<style>
.link,
.signupframe {
	color: #226699;
	font-family: Arial, Helvetica, sans-serif;
	}
	.link {
		text-decoration: none;
		}
	.signupframe {
		border: 1px solid #000000;
		background: #ffffff;
		}
</style>
<form method=post action="https://app.icontact.com/icp/signup.php" name="icpsignup" id="icpsignup929" accept-charset="UTF-8" onsubmit="return verifyRequired929();" >
<input type=hidden name=redirect value="http://www.domainname.com/thank-you" />
<input type=hidden name=errorredirect value="http://www.icontact.com/www/signup/error.html" />
 
<div id="SignUp">
<table width="260" class="signupframe" border="0" cellspacing="0" cellpadding="5">
	<tr>
      <td valign=top align=right>
        <font size="1" face="Arial,Helvetica, sans-serif">*</font> <font size="2">Email</font>
      </td>
      <td align=left>
        <input type=text name="fields_email">
      </td>
    </tr>
    <input type=hidden name="listid" value="15074">
    <input type=hidden name="specialid:15074" value="G5JF">
 
    <input type=hidden name=clientid value="717631">
    <input type=hidden name=formid value="929">
    <input type=hidden name=reallistid value="1">
    <input type=hidden name=doubleopt value="0">
    <TR>
      <TD> </TD>
      <TD><font size="1">*</font><font size="2"> = Required Field</FONT></TD>
    </TR>
    <tr>
      <td> </td>
      <td><input type="submit" name="Submit" value="Submit"></td>
    </tr>
    </table>
</div>
</form>
<script type="text/javascript">
 
var icpForm929 = document.getElementById('icpsignup929');
 
if (document.location.protocol === "https:")
 
	icpForm929.action = "https://app.icontact.com/icp/signup.php";
function verifyRequired929() {
  if (icpForm929["fields_email"].value == "") {
    icpForm929["fields_email"].focus();
    alert("The Email field is required.");
    return false;
  }
 
 
return true;
}
</script>
<a class="link" href="http://www.icontact.com"><font size="2">Email Marketing You Can Trust</font></a>