"hidden\" name=\"meta_web_form_id\" value=\"2077200058\"><input type=\"hidden\" name=\"meta_split_id\" value=\"\"><input type=\"hidden\" name=\"unit\" value=\"citrussafari\"><input type=\"hidden\" name=\"redirect\" value=\"http://clients.profollow.com/thankyou.htm?m=default\" id=\"redirect_5594241d7bbde6fb13df723714aa4f40\"><input type=\"hidden\" name=\"meta_redirect_onlist\" value=\"\"><input type=\"hidden\" name=\"meta_adtracking\" value=\"\"><input type=\"hidden\" name=\"meta_message\" value=\"1\"><input type=\"hidden\" name=\"meta_required\" value=\"name,from\"><input type=\"hidden\" name=\"meta_forward_vars\" value=\"0\"><table><tr><td colspan=2><center><div style=\"font-family: Verdana; font-weight: bold\"><font size=\"3\">If you would like more information about the upcoming Citrus Safari, please fill in your details on the form below. I will then follow up with you&nbsp; by phone or email.</font></div><div style=\"font-family: Verdana; font-weight: bold\"><font size=\"3\">&nbsp;</font></div><div><font style=\"font-weight: bold\" size=\"3\"><span style=\"font-family: Verdana\">Looking forward to hearing from you. </span></font><br></div></center></td></tr><tr><td>Full Name:</td><td><input type=\"text\" name=\"name\" value=\"\" size=\"20\"></td></tr><tr><td>Contact Telephone:</td><td><input type=\"text\" name=\"custom Contact Telephone\" value=\"\" size=\"20\"></td></tr><tr><td>Email Address:</td><td><input type=\"text\" name=\"from\" value=\"\" size=\"20\"></td></tr>    <tr><td colspan=2><center></center></td></tr><tr><td align=\"center\" colspan=\"2\"><input type=\"submit\" name=\"submit\" value=\"Submit\"></td></tr></table></form></center>");

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