document.write("<!-- Web Form Generator 2.0 --><center><form method=\"post\" action=\"http://clients.autopilotsolution.com/scripts/addlead.pl\"><input type=\"hidden\" name=\"meta_web_form_id\" value=\"1146907394\"><input type=\"hidden\" name=\"meta_split_id\" value=\"\"><input type=\"hidden\" name=\"unit\" value=\"ultimate-pass\"><input type=\"hidden\" name=\"redirect\" value=\"http://www.qcultimatefitness.com/free_stuff\" id=\"redirect_cff87abc15df53df5cee52ae5fca5f54\"><input type=\"hidden\" name=\"meta_redirect_onlist\" value=\"\"><input type=\"hidden\" name=\"meta_adtracking\" value=\"Free Pass Request\"><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><DIV align=center><FONT size=1><IMG title=\"\" height=90 alt=\"\" src=\"http://qcultimatefitness.com/i/u/6042203/i/Free_Pass_7.gif\" width=125></FONT></DIV><DIV align=center><SPAN style=\"FONT-SIZE: 14pt; COLOR: #ff0000\"><SPAN style=\"FONT-SIZE: 18pt\"><STRONG><FONT face=Verdana color=#000000 size=1><BR>Try before you join!</FONT></STRONG></SPAN></SPAN></DIV><DIV align=center><SPAN style=\"FONT-SIZE: 14pt; COLOR: #ff0000\"><SPAN style=\"FONT-SIZE: 18pt\"><STRONG><FONT face=Verdana size=2><BR>&nbsp;</DIV></FONT></STRONG></SPAN></SPAN></DIV></center></td></tr><tr><td>Name:</td><td><input type=\"text\" name=\"name\" value=\"\" size=\"20\"></td></tr><tr><td>Email:</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=\"Free VIP Membership\"></td></tr></table></form></center>");

      function setCookie(name, value, expires, path, domain, secure) {
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      ((path) ? "; path=" + path : "") +
      ((domain) ? "; domain=" + domain : "") +
      ((secure) ? "; secure" : "");
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      unique_track = new Image();
      unique_track.src = "http://forms.autopilotsolution.com/form/displays.htm?id=jIwsbJwM7MycLA==";