document.write ( '           <form action=http://anetm.com/r/r.cgi method=POST name=FormEBISU onSubmit="return EBISU_subCheck()" target="_blank"> ');
	document.write ( '              <input type="hidden" name=AC value="" > ');
	document.write ( '              <input type="hidden" name=SC value="DSP_RWREGOK" > ');
	document.write ( '              <input type="hidden" name=GAMEID value="1" > ');
	document.write ( ' ');
	document.write ( '	<INPUT TYPE="hidden" NAME="SYID" value="" > ');
	document.write ( '	<INPUT TYPE=hidden VALUE =""  NAME="NYMD" > ');
	document.write ( '	<INPUT TYPE=hidden VALUE =""  NAME="NTIM" > ');
	document.write ( '	<INPUT TYPE=hidden VALUE ="no"  NAME="z" > ');
	document.write ( ' ');
	document.write ( '<INPUT TYPE=hidden VALUE ="0"  NAME="BAXX" > ');
	document.write ( '<INPUT TYPE=hidden VALUE ="no"  NAME="z" > ');
	document.write ( '<input type=hidden size=4 maxlength=2 value="--" name=b01 onClick="EBISU_SetBingoNum(\'01\');" > ');
	document.write ( '<input type=hidden size=4 maxlength=2 value="--" name=b02 onClick="EBISU_SetBingoNum(\'02\')";> ');
	document.write ( '<input type=hidden size=4 maxlength=2 value="--" name=b03 onClick="EBISU_SetBingoNum(\'03\')";> ');
	document.write ( '<input type=hidden size=4 maxlength=2 value="--" name=b04 onClick="EBISU_SetBingoNum(\'04\')";> ');
	document.write ( '<input type=hidden size=4 maxlength=2 value="--" name=b05 onClick="EBISU_SetBingoNum(\'05\')";>');
	document.write ( '<input type=hidden size=4 maxlength=2 value="--" name=b06 onClick="EBISU_SetBingoNum(\'06\')";> ');
	document.write ( '<input type=hidden size=4 maxlength=2 value="--" name=b07 onClick="EBISU_SetBingoNum(\'07\')";> ');
	document.write ( '<input type=hidden size=4 maxlength=2 value="--" name=b08 onClick="EBISU_SetBingoNum(\'08\')";> ');
	document.write ( '<input type=hidden size=4 maxlength=2 value="--" name=b09 onClick="EBISU_SetBingoNum(\'09\')";> ');
	document.write ( '<input type=hidden size=4 maxlength=2 value="--" name=b10 onClick="EBISU_SetBingoNum(\'10\')";>');
	document.write ( '<input type=hidden size=4 maxlength=2 value="--" name=b11 onClick="EBISU_SetBingoNum(\'11\')";> ');
	document.write ( '<input type=hidden size=4 maxlength=2 value="--" name=b12 onClick="EBISU_SetBingoNum(\'12\')";> ');
	document.write ( '<input type=hidden size=4 maxlength=2 value="--" name=b13 onClick="EBISU_SetBingoNum(\'13\')";> ');
	document.write ( '<input type=hidden size=4 maxlength=2 value="--" name=b14 onClick="EBISU_SetBingoNum(\'14\')";> ');
	document.write ( '<input type=hidden size=4 maxlength=2 value="--" name=b15 onClick="EBISU_SetBingoNum(\'15\')";> ');
	document.write ( '<input type=hidden size=4 maxlength=2 value="--" name=b16 onClick="EBISU_SetBingoNum(\'16\')";> ');
	document.write ( '<input type=hidden size=4 maxlength=2 value="--" name=b17 onClick="EBISU_SetBingoNum(\'17\')";> ');
	document.write ( '<input type=hidden size=4 maxlength=2 value="--" name=b18 onClick="EBISU_SetBingoNum(\'18\')";> ');
	document.write ( '<input type=hidden size=4 maxlength=2 value="--" name=b19 onClick="EBISU_SetBingoNum(\'19\')";> ');
	document.write ( '<input type=hidden size=4 maxlength=2 value="--" name=b20 onClick="EBISU_SetBingoNum(\'20\')";>');
	document.write ( '<input type=hidden size=4 maxlength=2 value="--" name=b21 onClick="EBISU_SetBingoNum(\'21\')";> ');
	document.write ( '<input type=hidden size=4 maxlength=2 value="--" name=b22 onClick="EBISU_SetBingoNum(\'22\')";> ');
	document.write ( '<input type=hidden size=4 maxlength=2 value="--" name=b23 onClick="EBISU_SetBingoNum(\'23\')";> ');
	document.write ( '<input type=hidden size=4 maxlength=2 value="--" name=b24 onClick="EBISU_SetBingoNum(\'24\')";> ');
	document.write ( '<input type=hidden size=4 maxlength=2 value="--" name=b25 onClick="EBISU_SetBingoNum(\'25\')";> ');
	document.write ( '<input type=hidden  size=100 value="01 の番号を設定してください。" name=bxx   ');
	document.write ( 'style="font-family:ＭＳ Ｐゴシック, Osaka;font-size:9pt;color:#3333FF;border:0 solid #3300FF;" ');
	document.write ( ' >');
	document.write ( '<input type=hidden name="FIDKITAIGP" value="1000"> ');
	document.write ( 'メールアドレス：<input type="text" name="EMAIL"  size="32" ');
	document.write ( 'style="font-family:ＭＳ Ｐゴシック, Osaka;font-size:10pt;color:#000000;border:1 solid #6633CC;" ');
	document.write ( ' onFocus="this.style.backgroundColor=\'#CCCCFF\';if (this.value==\'メールアドレスを入力してね\')this.value=\'\';" ');
	document.write ( ' onBlur="this.style.backgroundColor=\'#FFFFFF\'" ');
	document.write ( ' onMouseOver="this.focus()"  ');
	document.write ( ' onClick=javascript:this.value="";  ');
	document.write ( ' value="メールアドレスを入力してね"  ');
	document.write ( '> ');
	document.write ( '<br><br> ');
	document.write ( '<input type=button  value="参加する" name=bsubmit onClick="EBISU_SetBingoNums()";  ');
	document.write ( '> <input type=button  value="取り消す" name=csubmit onClick=EBISU_doIt(\'\',\'\'); ');
	document.write ( '><br> ');
	document.write ( '<font size=1> ');
	document.write ( '取り消して、再度応募する場合も、「参加する」ボタンを押してください。<br> ');
	document.write ( '</font> ');
	document.write ( '<a href="http://anetm.com/r/gprank.htm" target="_blank"> 前回の当選者の発表！</a><br>');
	document.write ( '今月も連日開催中！');