function toggleDefaultValue(elm) 
	{
		if (elm.value==elm.defaultValue) elm.value = '';
		else if (elm.value=='') elm.value = elm.defaultValue;
	}


function Validateform()
{
  str = document.emailform.i_emailgeneric.value;
    if(str=="")
    {
		alert("Email Address is required");
		document.emailform.i_emailgeneric.focus();
		return false;
	}
	else
    {
         if(!ValidMail(document.emailform.i_emailgeneric.value))
		{ 
       	alert("This email address was not accepted because it was not formatted correctly. Please be sure to use an @ symbol. For example: janedoe@marchofdimes.com");
		document.emailform.i_emailgeneric.focus();
		return false;
		}
    }
return true;		            
}
function ValidMail(str)
{
var st2="0123456789abcdefghijklmnopqrstuvwxyzABCDEFGHIJKLMNOPQRSTUVWXYZ._-@";
	for(i=0;i<str.length;i++)
		{
			if(st2.indexOf(str.charAt(i))== -1)
				{ 
					return false;
					break;
				}
		} 

     if(str.substring(0,str.indexOf("@")-1).length==0) 
		{
		return false;
		}
	
	if(str.indexOf("@")==-1)
		{
		return false;
		}
		if(str.indexOf(".")==-1)
		{
		return false;
		}
		if(str.substring(str.indexOf("@")+1,str.indexOf(".")).length==0)
		{
		return false;
		}
		if(str.substring(str.indexOf(".")+1,str.length).length==0)
		{
		return false;
		}
			str=str.substring(str.indexOf("@")+1,str.length)
	if(str.indexOf("@")!=-1)
		{
		return false;
		}

return true;
}




var page_name = "Peristat Updates Signup"; 
var ref_URL = window.location.pathname; //document.referrer ;

document.write ( '<form name="emailform" action="../includes/forms/peristats/peristats_signup_submit.asp" method="post">');
document.write ( '<tr>');
document.write ( '<td>');

document.write ( '<input type="hidden" name="ref_URL" value="' +  ref_URL + '">');	
document.write ( '<input type="hidden" name="info_area" value="' + page_name + '">');


document.write ( '<input type="hidden" name="FormId" value="1459510"> ');
document.write ( '<input type="hidden" name="ThankYouURL" value="http://www.marchofdimes.com/peristats/default.aspx?sign=1">');

document.write ( '<input type="hidden" name="i_mbr_id" value="999999999"> ');
document.write ( '<input type="hidden" name="i_status_id" value="110"> ');
document.write ( '<input type="hidden" name="i_peristats_flg" value="Y">');

document.write ( '<input onblur="toggleDefaultValue(this);" style="WIDTH: 151px" onfocus="toggleDefaultValue(this);" type="text" size="14" value="your e-mail" name="i_emailgeneric">');
document.write ( '<br>');
document.write ( '<img src="../_images/_clr.gif" width="1" height="5"><br>');
document.write ( '<input onclick="return Validateform()" type="image" height="16" width="45" src="_images/_widget_button_submit_BlueD.gif" border="0" name="imageField2">');
document.write ( '    </tr>');
document.write ( '</form>');