document.write('<form action=\"http://be-spa.niouzletter.com/inscription.php\" method=\"POST\" id=\"NLform\" onsubmit=\"return NLverifierInscription();\"><input type=\"hidden\" name=\"cle\" value=\"1b3479c624616d77247164672\" /><script src=\"http://be-spa.niouzletter.com/js/formulaire.js\"></script><style type=\"text/css\">.form_erreur { border:2px solid #fdb33c !important; background-image:url(\'http://be-spa.niouzletter.com/images/form/ic-form-erreur.gif\'); background-repeat:no-repeat; background-position:right;}.form_ok { background-image:url(\'http://be-spa.niouzletter.com/images/form/ic-form-ok.gif\'); background-repeat:no-repeat; background-position:right;}#div_infoBulle { position:absolute; width:260px; height:69px; display:none;background-image:url(\'http://be-spa.niouzletter.com.niouzletter.com/images2/form/etiquette-erreur.png\');}#div_infoBulle p { margin-left:50px; margin-top:8px; width:210px; height:30px; color:white; overflow:hidden;}</style><div class=\"NLConteneur\"><div align=\"center\">* Champs obligatoires</div><table align=\"center\" class=\"NLTable\">	<input type=\'hidden\' id=\'NLemail_oblig\' />	            <tr>                <td><span class=\"TXTemail\">Email* :</span></td>                <td>		<input type=\"text\" value=\"\" name=\"email\"  id=\"NLemail\" class=\"NLemail\" />                </td></tr>               <tr>                <td><span class=\"TXTnom_societe\">Nom société :</span></td>                <td>		<input type=\"text\" value=\"\" name=\"nom_societe\"  id=\"NLnom_societe\" class=\"NLnom_societe\" />                </td></tr>   	<input type=\'hidden\' id=\'NLnom_oblig\' />	            <tr>                <td><span class=\"TXTnom\">Nom* :</span></td>                <td>		<input type=\"text\" value=\"\" name=\"nom\"  id=\"NLnom\" class=\"NLnom\" />                </td></tr>   	<input type=\'hidden\' id=\'NLprenom_oblig\' />	            <tr>                <td><span class=\"TXTprenom\">Prénom* :</span></td>                <td>		<input type=\"text\" value=\"\" name=\"prenom\"  id=\"NLprenom\" class=\"NLprenom\" />                </td></tr>   	<input type=\'hidden\' id=\'NLadresse_oblig\' />	            <tr>                <td><span class=\"TXTadresse\">Adresse* :</span></td>                <td>		<input type=\"text\" value=\"\" name=\"adresse\"  id=\"NLadresse\" class=\"NLadresse\" />                </td></tr>   	<input type=\'hidden\' id=\'NLcp_oblig\' />	            <tr>                <td><span class=\"TXTcp\">Cp* :</span></td>                <td>		<input type=\"text\" value=\"\" name=\"cp\"  id=\"NLcp\" class=\"NLcp\" />                </td></tr>   	<input type=\'hidden\' id=\'NLville_oblig\' />	            <tr>                <td><span class=\"TXTville\">Ville* :</span></td>                <td>		<input type=\"text\" value=\"\" name=\"ville\"  id=\"NLville\" class=\"NLville\" />                </td></tr>   	<input type=\'hidden\' id=\'NLtel_oblig\' />	            <tr>                <td><span class=\"TXTtel\">Tel* :</span></td>                <td>		<input type=\"text\" value=\"\" name=\"tel\"  id=\"NLtel\" class=\"NLtel\" />                </td></tr>               <tr>                <td><span class=\"TXTptb\">GSM :</span></td>                <td>		<input type=\"text\" value=\"\" name=\"ptb\"  id=\"NLptb\" class=\"NLptb\" />                </td></tr>       </td></tr>   <tr><td colspan=\"2\"><button type=\"submit\" id=\"NLsubmit\">S\'inscrire</button></td></tr></table></div></form>')