document.write('');
document.write('  <table align="center">');
document.write('<form method="post" action="http://111620.formmailer.onetwomax.de/">');
document.write('    <tr>');
document.write('      <td>Your Name and Surname/ Dein Name und Vorname *</td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id3]" value="" size="50">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td>Your e-mail / Deine E-Mail *<br><font color="#DF0174"><b><i>Please check correct spelling before send.');
document.write('<BR>');
document.write('Bitte achte auf Schreibfehler vor dem senden.</i></b></font></td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id4]" value="" size="50">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td>Your Mobile Nr. / Deine Handy Nr<br><font size="2">e.g. +254 722 412302');
document.write('<BR>');
document.write('We can contact you with SMS');
document.write('<BR>');
document.write('Wir können dich per SMS kotaktieren</font></td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id14]" value="" size="50">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td>Date of travel / Reisedatum</td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id8]" value="" size="50">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td>Hotel of your stay / Urlaubshotel</td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id9]" value="" size="50">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td>Interested in / Interessier in</td>');
document.write('      <td>');
document.write('        <select name="user_input[id11]">');
document.write('          <option value="0">Please select / Bitte wählen ');
document.write('</option>');
document.write('          <option value="1">Diving / Tauchen');
document.write('</option>');
document.write('          <option value="2">PADI Open Water Diver Course / Kurs');
document.write('</option>');
document.write('          <option value="3">PADI Advanced Open Water Diver Course / Kurs .');
document.write('</option>');
document.write('          <option value="4">PADI Speciality Course / Kurs');
document.write('</option>');
document.write('          <option value="5">PADI Rescue Diver Course / Kurs');
document.write('</option>');
document.write('          <option value="6">PADI Divemaster Course / Kurs');
document.write('</option>');
document.write('          <option value="7">Other / andere</option>');
document.write('        </select>');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td>Number of participants / Anzahl Teilnehmer</td>');
document.write('      <td>');
document.write('        <select name="user_input[id13]">');
document.write('          <option value="0">Please select / Bitte wählen . . . . . . . . . . . . . . . . . . . . . . ');
document.write('</option>');
document.write('          <option value="1">1');
document.write('</option>');
document.write('          <option value="2">2 ');
document.write('</option>');
document.write('          <option value="3">3 ');
document.write('</option>');
document.write('          <option value="4">4 ');
document.write('</option>');
document.write('          <option value="5">5 ');
document.write('</option>');
document.write('          <option value="6">6 ');
document.write('</option>');
document.write('          <option value="7">7 ');
document.write('</option>');
document.write('          <option value="8">6 ');
document.write('</option>');
document.write('          <option value="9">9 ');
document.write('</option>');
document.write('          <option value="10">10 ');
document.write('</option>');
document.write('          <option value="11">more than 10 / mehr als 10</option>');
document.write('        </select>');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td>Travelling from / Anreise von</td>');
document.write('      <td>');
document.write('        <select name="user_input[id12]">');
document.write('          <option value="0">Please select / Bitte wählen . . . . . . . . . . . . . . . . . . . . . .                          ');
document.write('</option>');
document.write('          <option value="1">');
document.write('</option>');
document.write('          <option value="2">Australia');
document.write('</option>');
document.write('          <option value="3">Austria');
document.write('</option>');
document.write('          <option value="4">Belgium ');
document.write('</option>');
document.write('          <option value="5">Czech Republic');
document.write('</option>');
document.write('          <option value="6">Denmark');
document.write('</option>');
document.write('          <option value="7">Finland');
document.write('</option>');
document.write('          <option value="8">France');
document.write('</option>');
document.write('          <option value="9">Germany');
document.write('</option>');
document.write('          <option value="10">Italy');
document.write('</option>');
document.write('          <option value="11">Kenya');
document.write('</option>');
document.write('          <option value="12">Ireland');
document.write('</option>');
document.write('          <option value="13">Norway');
document.write('</option>');
document.write('          <option value="14">Poland');
document.write('</option>');
document.write('          <option value="15">Portugal');
document.write('</option>');
document.write('          <option value="16">Russia');
document.write('</option>');
document.write('          <option value="17">South Africa');
document.write('</option>');
document.write('          <option value="18">Sweden');
document.write('</option>');
document.write('          <option value="19">Switzerland');
document.write('</option>');
document.write('          <option value="20">Tanzania');
document.write('</option>');
document.write('          <option value="21">United Kingdom');
document.write('</option>');
document.write('          <option value="22">United States of America');
document.write('</option>');
document.write('          <option value="23">');
document.write('</option>');
document.write('          <option value="24">');
document.write('</option>');
document.write('          <option value="25">Afghanistan');
document.write('</option>');
document.write('          <option value="26">Albania');
document.write('</option>');
document.write('          <option value="27">Algeria');
document.write('</option>');
document.write('          <option value="28">Andorra');
document.write('</option>');
document.write('          <option value="29">Angola');
document.write('</option>');
document.write('          <option value="30">Antigua and Barbuda');
document.write('</option>');
document.write('          <option value="31">Argentina');
document.write('</option>');
document.write('          <option value="32">Armenia');
document.write('</option>');
document.write('          <option value="33">Azerbaijan');
document.write('</option>');
document.write('          <option value="34">Bahamas');
document.write('</option>');
document.write('          <option value="35">Bahrain');
document.write('</option>');
document.write('          <option value="36">Bangladesh');
document.write('</option>');
document.write('          <option value="37">Barbados');
document.write('</option>');
document.write('          <option value="38">Belarus');
document.write('</option>');
document.write('          <option value="39">Belize');
document.write('</option>');
document.write('          <option value="40">Benin');
document.write('</option>');
document.write('          <option value="41">Bhutan');
document.write('</option>');
document.write('          <option value="42">Bolivia');
document.write('</option>');
document.write('          <option value="43">Botswana');
document.write('</option>');
document.write('          <option value="44">Bosnia and Herzegovina');
document.write('</option>');
document.write('          <option value="45">Brazil');
document.write('</option>');
document.write('          <option value="46">Brunei');
document.write('</option>');
document.write('          <option value="47">Bulgaria');
document.write('</option>');
document.write('          <option value="48">Burkina Faso');
document.write('</option>');
document.write('          <option value="49">Burundi');
document.write('</option>');
document.write('          <option value="50">Cambodia');
document.write('</option>');
document.write('          <option value="51">Cameroon');
document.write('</option>');
document.write('          <option value="52">Canada');
document.write('</option>');
document.write('          <option value="53">Cape Verde');
document.write('</option>');
document.write('          <option value="54">Central African Republic');
document.write('</option>');
document.write('          <option value="55">Chad');
document.write('</option>');
document.write('          <option value="56">Chile');
document.write('</option>');
document.write('          <option value="57">China');
document.write('</option>');
document.write('          <option value="58">Colombia');
document.write('</option>');
document.write('          <option value="59">Comoros');
document.write('</option>');
document.write('          <option value="60">Congo');
document.write('</option>');
document.write('          <option value="61">Costa Rica');
document.write('</option>');
document.write('          <option value="62">Côte d\'Ivoire');
document.write('</option>');
document.write('          <option value="63">Croatia');
document.write('</option>');
document.write('          <option value="64">Cuba');
document.write('</option>');
document.write('          <option value="65">Cyprus');
document.write('</option>');
document.write('          <option value="66">Djibouti');
document.write('</option>');
document.write('          <option value="67">Dominica');
document.write('</option>');
document.write('          <option value="68">Dominican Republic');
document.write('</option>');
document.write('          <option value="69">East Timor');
document.write('</option>');
document.write('          <option value="70">Ecuador');
document.write('</option>');
document.write('          <option value="71">Egypt');
document.write('</option>');
document.write('          <option value="72">El Salvador');
document.write('</option>');
document.write('          <option value="73">Equatorial Guinea');
document.write('</option>');
document.write('          <option value="74">Eritrea');
document.write('</option>');
document.write('          <option value="75">Estonia');
document.write('</option>');
document.write('          <option value="76">Ethiopia |');
document.write('</option>');
document.write('          <option value="77">Fijii');
document.write('</option>');
document.write('          <option value="78">French Guiana');
document.write('</option>');
document.write('          <option value="79">Gabon');
document.write('</option>');
document.write('          <option value="80">The Gambia');
document.write('</option>');
document.write('          <option value="81">Georgia');
document.write('</option>');
document.write('          <option value="82">Ghana');
document.write('</option>');
document.write('          <option value="83">Greece');
document.write('</option>');
document.write('          <option value="84">Grenada');
document.write('</option>');
document.write('          <option value="85">Guatemala');
document.write('</option>');
document.write('          <option value="86">Guinea');
document.write('</option>');
document.write('          <option value="87">Guinea-Bissau');
document.write('</option>');
document.write('          <option value="88">Guyana');
document.write('</option>');
document.write('          <option value="89">Haiti');
document.write('</option>');
document.write('          <option value="90">Honduras');
document.write('</option>');
document.write('          <option value="91">Hong Kong');
document.write('</option>');
document.write('          <option value="92">Hungary');
document.write('</option>');
document.write('          <option value="93">Iceland');
document.write('</option>');
document.write('          <option value="94">India');
document.write('</option>');
document.write('          <option value="95">Indonesia');
document.write('</option>');
document.write('          <option value="96">Iran');
document.write('</option>');
document.write('          <option value="97">Iraq');
document.write('</option>');
document.write('          <option value="98">Israel');
document.write('</option>');
document.write('          <option value="99">Jamaica');
document.write('</option>');
document.write('          <option value="100">Japan');
document.write('</option>');
document.write('          <option value="101">Jordan');
document.write('</option>');
document.write('          <option value="102">Kazakhstan');
document.write('</option>');
document.write('          <option value="103">Korea, North');
document.write('</option>');
document.write('          <option value="104">Korea, South');
document.write('</option>');
document.write('          <option value="105">Kuwait');
document.write('</option>');
document.write('          <option value="106">Kyrgyzstan');
document.write('</option>');
document.write('          <option value="107">Laos');
document.write('</option>');
document.write('          <option value="108">Latvia');
document.write('</option>');
document.write('          <option value="109">Lebanon');
document.write('</option>');
document.write('          <option value="110">Lesotho');
document.write('</option>');
document.write('          <option value="111">Liberia');
document.write('</option>');
document.write('          <option value="112">Libya');
document.write('</option>');
document.write('          <option value="113">Lithuani');
document.write('</option>');
document.write('          <option value="114">Luxembourg');
document.write('</option>');
document.write('          <option value="115">MMacao');
document.write('</option>');
document.write('          <option value="116">Macedonia');
document.write('</option>');
document.write('          <option value="117">Malawi');
document.write('</option>');
document.write('          <option value="118">Malaysia');
document.write('</option>');
document.write('          <option value="119">Maldives');
document.write('</option>');
document.write('          <option value="120">Mali');
document.write('</option>');
document.write('          <option value="121">Malta');
document.write('</option>');
document.write('          <option value="122">Marshall Islands');
document.write('</option>');
document.write('          <option value="123">Mauritania');
document.write('</option>');
document.write('          <option value="124">Mauritius');
document.write('</option>');
document.write('          <option value="125">Micronesia');
document.write('</option>');
document.write('          <option value="126">Moldova');
document.write('</option>');
document.write('          <option value="127">Monaco');
document.write('</option>');
document.write('          <option value="128">Mongolia');
document.write('</option>');
document.write('          <option value="129">Morocco');
document.write('</option>');
document.write('          <option value="130">Mexico');
document.write('</option>');
document.write('          <option value="131">Mozambique');
document.write('</option>');
document.write('          <option value="132">Myanmar (Burma)');
document.write('</option>');
document.write('          <option value="133">Namibia');
document.write('</option>');
document.write('          <option value="134">Nauru');
document.write('</option>');
document.write('          <option value="135">Nepal');
document.write('</option>');
document.write('          <option value="136">Netherlands');
document.write('</option>');
document.write('          <option value="137">New Zealand');
document.write('</option>');
document.write('          <option value="138">Nicaragua');
document.write('</option>');
document.write('          <option value="139">Niger');
document.write('</option>');
document.write('          <option value="140">Nigeria');
document.write('</option>');
document.write('          <option value="141">Oman');
document.write('</option>');
document.write('          <option value="142">Panama');
document.write('</option>');
document.write('          <option value="143">Peru');
document.write('</option>');
document.write('          <option value="144">Pakistan');
document.write('</option>');
document.write('          <option value="145">Papua New Guinea');
document.write('</option>');
document.write('          <option value="146">Palau');
document.write('</option>');
document.write('          <option value="147">Qatar');
document.write('</option>');
document.write('          <option value="148">Romania');
document.write('</option>');
document.write('          <option value="149">Rwanda');
document.write('</option>');
document.write('          <option value="150">St. Kitts and Nevis');
document.write('</option>');
document.write('          <option value="151">Saint Lucia');
document.write('</option>');
document.write('          <option value="152">St. Vincent and the Grenadines');
document.write('</option>');
document.write('          <option value="153">Samoa');
document.write('</option>');
document.write('          <option value="154">San Marino');
document.write('</option>');
document.write('          <option value="155">São Tomé and Príncipe ');
document.write('</option>');
document.write('          <option value="156">Saudi Arabia');
document.write('</option>');
document.write('          <option value="157">Senegal');
document.write('</option>');
document.write('          <option value="158">Serbia and Montenegro');
document.write('</option>');
document.write('          <option value="159">Seychelles');
document.write('</option>');
document.write('          <option value="160">Sierra Leone');
document.write('</option>');
document.write('          <option value="161">Singapore');
document.write('</option>');
document.write('          <option value="162">Slovakia');
document.write('</option>');
document.write('          <option value="163">Slovenia');
document.write('</option>');
document.write('          <option value="164">Solomon Islands');
document.write('</option>');
document.write('          <option value="165">Somalia');
document.write('</option>');
document.write('          <option value="166">Spain');
document.write('</option>');
document.write('          <option value="167">Sri Lanka');
document.write('</option>');
document.write('          <option value="168">Sudan');
document.write('</option>');
document.write('          <option value="169">Suriname');
document.write('</option>');
document.write('          <option value="170">Swaziland');
document.write('</option>');
document.write('          <option value="171">Syria');
document.write('</option>');
document.write('          <option value="172">Taiwan');
document.write('</option>');
document.write('          <option value="173">Tajikistan');
document.write('</option>');
document.write('          <option value="174">Togo');
document.write('</option>');
document.write('          <option value="175">Thailand');
document.write('</option>');
document.write('          <option value="176">Trinidad and Tobago');
document.write('</option>');
document.write('          <option value="177">Tunisia');
document.write('</option>');
document.write('          <option value="178">Turkey');
document.write('</option>');
document.write('          <option value="179">Turkmenistan');
document.write('</option>');
document.write('          <option value="180">Tuvalu');
document.write('</option>');
document.write('          <option value="181">Uganda');
document.write('</option>');
document.write('          <option value="182">Ukraine');
document.write('</option>');
document.write('          <option value="183">United Arab Emirates');
document.write('</option>');
document.write('          <option value="184">Uruguay');
document.write('</option>');
document.write('          <option value="185">Uzbekistan');
document.write('</option>');
document.write('          <option value="186">Venezuela');
document.write('</option>');
document.write('          <option value="187">Vietnam');
document.write('</option>');
document.write('          <option value="188">West Bank');
document.write('</option>');
document.write('          <option value="189">Western Sahara');
document.write('</option>');
document.write('          <option value="190">Yemen');
document.write('</option>');
document.write('          <option value="191">Yugoslavia');
document.write('</option>');
document.write('          <option value="192">Zaire');
document.write('</option>');
document.write('          <option value="193">Zambia');
document.write('</option>');
document.write('          <option value="194">Zimbabwe</option>');
document.write('        </select>');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td>Your Message / Deine Nachricht *</td>');
document.write('      <td>');
document.write('        <textarea name="user_input[id6]" style="width:100%" rows="7"></textarea>');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td colspan="2" align="center" valign="middle">');
document.write('        <input type="hidden" name="mq" value="\'">');
document.write('        <input type="hidden" name="action" value="send_mail">');
document.write('        <input type="hidden" name="entry" value="111620">');
document.write('        <input type="submit" name="submit" value="Abschicken">');
document.write('        <input type="reset" name="reset" value="Zur&uuml;cksetzen">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td colspan="2" align="center"><font size="-2">Powered by <a href="http://www.onetwomax.de" target="_blank">OneTwoMax</a> Formmailer Script</font></td>');
document.write('    </tr>');
document.write('</form>');
document.write('  </table>');
document.write('');