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<form method="post" class="af-form-wrapper" accept-charset="iso-8859-1" action="http://www.aweber.com/scripts/addlead.pl" >
<div style="display: none;">
<input type="hidden" name="meta_web_form_id" value="449192167" />
<input type="hidden" name="meta_split_id" value="" />
<input type="hidden" name="listname" value="mermaidsand" />
<input type="hidden" name="redirect" value="http://www.aweber.com/thankyou-coi.htm?m=text" id="redirect_862027566fa9751774e84c1e7346a7cd" />
<input type="hidden" name="meta_adtracking" value="bookmark_sign_up" />
<input type="hidden" name="meta_message" value="1" />
<input type="hidden" name="meta_required" value="name,email" />
<input type="hidden" name="meta_tooltip" value="custom State||Pick a state" />
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<div id="af-form-449192167" class="af-form"><div id="af-header-449192167" class="af-header"><div class="bodyText"><p> </p></div></div>
<div id="af-body-449192167" class="af-body af-standards">
<div class="af-element">
<label class="previewLabel" for="awf_field-67311339">Name: </label>
<div class="af-textWrap">
<input id="awf_field-67311339" type="text" name="name" class="text" value="" onfocus=" if (this.value == '') { this.value = ''; }" onblur="if (this.value == '') { this.value='';} " tabindex="500" />
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<div class="af-clear"></div></div>
<div class="af-element">
<label class="previewLabel" for="awf_field-67311341">Email: </label>
<div class="af-textWrap"><input class="text" id="awf_field-67311341" type="text" name="email" value="" tabindex="501" onfocus=" if (this.value == '') { this.value = ''; }" onblur="if (this.value == '') { this.value='';} " />
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</div>
<div class="af-element">
<label class="previewLabel" for="awf_field-67311342">Street address</label>
<div class="af-textWrap"><input type="text" id="awf_field-67311342" class="text" name="custom address" value="" onfocus=" if (this.value == '') { this.value = ''; }" onblur="if (this.value == '') { this.value='';} " tabindex="502" /></div>
<div class="af-clear"></div></div><div class="af-element">
<label class="previewLabel" for="awf_field-67311343">City:</label>
<div class="af-textWrap"><input type="text" id="awf_field-67311343" class="text" name="custom City" value="" onfocus=" if (this.value == '') { this.value = ''; }" onblur="if (this.value == '') { this.value='';} " tabindex="503" /></div>
<div class="af-clear"></div></div><div class="af-element">
<label class="previewLabel" for="awf_field-67311340">State:</label>
<div class="af-selectWrap"><select id="awf_field-67311340" name="custom State" tabindex="504" >
<option selected="selected" class="multiChoice" value="preSelectedHeadingSelected">Pick a state</option><option class="multiChoice" value="AL">AL</option>
<option class="multiChoice" value="AK">AK</option>
<option class="multiChoice" value="AZ">AZ</option>
<option class="multiChoice" value="AR">AR</option>
<option class="multiChoice" value="CA">CA</option>
<option class="multiChoice" value="CO">CO</option>
<option class="multiChoice" value="CT">CT</option>
<option class="multiChoice" value="DC">DC</option>
<option class="multiChoice" value="DE">DE</option>
<option class="multiChoice" value="FL">FL</option>
<option class="multiChoice" value="GA">GA</option>
<option class="multiChoice" value="HI">HI</option>
<option class="multiChoice" value="ID">ID</option>
<option class="multiChoice" value="IL">IL</option>
<option class="multiChoice" value="IN">IN</option>
<option class="multiChoice" value="IA">IA</option>
<option class="multiChoice" value="KS">KS</option>
<option class="multiChoice" value="KY">KY</option>
<option class="multiChoice" value="LA">LA</option>
<option class="multiChoice" value="ME">ME</option>
<option class="multiChoice" value="MD">MD</option>
<option class="multiChoice" value="MA">MA</option>
<option class="multiChoice" value="MI">MI</option>
<option class="multiChoice" value="MN">MN</option>
<option class="multiChoice" value="MS">MS</option>
<option class="multiChoice" value="MO">MO</option>
<option class="multiChoice" value="MT">MT</option>
<option class="multiChoice" value="NE">NE</option>
<option class="multiChoice" value="NV">NV</option>
<option class="multiChoice" value="NH">NH</option>
<option class="multiChoice" value="NJ">NJ</option>
<option class="multiChoice" value="NM">NM</option>
<option class="multiChoice" value="NY">NY</option>
<option class="multiChoice" value="NC">NC</option>
<option class="multiChoice" value="ND">ND</option>
<option class="multiChoice" value="OH">OH</option>
<option class="multiChoice" value="OK">OK</option>
<option class="multiChoice" value="OR">OR</option>
<option class="multiChoice" value="PA">PA</option>
<option class="multiChoice" value="PR">PR</option>
<option class="multiChoice" value="RI">RI</option>
<option class="multiChoice" value="SC">SC</option>
<option class="multiChoice" value="SD">SD</option>
<option class="multiChoice" value="TN">TN</option>
<option class="multiChoice" value="TX">TX</option>
<option class="multiChoice" value="UT">UT</option>
<option class="multiChoice" value="VT">VT</option>
<option class="multiChoice" value="VA">VA</option>
<option class="multiChoice" value="WA">WA</option>
<option class="multiChoice" value="WV">WV</option>
<option class="multiChoice" value="WI">WI</option>
<option class="multiChoice" value="WY">WY</option>
</select>
</div><input type="hidden" name="meta_preselected_awf_field-67311340" value=""/><div class="af-clear"></div></div><div class="af-element">
<label class="previewLabel" for="awf_field-67311345">Zip code:</label>
<div class="af-textWrap"><input type="text" id="awf_field-67311345" class="text" name="custom Zip code" value="" onfocus=" if (this.value == '') { this.value = ''; }" onblur="if (this.value == '') { this.value='';} " tabindex="505" /></div>
<div class="af-clear"></div></div><div class="af-element buttonContainer">
<input name="submit" id="af-submit-image-449192167" type="image" class="image" style="background: none; max-width: 100%;" alt="Submit Form" src="http://aweber.com/images/forms/plain/buttons/grey.png" tabindex="506" />
<div class="af-clear"></div>
</div>
<div class="af-element privacyPolicy" style="text-align: center"><p>We respect your <a title="Privacy Policy" href="http://www.aweber.com/permission.htm" target="_blank">email privacy</a></p>
<div class="af-clear"></div>
</div>
<div class="af-element poweredBy" style="text-align: center; font-size: 9px;"><p><a href="http://www.aweber.com" title="Email Marketing">Email Marketing</a> by AWeber</p>
<div class="af-clear"></div>
</div>
</div>
<div id="af-footer-449192167" class="af-footer"><div class="bodyText"><p> </p></div></div>
</div>
<div style="display: none;"><img src="http://forms.aweber.com/form/displays.htm?id=LCycjJxMjGzs" alt="" /></div>
</form>
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