// Copyright 2001 Facade.
// All rights reserved.
// Any modification of this code is strictly prohibited.
document.write('<form action="http://www.facade.com/biorhythm/personal/" method=get><table cellspacing=5 class=interact><tr><td><b>Biorhythm</b></td><td align=right><b><a href="http://www.facade.com/biorhythm/help" target="_blank" class=interact>HELP</a></b></td></tr><tr><td>Name:</td><td><input type=text size=23 name="Name" value="Anonymous" autocomplete=off></td></tr><tr><td>Birthdate:</td><td><select name="Month"><option value=""><option value="1" >January<option value="2" >February<option value="3" >March<option value="4" >April<option value="5" >May<option value="6" >June<option value="7" >July<option value="8" >August<option value="9" >September<option value="10" >October<option value="11" >November<option value="12" >December</select> <input type=text name="Day" value="" size=2 maxlength=2>, <input type=text name="Year" value="" size=4 maxlength=4></td></tr><tr><td>Target Date:</td><td><select name="tMonth"><option value=""><option value="1" >January<option value="2" >February<option value="3" >March<option value="4" SELECTED>April<option value="5" >May<option value="6" >June<option value="7" >July<option value="8" >August<option value="9" >September<option value="10" >October<option value="11" >November<option value="12" >December</select> <input type=text name="tDay" value="27" size=2 maxlength=2 autocomplete=off>, <input type=text name="tYear" value="2024" size=4 maxlength=4 autocomplete=off></td></tr><tr><td>Range:</td><td><select name="range"><option value="7">14 days<option value="14" SELECTED>28 days<option value="28">56 days</select></td></tr><td></td><td><input type=submit class=submit value="FREE Chart"></td></tr><tr><td colspan=2 align=right><font size=1><a href="http://www.facade.com/content"><b>Add biorhythms to your site!</b></a></font></td></tr></table></form>
');