document.writeln('<iframe src=\"about:blank\" name=\"hidform42\" style=\"width:0px;height:0px;display:none\"></iframe>')
document.writeln('<script src=\"/ks_inc/common.js\"></script>')
document.writeln('<script src=\"/ks_inc/form_ck.js\"></script>')
document.writeln('<form name=\"myform42\" action=\"/plus/form/form.asp\" onSubmit=\"return(form_c(42));\"  target=\"hidform42\" method=\"post\"> ')
document.writeln('<table width=\"100%\" border=\"0\" cellspacing=\"2\" cellpadding=\"1\">')
document.writeln('<input type=\"hidden\" value=\"Save\" name=\"action\"/>')
document.writeln('<input type=\"hidden\" value=\"42\" name=\"id\"/>')
document.writeln('<input type=\"hidden\" value=\"0\" name=\"m\"/>')
document.writeln('<input type=\"hidden\" value=\"0\" name=\"d\"/>')
document.writeln('<input type=\"hidden\" value=\"{$ToUserName}\" id=\"tousername\" name=\"tousername\"/>')
document.writeln(' <tr class=\"tdbg\">')
document.writeln('  <td align=\"right\" class=\"lefttdbg\"  width=\"90px\">您的姓名</td>')
document.writeln('  <td><input type=\"text\" maxlength=\"255\" class=\"upfile\" style=\"width:100px\" id=\"KS_xingming\" name=\"KS_xingming\" value=\"\"><span ')
document.writeln('class=\"formstrck42\" id=\"您的姓名|%|KS_xingming|%|1\" style=\"display:none\"></span>')
document.writeln('<font color=\"red\"> * </font>  </td>')
document.writeln('</tr>')
document.writeln(' <tr class=\"tdbg\">')
document.writeln('  <td align=\"right\" class=\"lefttdbg\">性别：</td>')
document.writeln('  <td><input type=\"radio\" id=\"KS_xingbie\" name=\"KS_xingbie\" value=\"男\">男<input type=\"radio\" id=\"KS_xingbie\" name=\"KS_xingbie\" ')
document.writeln('value=\"女\">女<span class=\"formstrck42\" id=\"性别|%|KS_xingbie|%|6\" ')
document.writeln('style=\"display:none\"></span><font color=\"red\"> * </font>  </td>')
document.writeln('</tr>')
document.writeln(' <tr class=\"tdbg\">')
document.writeln('  <td align=\"right\" class=\"lefttdbg\">年龄：</td>')
document.writeln('  <td><input type=\"text\" maxlength=\"255\" class=\"upfile\" style=\"width:100px\" id=\"KS_nianling\" name=\"KS_nianling\" value=\"\"><span ')
document.writeln('class=\"formstrck42\" id=\"年龄|%|KS_nianling|%|1\" style=\"display:none\"></span><font color=\"red\"> * </font></td>')
document.writeln('</tr>')
document.writeln(' <tr class=\"tdbg\">')
document.writeln('  <td align=\"right\" class=\"lefttdbg\">手机号码</td>')
document.writeln('  <td><input type=\"text\" maxlength=\"255\" class=\"upfile\" style=\"width:100px\" id=\"KS_shouji\" name=\"KS_shouji\" value=\"\"><span ')
document.writeln('class=\"formstrck42\" id=\"手机号码|%|KS_shouji|%|1\" style=\"display:none\"></span><font ')
document.writeln('color=\"red\"> * </font>  </td>')
document.writeln('</tr>')
document.writeln(' <tr class=\"tdbg\">')
document.writeln('  <td align=\"right\" class=\"lefttdbg\">微信号码</td>')
document.writeln('  <td><input type=\"text\" maxlength=\"255\" class=\"upfile\" style=\"width:100px\" id=\"KS_weixin\" name=\"KS_weixin\" value=\"\"><span ')
document.writeln('class=\"formstrck42\" id=\"微信号码|%|KS_weixin|%|1\" style=\"display:none\"></span><font ')
document.writeln('color=\"red\"> * </font> <span style=\"margin-top:5px\">若无微信请填 “0”</span>  </td>')
document.writeln('</tr>')
document.writeln(' <tr class=\"tdbg\">')
document.writeln('  <td align=\"right\" class=\"lefttdbg\">常驻省市</td>')
document.writeln('  <td><input type=\"text\" maxlength=\"255\" class=\"upfile\" style=\"width:100px\" id=\"KS_juzhudi\" name=\"KS_juzhudi\" value=\"\"><span ')
document.writeln('class=\"formstrck42\" id=\"常驻省市|%|KS_juzhudi|%|1\" style=\"display:none\"></span><font ')
document.writeln('color=\"red\"> * </font> <span style=\"margin-top:5px\">填省份和城市名称即可</span>  </td>')
document.writeln('</tr>')
document.writeln(' <tr class=\"tdbg\">')
document.writeln('  <td align=\"right\" class=\"lefttdbg\">佩戴产品</td>')
document.writeln('  <td><input type=\"checkbox\" id=\"KS_peidaichanping\" name=\"KS_peidaichanping\" value=\"助听器\">助听器<input type=\"checkbox\" ')
document.writeln('id=\"KS_peidaichanping\" name=\"KS_peidaichanping\" value=\"人工耳蜗\">人工耳蜗<input ')
document.writeln('type=\"checkbox\" id=\"KS_peidaichanping\" name=\"KS_peidaichanping\" value=\"都没戴\">都没戴 <span style=\"margin-top:5px\">您佩戴哪种助听产')
document.writeln('品？可多选</span> <font ')
document.writeln('color=\"red\"> * </font>   </td>')
document.writeln('</tr>')
document.writeln('<tr><td colspan=\"2\" class=\"subtdbg\" align=\"center\"><input type=\"submit\" value=\"确认提交\" name=\"submit1\"></td></tr>')
document.writeln('</table>')
document.writeln('</form>')
document.writeln('')