document.write("<title>Demystifying Chakras</title>\n");
document.write("Fill out the following information and click 'Submit'.<br>\n");
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document.write("<table border=\"0\" cellspacing=\"0\" cellpadding=\"3\">\n");
document.write("<tr><td nowrap class=\"textLabel\" align=\"left\" >*Full Name:</td><td align=left valign=top nowrap class=\"textLabel\"><input  onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=\"text\" name=\"FullName\"  size=\"30\"  > <!-- tr ph 0--></td></tr>\n");
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document.write("<tr><td colspan=2 align=\"center\"><input onmouseover=\"className='buttonfieldFocus'\" onmouseout=\"className='buttonfield'\" class=\"buttonfield\" type=button value=\"Back\" onClick=\"history.back();\"><input onmouseover=\"className='buttonfieldFocus'\" onmouseout=\"className='buttonfield'\" class=\"buttonfield\" type=submit value=\"Submit\"></td></tr>\n");
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