document.write('<form name="pray_say" method="post" action="http://www.prayitsayit.net/index.php" target="_blank">'
            +  '        <input type="hidden" name="page_action" value="Pray-it" />'
            +  '        <table border="2" cellpadding="0" cellspacing="1" width="150" style="color: black; background-color: white; font-family: sans-serif; font-size: xx-small; ">'
            +  '            <tr>'
            +  '                <td>'
            +  '                    <table width="150" border="0" cellpadding="2" background="http://www.prayitsayit.net/graphics/military.jpg">'
            +  '                        <tr>'
            +  '                            <td valign="bottom" align="right" height="70" style="color: #0099FF; font-family: sans-serif; font-size: xx-small; font-weight: bold; ">'
            +  '                                <br />&nbsp;'
            +  '                                <br />&nbsp;'
            +  '                                <br />&nbsp;'
            +  '                                <br />&nbsp;'
            +  '                                <input type="text" name="recipient" size="18" value="person&#039;s name" style="color: black; font-family: sans-serif; font-size: xx-small; " />'
            +  '                            </td>'
            +  '                        </tr>'
            +  '                        <tr>'
            +  '                            <td align="right" nowrap>'
            +  '                                <select name="topic" size="1" style="color: black; font-family: sans-serif; font-size: xx-small; margin-bottom: 2; ">'
            +  '                                    <option value="anxiety_fear">Anxiety/Fear</option>'
            +  '                                    <option value="children">Children</option>'
            +  '                                    <option value="encouragement">Encouragement</option>'
            +  '                                    <option value="generalblessing">General Blessing</option>'
            +  '                                    <option value="grief">Grief</option>'
            +  '                                    <option value="healing">Healing</option>'
            +  '                                    <option value="missionary">Missionary</option>'
            +  '                                    <option value="pastor_priest">Pastor/Priest</option>'
            +  '                                    <option value="powerforministry">Power for Ministry</option>'
            +  '                                    <option value="provision">Provision</option>'
            +  '                                    <option value="salvation">Salvation</option>'
            +  '                                    <option value="soldiers" selected>Military Personnel</option>'
            +  '                                    <option value="teens">Teens</option>'
            +  '                                </select><input type="submit" name="ps_service" value="Go" style="color: black; font-family: sans-serif; font-size: xx-small; " />'
            +  '                            </td>'
            +  '                        </tr>'
            +  '                        <tr>'
            +  '                            <td align="center" style="color: white; font-family: sans-serif; font-size: xx-small; ">'
            +  '                                send a <a href="http://www.prayitsayit.net" target="_blank" style="color: white; font-family: sans-serif; font-size: xx-small; ">pray-it say-it card</a>'
            +  '                            </td>'
            +  '                        </tr>'
            +  '                    </table>'
            +  '                </td>'
            +  '            </tr>'
            +  '        </table>'
            +  '    </form>');