function ap_validate_1070() {
   var form = document.ap_form_1070;
   var regexp_12444 = /^[a-zA-Z]+(([\'\,\.\-][a-zA-Z])?[a-zA-Z]*)*$/;
   var regexp_12445 = /^[a-zA-Z]+(([\'\,\.\-][a-zA-Z])?[a-zA-Z]*)*$/;
   var regexp_12443 = /^(([A-Za-z0-9]+_+)|([A-Za-z0-9]+\-+)|([A-Za-z0-9]+\.+)|([A-Za-z0-9]+\++))*[A-Za-z0-9]+@((\w+\-+)|(\w+\.))*\w{1,63}\.[a-zA-Z]{2,6}$/;
   var regexp_12448 = /^(\+?((0(\d{2})?)|1)?\s*[-\/\.]?)?(\((\d{3})\)|(\d{3}))?\s*[-\/\.]?\s*(\((\d{3})\)|(\d{3}))?[-\/\.]?\s*(\d{4})\s*(([xX]|[eE][xX][tT])\.?\s*(\d+))*/;
    if (form.name === ""){
      alert( "There was an error on this form." );
    } else if (form.ap_field_12444.value === ""){
      alert( "Please enter all required fields: First Name " );
    } else if (!regexp_12444.test(form.ap_field_12444.value)){
      form.ap_field_12444.focus();
      form.ap_field_12444.select();
      alert( "Please correct required field: First Name" );
    } else if (form.ap_field_12445.value === ""){
      alert( "Please enter all required fields: Last Name " );
    } else if (!regexp_12445.test(form.ap_field_12445.value)){
      form.ap_field_12445.focus();
      form.ap_field_12445.select();
      alert( "Please correct required field: Last Name" );
    } else if (form.ap_field_12443.value === ""){
      alert( "Please enter all required fields: Email " );
    } else if (!regexp_12443.test(form.ap_field_12443.value)){
      form.ap_field_12443.focus();
      form.ap_field_12443.select();
      alert( "Please correct required field: Email" );
    } else if (form.ap_field_12448.value === ""){
      alert( "Please enter all required fields: Mobile Phone " );
    } else if (!regexp_12448.test(form.ap_field_12448.value)){
      form.ap_field_12448.focus();
      form.ap_field_12448.select();
      alert( "Please correct required field: Mobile Phone" );
    } else {
      document.ap_form_1070.submit();
    }
 }

function showForm(){
var formHTML = '<div style="width:550px; background: white; 1px #ccc; display:block; float:left; padding:5px;">       <div style="width:95%; float:left; clear:both;">            <span style="font: bold 1.5em helvetica;"></span>       </div>       <div style="width:95%;float:left; clear:both;margin:0px 0px 7px 0px;">            <span style="font: bold 1.25em helvetica;"><font size=2>Complete this short form to print your FREE 7-Day Trial Membership Coupon and have access to all of our Services & Fitness Classes at no cost or obligation.</font>  <P><P><P>  VALID ONLY AT LAUREL, MARYLAND LOCATION.</span>       </div>  <form name="ap_form_1070" ID="ap_form_1070" method="post" action="https://www.aimcrm.com/remote/form_post.php" enctype="multipart/form-data"><input type="hidden" name="action" value="feedback_visitor_add"><input type="hidden" name="org_id" value="350"><input type="hidden" name="f_id" value="1070"><div style="width:95%; float:left; clear:both;margin:  0px 0px 3px 0px;">            <span style="width:35%; float:left;margin: 0px 0px 0px 5px; ">                 <span style=" font-weight:bold;float: left;">First Name<span style="font-size:7pt;color:red;">*</span></span>                 <span style=" font:italic helvetica smaller normal; float: left;"></span>            </span>            <span style="width:60%; float:left;"><input type="text" id="ap_field_12444" name="ap_field_12444" value="" style="" /></span>       </div>  <div style="width:95%; float:left; clear:both;margin:  0px 0px 3px 0px;">            <span style="width:35%; float:left;margin: 0px 0px 0px 5px; ">                 <span style=" font-weight:bold;float: left;">Last Name<span style="font-size:7pt;color:red;">*</span></span>                 <span style=" font:italic helvetica smaller normal; float: left;"></span>            </span>            <span style="width:60%; float:left;"><input type="text" id="ap_field_12445" name="ap_field_12445" value="" style="" /></span>       </div>  <div style="width:95%; float:left; clear:both;margin:  0px 0px 3px 0px;">            <span style="width:35%; float:left;margin: 0px 0px 0px 5px; ">                 <span style=" font-weight:bold;float: left;">Email<span style="font-size:7pt;color:red;">*</span></span>                 <span style=" font:italic helvetica smaller normal; float: left;"></span>            </span>            <span style="width:60%; float:left;"><input type="text" id="ap_field_12443" name="ap_field_12443" value="" style="" /></span>       </div>  <div style="width:95%; float:left; clear:both;margin:  0px 0px 3px 0px;">            <span style="width:35%; float:left;margin: 0px 0px 0px 5px; ">                 <span style=" font-weight:bold;float: left;">Mobile Phone<span style="font-size:7pt;color:red;">*</span></span>                 <span style=" font:italic helvetica smaller normal; float: left;"></span>            </span>            <span style="width:60%; float:left;"><input type="text" id="ap_field_12448" name="ap_field_12448" value="" style="" /></span>       </div>  <div style="width:95%; float:left; clear:both;margin:  0px 0px 3px 0px;">            <span style="width:35%; float:left;margin: 0px 0px 0px 5px; ">                 <span style=" font-weight:bold;float: left;">Best Time to Call</span>                 <span style=" font:italic helvetica smaller normal; float: left;"></span>            </span>            <span style="width:60%; float:left;"><input type="text" id="ap_field_12499" name="ap_field_12499" value="" style="" /></span>       </div>  <div style="width:95%; float:left; clear:both;margin:  0px 0px 3px 0px;">            <span style="width:35%; float:left;margin: 0px 0px 0px 5px; ">                 <span style=" font-weight:bold;float: left;">How Did You Hear About Us?</span>                 <span style=" font:italic helvetica smaller normal; float: left;"></span>            </span>            <span style="width:60%; float:left;"><select style="" id="ap_field_13179" name="ap_field_13179"><option value="Internet Search Engine (Google, Yahoo, etc)" >Internet Search Engine (Google, Yahoo, etc)</option><option value="Internet Yellow Pages" >Internet Yellow Pages</option><option value="PennySaver" >PennySaver</option><option value="The Gazette" >The Gazette</option><option value="Friend" >Friend</option><option value="" SELECTED CHECKED></option></select></span>       </div>  <div>            <span><input name="Submit" type="button" value="Submit" onclick="ap_validate_1070()"><p><span style="font-size:8pt;color:red;">* Required Field</span><a href="http://www.aimcrm.com" style="text-decoration:none;border:none;" title="lead management"><div style="font-size:8pt;color:black;"></div></a></p></span>       </div>  </div></form>';
if(!formShown){
     document.writeln(formHTML);
}
formShown=true;
}
var formShown = false;
showForm();