document.writeln('<div style=\"width:500px;border:1px solid black;background:#000000;\" id=\"le_formulaire\"><div style=\"font-size:1.2em;width:100%;height:50px;text-align:center;margin:10px;color:#000000;font-style:normal;font-weight:normal;\" id=\"titre_formulaire\"> Questionnaire</div><form method=\"post\" action=\"http://www.magic-questionnaire.com/retour_form.php?id_formulaire=1879\" accept-charset=\"UTF-8\"><input type=\"hidden\" name=\"ieutf8\" value=\"&#153;\" /><div style=\"width:450px;margin:auto;color:#ff00cc;font-style:normal;font-weight:bold;\" class=\"question\">Have you ever been to Disneyland Paris?<br /><input type=\"checkbox\" name=\"repcheckbox_125383\" value=\"125383\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >   Yes</span><br /><input type=\"checkbox\" name=\"repcheckbox_125384\" value=\"125384\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >   No</span></div><br /><div style=\"width:450px;margin:auto;color:#ff00cc;font-style:normal;font-weight:bold;\" class=\"question\">Would you like to spend a weekend in an amusement park such as Disney?<br /><input type=\"checkbox\" name=\"repcheckbox_125385\" value=\"125385\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >   Yes</span><br /><input type=\"checkbox\" name=\"repcheckbox_125386\" value=\"125386\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >   No</span></div><br /><div style=\"width:450px;margin:auto;color:#ff00cc;font-style:normal;font-weight:bold;\" class=\"question\">Are you keen on spending a week end in Paris and discover the city while we&rsquo;re there?<br /><input type=\"checkbox\" name=\"repcheckbox_125387\" value=\"125387\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >   Yes</span><br /><input type=\"checkbox\" name=\"repcheckbox_125388\" value=\"125388\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >   No</span></div><br /><div style=\"width:450px;margin:auto;color:#ff00cc;font-style:normal;font-weight:bold;\" class=\"question\">How much money are you willing to pay for this trip? (Including Transport/Accommodation/Disneyland ticket/Visit of Paris)<br /><textarea  cols=\"47\" rows=\"5\"  name=\"replibre_17696\"></textarea></div><br /><br /><input type=\"submit\" value=\"Envoyer\" /></form></div>');
