function writeSupportForm(prodName, flag) {
	document.write('<table width"100%" cellpadding="0" cellspacing="0" border="0">');
	document.write('<tr>');
	document.write('<td>The form below will allow you to enter our secure training materials site. You will receive a username and password via email within 3 business days, then you will have access to the training materials.</td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td>Required Fields are denoted with <span class="required">*</span>.</td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td colspan="2" valign="top" align="right">');
	document.write('<table cellpadding="0" cellspacing="0" width="100%" border="0">');
	document.write('<tr>');
	document.write('<td>');
	document.write('<form id="supportform" name="supportform" method="post" action="/email_send/GenericEmailRedirect.jsp">');
	document.write('<input type="hidden" name="subject" id="subject" value="SB5 University Training Resources Password Request">');
	document.write('<input type="hidden" name="toAddress" id="toAddress" value="RPC_Customer_Service@hmhpub.com">');
	document.write('<input type="hidden" name="redirectPath" id="redirectPath" value="/products/sb5/thankyou.html">');
	document.write('<input type="hidden" name="required" value="Name, Title, School or Organization, Address Line 1, City, State, Zip, Email, Phone, Licensed In, License Number, License State, Expiration Date">');
	document.write('<input type="hidden" name="print_config" value="name">');
	document.write('<input type="hidden" name="htmlContent" id="htmlContent" value="" />');
	document.write('<td align="left" valign="top">');
	document.write('<table width="100%" cellpadding="0" cellspacing="0" border="0">');
	document.write('<tr>');
	document.write('<td width="40"><img src="/images/site/spacer.gif" width="20" height="1"></td>');
	document.write('<td>');
	document.write('<table cellpadding="0" cellspacing="0" border="0" width="350">');
	document.write('<tr>');
	document.write('<td colspan="3"><img src="/images/site/spacer.gif" height="5"></td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td colspan="3">Name<span class="required">*</span></td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td colspan="3"><input type="text" size="70" name="Name" id="name"></td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td colspan="3">Job Title<span class="required">*</span></td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td colspan="3"><input type="text" size="70" name="Title" id="JobTitle"></td>');
	document.write('</tr>');
	document.write('<TR>');
	document.write('<td colspan="3">School or Organization<span class="required">*</span></td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td colspan="3"><input type="text" size="70" name="School or Organization" id="SchoolorOrganization"></td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td colspan="3"><img src="/images/site/spacer.gif" height="5"></td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td colspan="3">Address Line 1<span class="required">*</span></td>');
	document.write('</tr>');
	document.write('<Tr>');
	document.write('<td colspan="3"><input type="text" size="70" name="Address Line 1" id="address"></td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td colspan="3"><img src="/images/site/spacer.gif" height="5"></td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td colspan="3">Address Line 2</td>');
	document.write('</tr>');
	document.write('<Tr>');
	document.write('<td colspan="3"><input type="text" size="70" name="addr_2"></td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td colspan="3"><img src="/images/site/spacer.gif" height="5"></td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td width="33%">City<span class="required">*</span></td>');
	document.write('<td width="33%" align="center">State<span class="required">*</span></td>');
	document.write('<td width="33%">Zip Code<span class="required">*</span></td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td width="33%"><input type="text" name="City" id="city"></td>');
	document.write('<td width="33%" align="center"><input size="2" type="text" name="State" id="state"></td>');
	document.write('<td width="33%"><input size="9" type="text" name="Zip" id="zip"></td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td colspan="3"><img src="/images/site/spacer.gif" height="5"></td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td colspan="3">Email Address<span class="required">*</span></td>');
	document.write('</tr>');
	document.write('<Tr>');
	document.write('<td colspan="3"><input type="text" size="70" name="Email" id="email"></td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td colspan="3"><img src="/images/site/spacer.gif" height="5"></td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td colspan="3">Phone<span class="required">*</span></td>');
	document.write('</tr>');
	document.write('<Tr>');
	document.write('<td colspan="3"><input type="text" name="Phone" id="phone"></td>');
	document.write('</tr>');	
	document.write('<tr>');
	document.write('<td colspan="3"><img src="/images/site/spacer.gif" height="10"></td>');
	document.write('</tr>');
	
	document.write('<tr>');
	document.write('<td colspan="3">Licensed In (Area)<span class="required">*</span></td>');
	document.write('</tr>');
	document.write('<Tr>');
	document.write('<td colspan="3"><input type="text" name="Licensed In" id="LicensedIn"></td>');
	document.write('</tr>');	
	document.write('<tr>');
	document.write('<td colspan="3"><img src="/images/site/spacer.gif" height="10"></td>');
	document.write('</tr>');	
	document.write('<tr>');
	document.write('<td width="33%">License Number<span class="required">*</span></td>');
	document.write('<td width="33%" align="center">State<span class="required">*</span></td>');
	document.write('<td width="33%">Expiration Date<span class="required">*</span></td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td width="33%"><input type="text" name="License Number" id="LicenseNumber"></td>');
	document.write('<td width="33%" align="center"><input size="2" type="text" name="License State"></td>');
	document.write('<td width="33%"><input size="9" type="text" name="Expiration Date"></td>');
	document.write('</tr>');	
	document.write('<tr>');
	document.write('<td colspan="3"><img src="/images/site/spacer.gif" height="10"></td>');
	document.write('</tr>');
	
	document.write('<tr>');
	document.write('<td colspan="3">Professional Credentials / Level of Training</td>');
	document.write('</tr>');	
	document.write('<tr>');
	document.write('<td colspan="3"><img src="/images/site/spacer.gif" height="10"></td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td width="33%">Bachelor Degree</td>');
	document.write('<td width="33%" align="center">Year</td>');
	document.write('<td width="33%">Institution</td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td width="33%"><input type="text" name="bachelor_degree"></td>');
	document.write('<td width="33%" align="center"><input size="4" type="text" name="bachelor_year"></td>');
	document.write('<td width="33%"><input size="20" type="text" name="bachelor_institution"></td>');
	document.write('</tr>');	
	document.write('<tr>');
	document.write('<td colspan="3"><img src="/images/site/spacer.gif" height="10"></td>');
	document.write('</tr>');	
	document.write('<tr>');
	document.write('<td width="33%">Masteral Degree</td>');
	document.write('<td width="33%" align="center">Year</td>');
	document.write('<td width="33%">Institution</td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td width="33%"><input type="text" name="masteral_degree"></td>');
	document.write('<td width="33%" align="center"><input size="4" type="text" name="masteral_year"></td>');
	document.write('<td width="33%"><input size="20" type="text" name="masteral_institution"></td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td colspan="3"><img src="/images/site/spacer.gif" height="10"></td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td width="33%">Doctoral Degree</td>');
	document.write('<td width="33%" align="center">Year</td>');
	document.write('<td width="33%">Institution</td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td width="33%"><input type="text" name="doctoral_degree"></td>');
	document.write('<td width="33%" align="center"><input size="4" type="text" name="doctoral_year"></td>');
	document.write('<td width="33%"><input size="20" type="text" name="doctoral_institution"></td>');
	document.write('</tr>');
	
	document.write('<tr>');
	document.write('<td colspan="3"><input type="hidden" name="product" size="50" value="SB5 Training Resources Web Password Request"></td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td colspan="3"><img src="/images/site/spacer.gif" height="10"></td>');
	document.write('</tr>');
	
	document.write('<tr>');
	document.write('<td colspan="3">Your educational background (courses and other study):</td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td colspan="3">a. Courses (course completed and level at which course was completed)</td>');
	document.write('</tr>')
	document.write('<tr>');
	document.write('<td colspan="3"><img src="/images/site/spacer.gif" height="10"></td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td colspan="3">U=Undergraduate; G=Graduate; O=Other (special courses you have completed, workshops, in-service training, etc.)</td>');
	document.write('</tr>')
	document.write('<tr>');
	document.write('<td colspan="3"><img src="/images/site/spacer.gif" height="10"></td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td colspan="2">Basic tests and measurements</td>');
	document.write('<td><input size="4" type="text" name="courses1"></td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td colspan="3"><img src="/images/site/spacer.gif" height="10"></td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td colspan="2">Descriptive statistics</td>');
	document.write('<td><input size="4" type="text" name="courses2"></td>');
	document.write('</tr>')
	document.write('<tr>');
	document.write('<td colspan="3"><img src="/images/site/spacer.gif" height="10"></td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td colspan="2">Intelligence/cognitive testing</td>');
	document.write('<td><input size="4" type="text" name="courses3"></td>');
	document.write('</tr>')
	document.write('<tr>');
	document.write('<td colspan="3"><img src="/images/site/spacer.gif" height="10"></td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td colspan="2">Speech, hearing and language assessment</td>');
	document.write('<td><input size="4" type="text" name="courses4"></td>');
	document.write('</tr>')
	document.write('<tr>');
	document.write('<td colspan="3"><img src="/images/site/spacer.gif" height="10"></td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td colspan="2">Educational diagnostics</td>');
	document.write('<td><input size="4" type="text" name="courses5"></td>');
	document.write('</tr>')
	document.write('<tr>');
	document.write('<td colspan="3"><img src="/images/site/spacer.gif" height="10"></td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td colspan="2">Assessment course in major field</td>');
	document.write('<td><input size="4" type="text" name="courses6"></td>');
	document.write('</tr>')
	document.write('<tr>');
	document.write('<td colspan="3"><img src="/images/site/spacer.gif" height="10"></td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td colspan="2">Use of tests in counseling</td>');
	document.write('<td><input size="4" type="text" name="courses7"></td>');
	document.write('</tr>')
	document.write('<tr>');
	document.write('<td colspan="3"><img src="/images/site/spacer.gif" height="10"></td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td colspan="2">Career assessment</td>');
	document.write('<td><input size="4" type="text" name="courses8"></td>');
	document.write('</tr>')
	document.write('<tr>');
	document.write('<td colspan="3"><img src="/images/site/spacer.gif" height="10"></td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td colspan="2">Neuropsychological assessment</td>');
	document.write('<td><input size="4" type="text" name="courses9"></td>');
	document.write('</tr>')
	document.write('<tr>');
	document.write('<td colspan="3"><img src="/images/site/spacer.gif" height="10"></td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td colspan="2">Projective techniques</td>');
	document.write('<td><input size="4" type="text" name="courses10"></td>');
	document.write('</tr>')
	document.write('<tr>');
	document.write('<td colspan="3"><img src="/images/site/spacer.gif" height="10"></td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td colspan="3">Other (list below)</td>');
	document.write('</tr>')
	document.write('<Tr>');
	document.write('<td colspan="3"><input type="text" size="70" name="courses11"></td>');
	document.write('</tr>');
	document.write('<Tr>');
	document.write('<td colspan="3"><input type="text" size="70" name="courses12"></td>');
	document.write('</tr>');
	document.write('<Tr>');
	document.write('<td colspan="3"><input type="text" size="70" name="courses13"></td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td colspan="3"><img src="/images/site/spacer.gif" height="10"></td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td colspan="3">b. Other Study (type of program completed)</td>');
	document.write('</tr>')
	document.write('<tr>');
	document.write('<td colspan="3"><img src="/images/site/spacer.gif" height="10"></td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td colspan="3">Practicum in test administration and interpretation</td>');
	document.write('</tr>')
	document.write('<Tr>');
	document.write('<td colspan="3"><input type="text" size="70" name="other1"></td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td colspan="3"><img src="/images/site/spacer.gif" height="10"></td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td colspan="3">Internship (list type: school psychology, counseling, etc.)</td>');
	document.write('</tr>')
	document.write('<Tr>');
	document.write('<td colspan="3"><input type="text" size="70" name="other2"></td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td colspan="3"><img src="/images/site/spacer.gif" height="10"></td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td colspan="3">Attending workshops, seminars, conferences (please specify)</td>');
	document.write('</tr>')
	document.write('<Tr>');
	document.write('<td colspan="3"><input type="text" size="70" name="other3"></td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td colspan="3"><img src="/images/site/spacer.gif" height="10"></td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td colspan="3">Your special competence: (List one test which you use regularly that best illustrates your skill in test administration and interpretation)</td>');
	document.write('</tr>');
	document.write('<Tr>');
	document.write('<td colspan="3"><input type="text" size="70" name="competence"></td>');
	document.write('</tr>');	
	
	document.write('<tr>');
	document.write('<td colspan="3"><img src="/images/site/spacer.gif" height="10"></td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td colspan="3">Member of Professional Organizations (Check All that Apply)</td>');
	document.write('</tr>');
	/*
	document.write('<tr>');
	document.write('<td colspan="3"><textarea name="comments" rows="5" cols="50"></textarea></td>');
	document.write('</tr>');
	*/
	document.write('<tr>');
	document.write('<td><input type="checkbox" name="orgsACA">ACA</td>');
	document.write('<td><input type="checkbox" name="orgsAPA">APA</td>');
	document.write('<td><input type="checkbox" name="orgsNASP">NASP</td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td><input type="checkbox" name="orgsCEC">CEC</td>');
	document.write('<td><input type="checkbox" name="orgsASHA">ASHA</td>');
	document.write('</tr>')
	document.write('<Tr>');
	document.write('<td>Other (please specify)</td>');
	document.write('<td colspan="3"><input type="text" size="45" name="orgsOther"></td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td colspan="3"><img src="/images/site/spacer.gif" height="10"></td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td colspan="3" align="center"><input type="button" onclick="submitform();" value="Submit">&nbsp;<input type="reset" value="Clear"></td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td colspan="3"><img src="/images/site/spacer.gif" height="10"></td>');
	document.write('</tr>');
	document.write('</table>');
	document.write('</td>');
	document.write('</tr>');
	document.write('</table>');
	document.write('</td>');
	document.write('</tr>');
	document.write('</table>');
	document.write('</td>');
	document.write('</tr>');
	document.write('</table>');

}