//<script LANGUAGE="JAVASCRIPT">
			
				function submitMyForm(){
					
					if(document.customForm29605.onsubmit())
						{
							ValidateCustomForm(document.customForm29605,0);
							document.customForm29605.submit();
						}
				}
				
				document.writeln('<div>');
				document.writeln('	<h5 class="paddingbottom">Gold Requests: Email Dean</h5>');
				
				document.writeln('</div>');
				document.writeln('<div style="float:right;clear:both;line-height:20px;font-size:1.0em;"><p>* Required fields</p>');
				document.writeln('</div>');	
				document.writeln('<div class="leftContainer">');
				document.writeln('	<div id="genericCRMForm">');

				document.writeln('<scr' + 'ipt language="javascript" src="/jsfiles/incCustomFormValidate.js"></sc' + 'ript>');
				document.writeln('<scr' + 'ipt language="javascript" src="/jsfiles/incWsPafLookup.js"></sc' + 'ript>');
				document.writeln('		<scr'+'ipt language="Javascript">');
				document.writeln('	  		//Status for PAF Function');
				document.writeln('			function funPAFLookupStatus(sStatus){');
				document.writeln('				if (sStatus == "BEGIN") {');
				document.writeln('					document.getElementById("spanPAFStatus").innerText = "Please wait..";');
				document.writeln('				}');
				document.writeln('				else if (sStatus == "ERROR") {');
				document.writeln('					document.getElementById("spanPAFStatus").innerText = " Error.";');
				document.writeln('				}');
				document.writeln('				else {');
				document.writeln('					document.getElementById("spanPAFStatus").innerText = "Lookup Complete";');
				document.writeln('				}');
				document.writeln('			}');
				document.writeln('			</scr'+'ipt>');				
				document.writeln('<form name="customForm29605" action="/CustomFormProcess.asp" method="post" onsubmit="return ValidateCustomForm(this,0)">');
				document.writeln('<input type="hidden" name="Title" value="Gold Requests: Email Dean">');
				document.writeln('<input type="hidden" name="ID" value="29605">');
				document.writeln('<input type="hidden" name="nConfirmationNum" value="899">');
			 	document.writeln('<input type="hidden" name="NumQuestions" value="0">');
			 	document.writeln('<input type="hidden" name="NumFields" value="-1">');
				//Set the Template and Custom ID
				if (gnTemplateID != null) {
					document.writeln('<input type="hidden" name="TemplateID" value="' + gnTemplateID + '" />');
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				if (gnCustomID != null) {
					document.writeln('<input type="hidden" name="CustomID" value="' + gnCustomID + '" />');
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				var sColorSchemeID // USE FOR SUBMIT AND CHECK ADDRESS IMAGES URL
				if (gnColorSchemeID != null) {
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					document.writeln('<input type="hidden" name="ColorSchemeID" value="' + gnColorSchemeID + '" />');
				}
				
			//</script>	 	
      
			
document.writeln('<div class="formwrap generic">');
	
		document.writeln('	<label class="generic">*<input type="hidden" name="FirstNameRequired" value>');
	
	document.writeln('first name:</label>');
document.writeln('	<div class="elementwrap" style="line-height:20px;">');

  
			document.writeln('       <input type="text" id="txtFirstName" name="txtFirstName" value=""  class="genericTxt" size="20" maxLength="80">');
		
document.writeln('    <input type="hidden" name="FirstNameLabel" value="First Name">');
document.writeln('	</div>	');	
document.writeln('</div>	');	


document.writeln('<div class="formwrap generic">');
	
		document.writeln('	<label class="generic">*<input type="hidden" name="LastNameRequired" value>');
	
	document.writeln('surname:</label>');
document.writeln('	<div class="elementwrap" style="line-height:20px;">');

  
			document.writeln('       <input type="text" id="txtLastName" name="txtLastName" value=""  class="genericTxt" size="20" maxLength="80">');
		
document.writeln('    <input type="hidden" name="LastNameLabel" value="Surname">');
document.writeln('	</div>	');	
document.writeln('</div>	');	


document.writeln('<div class="formwrap generic">');
	
		document.writeln('	<label class="generic">*<input type="hidden" name="EmailRequired" value>');
	
	document.writeln('email address:</label>');
document.writeln('	<div class="elementwrap" style="line-height:20px;">');

  
			document.writeln('       <input type="text" id="txtEmail" name="txtEmail" class="genericTxt" size="20" maxLength="80">');
		
document.writeln('    <input type="hidden" name="EmailLabel" value="Email address">');
document.writeln('	</div>	');	
document.writeln('</div>	');	


document.writeln('<div class="formwrap generic">');
	
		document.writeln('	<label class="generic notReq">&nbsp;');
	
	document.writeln('daytime phone:</label>');
document.writeln('	<div class="elementwrap" style="line-height:20px;">');

  
			document.writeln('       <input type="text" id="txtDayPhone" name="txtDayPhone" class="genericTxt" size="20" maxLength="15">');
		
document.writeln('    <input type="hidden" name="DayPhoneLabel" value="Daytime Phone">');
document.writeln('	</div>	');	
document.writeln('</div>	');	


document.writeln('<div class="formwrap generic">');
	
		document.writeln('	<label class="generic">*<input type="hidden" name="GenderRequired" value>');
	
	document.writeln('gender:</label>');
document.writeln('	<div class="elementwrap" style="line-height:20px;">');

  
	document.writeln('  	<label class="genericRadio">male</label><input class="genericRadio" type="radio" name="txtGender" value="Male" id="txtGender">');
	document.writeln('  	<label class="genericRadio">female</label><input class="genericRadio" type="radio" name="txtGender" value="Female" id="txtGender">');
				
  
document.writeln('    <input type="hidden" name="GenderLabel" value="Gender">');
document.writeln('	</div>	');	
document.writeln('</div>	');	


document.writeln('<div class="formwrap generic">');
	
		document.writeln('	<label class="generic">*<input type="hidden" name="PostcodeRequired" value>');
	
	document.writeln('postcode:</label>');
document.writeln('	<div class="elementwrap" style="line-height:20px;">');

  
			document.writeln('      <input class="genericTxt"  type="text" id="txtPostcode" name="txtPostcode" maxLength="30" />');
		
		
document.writeln('    <input type="hidden" name="PostcodeLabel" value="Postcode">');
document.writeln('	</div>	');	
document.writeln('</div>	');	


					document.writeln('	  <div class="formSpacer"></div>');
					
					  document.writeln(' <div class="formwrap generic">');
					  document.writeln('	<label class="generic">');
										  
					  document.writeln('Your Message:');
					  document.writeln('	</label></div>');
					  document.writeln('	<input type="hidden" name="Question0" value="Your Message:">');
					  document.writeln('	<input type="hidden" name="QuestionRequired0" value="0">');
				document.writeln('<div class="formwrap generic"  style="font-size:1.2em !important"><textarea style="font-size:0.95em !important" Name=Question0answer></textarea></div>');
				//<script LANGUAGE="JAVASCRIPT">
				document.writeln('	  <div class="formwrap generic">');
				document.writeln('		<input type="checkbox" class="genericRadio" name="AgreeCheckBox" value="1" id="AgreeCheckBox"><label class="genericRadio" for="AgreeCheckBox">*I have read and agreed to the <a href="/article.asp?id=487570" target="_blank">terms and conditions</a> and Gold\'s <a href="/article.asp?id=487576" target="_blank">privacy policy</a></label> ');
				document.writeln('		<input type="hidden" name="AgreeRequired" value="">');
				document.writeln('		<input type="hidden" name="AgreeLabel" value="Please tick the box agreeing to the station\'s privacy policy">');
				document.writeln('	  </div>');
				//</script>
				
				//<script LANGUAGE="JAVASCRIPT">
				document.writeln('	  <div class="formSpacer"></div>');
				document.writeln('		<div class="formwrap generic">');
				document.writeln('		<input type="image" src="/images/bg/' + sColorSchemeID + '/register_btn.gif" title="send" class="genericReg" /><label class="genericReg"><a href="javascript:submitMyForm();"><strong>Submit</strong></a></label>');
				document.writeln('		</div>');
				document.writeln('		</form>');
				document.writeln('	  </div>');
				document.writeln('</div>');
			//</script>