
function CheckField25763(fldName){ if ( document.frmLB25763[fldName].length ) { for ( var i = 0, l = document.frmLB25763[fldName].length; i < l; i++ ) {  if (  document.frmLB25763[fldName].type =='select-one' ) {   if ( document.frmLB25763[fldName][i].selected ) { return true; }    }  else    {     if ( document.frmLB25763[fldName][i].checked ) { return true; }    }; } return false; } else { document.frmLB25763[fldName].focus(); return (document.frmLB25763[fldName].value.length > 0);}}
function rmspaces(x) {var leftx = 0;var rightx = x.length -1;while ( x.charAt(leftx) == ' ') { leftx++; }while ( x.charAt(rightx) == ' ') { --rightx; }var q = x.substr(leftx,rightx-leftx + 1);if ( (leftx == x.length) && (rightx == -1) ) { q =''; } return(q); }
function checkfield(data) {if (rmspaces(data) == ""){return false;}else {return true;}}
function isemail(data) {var flag = false;if (  data.indexOf("@",0)  == -1 || data.indexOf("\\",0)  != -1 ||data.indexOf("/",0)  != -1 ||!checkfield(data) ||  data.indexOf(".",0)  == -1  ||  data.indexOf("@")  == 0 ||data.lastIndexOf(".") < data.lastIndexOf("@") ||data.lastIndexOf(".") == (data.length - 1)   ||data.lastIndexOf("@") !=   data.indexOf("@") ||data.indexOf(",",0)  != -1 ||data.indexOf(":",0)  != -1 ||data.indexOf(";",0)  != -1  ) {return flag;} else {var temp = rmspaces(data);if (temp.indexOf(' ',0) != -1) { flag = true; }var d3 = temp.lastIndexOf('.') + 4;var d4 = temp.substring(0,d3);var e2 = temp.length  -  temp.lastIndexOf('.')  - 1;var i1 = temp.indexOf('@');if (  (temp.charAt(i1+1) == '.') || ( e2 > 4 )  ||  ( e2 < 2 ) ) { flag = true; }return !flag;}}
function _checkSubmit25763(){
if ( !isemail(document.frmLB25763["fldEmail"].value) ) { 
   alert("Please enter the Email");
   return false;
}
 return true; }
 document.write("<div align=\"center\"><form style=\"display:inline;\" action=\"http://lb.benchmarkemail.com//code/lbform\" method=post name=\"frmLB25763\" accept-charset=\"UTF-8\" onsubmit=\"return _checkSubmit25763();\" ><input type=hidden name=successurl value=\"http://www.benchmarkemail.com/Code/ThankYouOptin\" /><input type=hidden name=errorurl value=\"http://lb.benchmarkemail.com//Code/Error\" /><input type=hidden name=token value=\"mFcQnoBFKMQhXw3hVnIm7%2BoNbCMyivkXusCNcFvFvDk%3D\" /><input type=hidden name=doubleoptin value=\"\" /><table id=tblFormLogo25763 width=\"220\" border=\"0\" cellspacing=\"0\" cellpadding=\"0\" ><tr><td id='tdLogo25763' align=center><img src=\"http://images.benchmarkemail.com/client58922/lb25763.jpg\" /></td></tr></table><table id=tblFormData25763 width=\"220\" border=\"0\" cellspacing=\"0\" cellpadding=\"0\"  style=\"border: 1px solid #494949;background: #fffee6;color: #000000; font-family:Arial; font-size:12px\"><tr><td valign=top id=tblForm25763 bgcolor=\"#fffee6\" ><table width='100%' border=0 cellspacing=0 cellpadding=0><tr><td id=tdHeader25763 align=left valign=top bgcolor=\"#971E42\"  style=\"color:#ffffff;font-family:Arial;font-size:16px;padding:5px 5px 5px 10px;\"><b>Join Our Preferred Customer Program</b></td></tr></table><div style=\"padding:20px;\"><table border=0 cellspacing=0 cellpadding=0><tr><td valign=top id=tdIntro25763 align=left style=\"font-family:Arial;font-size:12px;color:#000000;\">Join the Medical Aesthetics of New England, PC Preferred Customer Program for Special Offers, E-newsletters & much more! Remember to add gwalter@medicalaestheticsne.com to your address book to ensure you will receive your confirmation email. You may also want to check your spam folder if you do not receive a confirmation email in the next 24 hours. Once you click on the link to confirm, you will start to receive all Medical Aesthetics of New England, PC Preferred Customer Program emails.<br /></td></tr></table><table id=tblFieldData25763 border=0 cellpadding=0 cellspacing=0 style=\"background: #fffee6;color: #000000; font-family:Arial; font-size:12px\"><tr><td valign=top align=left style='padding:0px 0px 10px 0px'><div style='width:120px;float:left;padding-top:5px;'><b>Email <span style='color:#CC0000;font-size:125%;'> *</span> </b></div><br clear=all /><div style='float:left;padding-top:3px;'><input type=text style='width:180px' name=fldEmail maxlength=100 /></div></td></tr><tr><td valign=top align=left style='padding:0px 0px 10px 0px'><div style='width:120px;float:left;padding-top:5px;'><b>First Name</b></div><br clear=all /><div style='float:left;padding-top:3px;'><input type=text style='width:180px' name=fldfirstname maxlength=100 /></div></td></tr><tr><td valign=top align=left style='padding:0px 0px 10px 0px'><div style='width:120px;float:left;padding-top:5px;'><b>Last Name</b></div><br clear=all /><div style='float:left;padding-top:3px;'><input type=text style='width:180px' name=fldlastname maxlength=100 /></div></td></tr><tr><td valign=top align=left style='padding:0px 0px 10px 0px'><div style='width:120px;float:left;padding-top:5px;'><b>Birthday</b></div><br clear=all /><div style='float:left;padding-top:3px;'><input type=text style='width:180px' name=fldfield19 maxlength=100 /></div></td></tr></table></div></td></tr><tr><td valign=top id='tdSep25763' style='background-color:#494949;padding:0px;' ><img src='http://lb.benchmarkemail.com//images/blank.gif' height=1 width=1 /></td></tr><tr><td valign=top style='padding-top:10px;padding-bottom:10px;' align=center><input type=\"submit\" id=\"btnSubmit\" value=\"Save\" style='font-size:12px;font-family:Arial;padding-left:10px;padding-right:10px;color:#000000;' /></td></tr></table><table id=\"tblRequiredField25763\" width=\"220\" border=\"0\" cellspacing=\"0\" cellpadding=\"0\" ><tr><td align=right style='font-size:10px;'>* Required Field </td></tr></table></form></div><!-- BEGIN: Email Marketing By Benchmark Email ------><div align=\"center\" style=\"padding-top:5px;font-family:Arial,Helvetica,sans-serif;font-size:10px;color:#999999;\"><a href=\"http://www.benchmarkemail.com/email-marketing/email-campaigns\" target=_new style=\"text-decoration:none;font-family:Arial,Helvetica,sans-serif;font-size:10px;color:#999999;\">Email Campaign</a> by Benchmark Email</div>");