function jobform(jobtype) {
document.write(" \
<form id='quicksearch' name='quicksearch' method='get' action='http://www.mommd.com/jobs/index.php'> \
<input id='action' type='hidden' value='quick_search' name='action'/> \
<input id='page' type='hidden' value='quick_search' name='page'/> \
<input id='template_used' type='hidden' value='quick_search_secondary' name='template_used'/> \
<input id='country' type='hidden' value='United States' name='country'/> \
<div id='quick_search_keywords' class='quick_search'> \
	<label for='keywords'> </label> \
	<div id='quick_search_keywords_left' class='quick_search_left'> Enter Keywords </div> \
	<div id='quick_search_keywords_right' class='quick_search_right'> \
		<input id='keywords' class='quick_search' type='text' value='' name='keywords' gtbfieldid='1'/> \
	</div> \
</div> \
<!-- <div id='quick_search_industry' class='quick_search'> \
<label for='industry'> </label> \
<div id='quick_search_industry_left' class='quick_search_left'> Job Type </div> \
<div id='quick_search_industry_right' class='quick_search_right'> \
<select id='industry' class='quick_search' name='industry' gtbfieldid='2'> \
<option value=''>All Types</option> \
<option value='Multi-Specialty Physician Jobs'>Multi-Specialty Physician Jobs</option> \
<option value='Academic Jobs'>Academic Jobs</option> \
<option value='Addictions Medicine Jobs'>Addictions Medicine Jobs</option> \
<option value='Administration-Management Jobs'>Administration-Management Jobs</option> \
<option value='Aerospace Medicine Jobs'>Aerospace Medicine Jobs</option> \
<option value='Allergy Jobs'>Allergy Jobs</option> \
<option value='Allergy and Immunology Jobs'>Allergy and Immunology Jobs</option> \
<option value='Alternative Medicine Jobs'>Alternative Medicine Jobs</option> \
<option value='Anesthesiology Jobs'>Anesthesiology Jobs</option> \
<option value='Armed Forces Medical Consultant'>Armed Forces Medical Consultant</option> \
<option value='Bariatric Jobs'>Bariatric Jobs</option> \
<option value='Cardiac Electrophysiology Jobs'>Cardiac Electrophysiology Jobs</option> \
<option value='Cardiac Surgery Jobs'>Cardiac Surgery Jobs</option> \
<option value='Cardio-Thoracic Surgery Jobs'>Cardio-Thoracic Surgery Jobs</option> \
<option value='Cardiology Jobs'>Cardiology Jobs</option> \
<option value='Cardiology - Interventional'>Cardiology - Interventional</option> \
<option value='Cardiology - Invasive'>Cardiology - Invasive</option> \
<option value='Cardiology - Non-Invasive'>Cardiology - Non-Invasive</option> \
<option value='Colon and Rectal Surgery'>Colon and Rectal Surgery</option> \
<option value='Critical Care Jobs'>Critical Care Jobs</option> \
<option value='Cytopathology'>Cytopathology</option> \
<option value='Dermatology Jobs'>Dermatology Jobs</option> \
<option value='Emergency Medicine Jobs'>Emergency Medicine Jobs</option> \
<option value='Endocrinology Jobs'>Endocrinology Jobs</option> \
<option value='Endocrinology- Reproductive'>Endocrinology- Reproductive</option> \
<option value='ENT - Otorhinolaryngology'>ENT - Otorhinolaryngology</option> \
<option value='Family Practice Jobs'>Family Practice Jobs</option> \
<option value='Family Practice-OB'>Family Practice-OB</option> \
<option value='Family Practice - Outpatient Clinic'>Family Practice - Outpatient Clinic</option> \
<option value='Flight Surgery-Aerospace Medicine'>Flight Surgery-Aerospace Medicine</option> \
<option value='Gastroenterology Jobs'>Gastroenterology Jobs</option> \
<option value='General Practice Jobs'>General Practice Jobs</option> \
<option value='General Preventive Medicine'>General Preventive Medicine</option> \
<option value='Genetics'>Genetics</option> \
<option value='Geriatric Medicine'>Geriatric Medicine</option> \
<option value='Geriatrics'>Geriatrics</option> \
<option value='Gynecology Jobs'>Gynecology Jobs</option> \
<option value='Gynecology-Oncology'>Gynecology-Oncology</option> \
<option value='Head and Neck Surgery'>Head and Neck Surgery</option> \
<option value='Hematology'>Hematology</option> \
<option value='Hematology and Oncology'>Hematology and Oncology</option> \
<option value='Hepatology'>Hepatology</option> \
<option value='Hospitalist Jobs'>Hospitalist Jobs</option> \
<option value='Hyperbaric Medicine'>Hyperbaric Medicine</option> \
<option value='Immunology'>Immunology</option> \
<option value='Immunology - Clinical and Lab'>Immunology - Clinical and Lab</option> \
<option value='Industry'>Industry</option> \
<option value='Infectious Disease'>Infectious Disease</option> \
<option value='Insurance Medicine'>Insurance Medicine</option> \
<option value='Internal Medicine Jobs'>Internal Medicine Jobs</option> \
<option value='Internal Medicine - Addictions'>Internal Medicine - Addictions</option> \
<option value='Maternal-Fetal Medicine'>Maternal-Fetal Medicine</option> \
<option value='Med-Peds'>Med-Peds</option> \
<option value='Med-Surg'>Med-Surg</option> \
<option value='Medical Informatics'>Medical Informatics</option> \
<option value='Medical Microbiology'>Medical Microbiology</option> \
<option value='Neonatology'>Neonatology</option> \
<option value='Nephrology'>Nephrology</option> \
<option value='Neuro-Oncologist'>Neuro-Oncologist</option> \
<option value='Neurology'>Neurology</option> \
<option value='Neurology-Child'>Neurology-Child</option> \
<option value='Neuroradiology'>Neuroradiology</option> \
<option value='Neurosurgery'>Neurosurgery</option> \
<option value='Nuclear Medicine'>Nuclear Medicine</option> \
<option value='Nurse'>Nurse</option> \
<option value='Nurse Midwife'>Nurse Midwife</option> \
<option value='Nurse Practitioner'>Nurse Practitioner</option> \
<option value='Obstetrics/Gynecology'>Obstetrics/Gynecology</option> \
<option value='Occupational Medicine'>Occupational Medicine</option> \
<option value='Oncology'>Oncology</option> \
<option value='Oncology - Breast Surgery'>Oncology - Breast Surgery</option> \
<option value='Oncology - Gynecological'>Oncology - Gynecological</option> \
<option value='Oncology - Medical'>Oncology - Medical</option> \
<option value='Oncology - Surgical'>Oncology - Surgical</option> \
<option value='Oncology - Urology'>Oncology - Urology</option> \
<option value='Ophthalmology'>Ophthalmology</option> \
<option value='Ophthalmology-Retinal Surgery'>Ophthalmology-Retinal Surgery</option> \
<option value='Oral and Maxillofacial Surgery'>Oral and Maxillofacial Surgery</option> \
<option value='Orthopaedic Surgery'>Orthopaedic Surgery</option> \
<option value='Orthopaedic Surgery - Hand'>Orthopaedic Surgery - Hand</option> \
<option value='Orthopaedic Surgery - Shoulder'>Orthopaedic Surgery - Shoulder</option> \
<option value='Orthopaedic Surgery - Spine'>Orthopaedic Surgery - Spine</option> \
<option value='Orthopaedic Surgery - Trauma'>Orthopaedic Surgery - Trauma</option> \
<option value='Otolaryngology'>Otolaryngology</option> \
<option value='Pain Medicine'>Pain Medicine</option> \
<option value='Palliative Care and Hospice'>Palliative Care and Hospice</option> \
<option value='Pathology'>Pathology</option> \
<option value='Pediatric Nurse Practitioner'>Pediatric Nurse Practitioner</option> \
<option value='Pediatrics'>Pediatrics</option> \
<option value='Pediatrics - Adolescent Med'>Pediatrics - Adolescent Med</option> \
<option value='Pediatrics - Allergy & Imm.'>Pediatrics - Allergy & Imm.</option> \
<option value='Pediatrics - Anesthesiology'>Pediatrics - Anesthesiology</option> \
<option value='Pediatrics - Bone Marrow Transplant'>Pediatrics - Bone Marrow Transplant</option> \
<option value='Pediatrics - Cardiology'>Pediatrics - Cardiology</option> \
<option value='Pediatrics - Critical Care'>Pediatrics - Critical Care</option> \
<option value='Pediatrics - Developmental-Behavioral'>Pediatrics - Developmental-Behavioral</option> \
<option value='Pediatrics - Emergency Med'>Pediatrics - Emergency Med</option> \
<option value='Pediatrics - Endocrinology'>Pediatrics - Endocrinology</option> \
<option value='Pediatrics - Gastroenterology'>Pediatrics - Gastroenterology</option> \
<option value='Pediatrics - Genetics'>Pediatrics - Genetics</option> \
<option value='Pediatrics - Hematology-Oncology'>Pediatrics - Hematology-Oncology</option> \
<option value='Pediatrics - Hospitalist'>Pediatrics - Hospitalist</option> \
<option value='Pediatrics - Infectious Disease'>Pediatrics - Infectious Disease</option> \
<option value='Pediatrics - Intensivist'>Pediatrics - Intensivist</option> \
<option value='Pediatrics - Nephrology'>Pediatrics - Nephrology</option> \
<option value='Pediatrics - Neurology'>Pediatrics - Neurology</option> \
<option value='Pediatrics - Neurosurgery'>Pediatrics - Neurosurgery</option> \
<option value='Pediatrics - Opthalmology'>Pediatrics - Opthalmology</option> \
<option value='Pediatrics - Orthopaedics'>Pediatrics - Orthopaedics</option> \
<option value='Pediatrics - Otolaryngology'>Pediatrics - Otolaryngology</option> \
<option value='Pediatrics - PMR'>Pediatrics - PMR</option> \
<option value='Pediatrics - Pulmonary'>Pediatrics - Pulmonary</option> \
<option value='Pediatrics - Radiology'>Pediatrics - Radiology</option> \
<option value='Pediatrics - Rheumatology'>Pediatrics - Rheumatology</option> \
<option value='Pediatrics - Surgery'>Pediatrics - Surgery</option> \
<option value='Pediatrics - Urology'>Pediatrics - Urology</option> \
<option value='Perinatal Medicine'>Perinatal Medicine</option> \
<option value='Pharmaceutical Industry'>Pharmaceutical Industry</option> \
<option value='Physiatrist'>Physiatrist</option> \
<option value='Physical Medicine/Rehab'>Physical Medicine/Rehab</option> \
<option value='Physician Assistant'>Physician Assistant</option> \
<option value='Plastic and Reconstructive Surgery'>Plastic and Reconstructive Surgery</option> \
<option value='Podiatry'>Podiatry</option> \
<option value='Preventive Medicine'>Preventive Medicine</option> \
<option value='Proctology'>Proctology</option> \
<option value='Psychiatry'>Psychiatry</option> \
<option value='Psychiatry - Child'>Psychiatry - Child</option> \
<option value='Psychiatry - Geriatric'>Psychiatry - Geriatric</option> \
<option value='Psychology'>Psychology</option> \
<option value='Psychology - Clinical'>Psychology - Clinical</option> \
<option value='Public Health'>Public Health</option> \
<option value='Pulmonary Disease - Critical Care'>Pulmonary Disease - Critical Care</option> \
<option value='Pulmonary Medicine'>Pulmonary Medicine</option> \
<option value='Radiation Oncology'>Radiation Oncology</option> \
<option value='Radiologist - Ultrasound'>Radiologist - Ultrasound</option> \
<option value='Radiology'>Radiology</option> \
<option value='Radiology - Breast Mammography'>Radiology - Breast Mammography</option> \
<option value='Radiology - Interventional'>Radiology - Interventional</option> \
<option value='Radiology - Neuro-Interventional'>Radiology - Neuro-Interventional</option> \
<option value='Radiology - Nuclear'>Radiology - Nuclear</option> \
<option value='Radiology - Tele'>Radiology - Tele</option> \
<option value='Radiology - Women's Imager'>Radiology - Women's Imager</option> \
<option value='Research'>Research</option> \
<option value='Rheumatology'>Rheumatology</option> \
<option value='Sleep Medicine'>Sleep Medicine</option> \
<option value='Sports Medicine'>Sports Medicine</option> \
<option value='Surgery - Abdominal'>Surgery - Abdominal</option> \
<option value='Surgery - Cardiovascular'>Surgery - Cardiovascular</option> \
<option value='Surgery - Colon and Rectal'>Surgery - Colon and Rectal</option> \
<option value='Surgery - Craniofacial'>Surgery - Craniofacial</option> \
<option value='Surgery - Dermatological'>Surgery - Dermatological</option> \
<option value='Surgery - Gastrointestinal'>Surgery - Gastrointestinal</option> \
<option value='Surgery - General'>Surgery - General</option> \
<option value='Surgery - Hand and Plastic'>Surgery - Hand and Plastic</option> \
<option value='Surgery - Hip & Knee'>Surgery - Hip & Knee</option> \
<option value='Surgery - Laparoendoscopic'>Surgery - Laparoendoscopic</option> \
<option value='Surgery - Military'>Surgery - Military</option> \
<option value='Surgery - Neurological'>Surgery - Neurological</option> \
<option value='Surgery - Pediatric'>Surgery - Pediatric</option> \
<option value='Surgical Critical Care'>Surgical Critical Care</option> \
<option value='Technology'>Technology</option> \
<option value='Telemedicine'>Telemedicine</option> \
<option value='Thoracic Surgery'>Thoracic Surgery</option> \
<option value='Transfusion Medicine'>Transfusion Medicine</option> \
<option value='Transplant Surgery'>Transplant Surgery</option> \
<option value='Trauma Surgery'>Trauma Surgery</option> \
<option value='Tropical Medicine and Disease'>Tropical Medicine and Disease</option> \
<option value='Urgent Care'>Urgent Care</option> \
<option value='Urology'>Urology</option> \
<option value='Vascular Medicine'>Vascular Medicine</option> \
<option value='Vascular Surgery'>Vascular Surgery</option> \
<option value='Women's Health'>Women's Health</option> \
<option value='Other'>Other</option> \
</select> \
</div> \
</div> --> \
<div id='quick_search_country' class='quick_search'> \
<label for='country'> </label> \
<div id='quick_search_country_left' class='quick_search_left'>Country</div> \
<div id='quick_search_country_right' class='quick_search_right'> \
<select id='country' class='quick_search' onchange='javascript:document.quicksearch.action.value='load_states';document.quicksearch.template_used.value='quick_search';document.quicksearch.state.value='';document.quicksearch.submit();' name='country' gtbfieldid='3'> \
<option value=''>All Countries</option> \
<option selected='selected' value='United States'>United States</option> \
<option value='APO/FPO'>APO/FPO</option> \
<option value='Canada'>Canada</option> \
<option value='United Kingdom'>United Kingdom</option> \
<option value='Afghanistan'>Afghanistan</option> \
<option value='Albania'>Albania</option> \
<option value='Algeria'>Algeria</option> \
<option value='American Samoa'>American Samoa</option> \
<option value='Andorra'>Andorra</option> \
<option value='Angola'>Angola</option> \
<option value='Anguilla'>Anguilla</option> \
<option value='Antigua and Barbuda'>Antigua and Barbuda</option> \
<option value='Argentina'>Argentina</option> \
<option value='Armenia'>Armenia</option> \
<option value='Aruba'>Aruba</option> \
<option value='Australia'>Australia</option> \
<option value='Austria'>Austria</option> \
<option value='Azerbaijan Republic'>Azerbaijan Republic</option> \
<option value='Bahamas'>Bahamas</option> \
<option value='Bahrain'>Bahrain</option> \
<option value='Bangladesh'>Bangladesh</option> \
<option value='Barbados'>Barbados</option> \
<option value='Belarus'>Belarus</option> \
<option value='Belgium'>Belgium</option> \
<option value='Belize'>Belize</option> \
<option value='Benin'>Benin</option> \
<option value='Bermuda'>Bermuda</option> \
<option value='Bhutan'>Bhutan</option> \
<option value='Bolivia'>Bolivia</option> \
<option value='Bosnia and Herzegovina'>Bosnia and Herzegovina</option> \
<option value='Botswana'>Botswana</option> \
<option value='Brazil'>Brazil</option> \
<option value='British Virgin Islands'>British Virgin Islands</option> \
<option value='Brunei Darussalam'>Brunei Darussalam</option> \
<option value='Bulgaria'>Bulgaria</option> \
<option value='Burkina Faso'>Burkina Faso</option> \
<option value='Burma'>Burma</option> \
<option value='Burundi'>Burundi</option> \
<option value='Cambodia'>Cambodia</option> \
<option value='Cameroon'>Cameroon</option> \
<option value='Cape Verde Islands'>Cape Verde Islands</option> \
<option value='Cayman Islands'>Cayman Islands</option> \
<option value='Central African Republic'>Central African Republic</option> \
<option value='Chad'>Chad</option> \
<option value='Chile'>Chile</option> \
<option value='China'>China</option> \
<option value='Colombia'>Colombia</option> \
<option value='Comoros'>Comoros</option> \
<option value='Congo, Democratic Republic of the'>Congo, Democratic Republic of the</option> \
<option value='Congo, Republic of the'>Congo, Republic of the</option> \
<option value='Cook Islands'>Cook Islands</option> \
<option value='Costa Rica'>Costa Rica</option> \
<option value='Cote d Ivoire (Ivory Coast)'>Cote d Ivoire (Ivory Coast)</option> \
<option value='Croatia, Republic of'>Croatia, Republic of</option> \
<option value='Cuba'>Cuba</option> \
<option value='Cyprus'>Cyprus</option> \
<option value='Czech Republic'>Czech Republic</option> \
<option value='Denmark'>Denmark</option> \
<option value='Djibouti'>Djibouti</option> \
<option value='Dominica'>Dominica</option> \
<option value='Dominican Republic'>Dominican Republic</option> \
<option value='Ecuador'>Ecuador</option> \
<option value='Egypt'>Egypt</option> \
<option value='El Salvador'>El Salvador</option> \
<option value='Equatorial Guinea'>Equatorial Guinea</option> \
<option value='Eritrea'>Eritrea</option> \
<option value='Estonia'>Estonia</option> \
<option value='Ethiopia'>Ethiopia</option> \
<option value='Falkland Islands (Islas Malvinas)'>Falkland Islands (Islas Malvinas)</option> \
<option value='Fiji'>Fiji</option> \
<option value='Finland'>Finland</option> \
<option value='France'>France</option> \
<option value='French Guiana'>French Guiana</option> \
<option value='French Polynesia'>French Polynesia</option> \
<option value='Gabon Republic'>Gabon Republic</option> \
<option value='Gambia'>Gambia</option> \
<option value='Georgia'>Georgia</option> \
<option value='Germany'>Germany</option> \
<option value='Ghana'>Ghana</option> \
<option value='Gibraltar'>Gibraltar</option> \
<option value='Greece'>Greece</option> \
<option value='Greenland'>Greenland</option> \
<option value='Grenada'>Grenada</option> \
<option value='Guadeloupe'>Guadeloupe</option> \
<option value='Guam'>Guam</option> \
<option value='Guatemala'>Guatemala</option> \
<option value='Guernsey'>Guernsey</option> \
<option value='Guinea'>Guinea</option> \
<option value='Guinea-Bissau'>Guinea-Bissau</option> \
<option value='Guyana'>Guyana</option> \
<option value='Haiti'>Haiti</option> \
<option value='Honduras'>Honduras</option> \
<option value='Hong Kong'>Hong Kong</option> \
<option value='Hungary'>Hungary</option> \
<option value='Iceland'>Iceland</option> \
<option value='India'>India</option> \
<option value='Indonesia'>Indonesia</option> \
<option value='Iran'>Iran</option> \
<option value='Iraq'>Iraq</option> \
<option value='Ireland'>Ireland</option> \
<option value='Israel'>Israel</option> \
<option value='Italy'>Italy</option> \
<option value='Jamaica'>Jamaica</option> \
<option value='Jan Mayen'>Jan Mayen</option> \
<option value='Japan'>Japan</option> \
<option value='Jersey'>Jersey</option> \
<option value='Jordan'>Jordan</option> \
<option value='Kazakhstan'>Kazakhstan</option> \
<option value='Kenya Coast Republic'>Kenya Coast Republic</option> \
<option value='Kiribati'>Kiribati</option> \
<option value='Korea, North'>Korea, North</option> \
<option value='Korea, South'>Korea, South</option> \
<option value='Kuwait'>Kuwait</option> \
<option value='Kyrgyzstan'>Kyrgyzstan</option> \
<option value='Laos'>Laos</option> \
<option value='Latvia'>Latvia</option> \
<option value='Lebanon'>Lebanon</option> \
<option value='Liechtenstein'>Liechtenstein</option> \
<option value='Lithuania'>Lithuania</option> \
<option value='Luxembourg'>Luxembourg</option> \
<option value='Macau'>Macau</option> \
<option value='Macedonia'>Macedonia</option> \
<option value='Madagascar'>Madagascar</option> \
<option value='Malawi'>Malawi</option> \
<option value='Malaysia'>Malaysia</option> \
<option value='Maldives'>Maldives</option> \
<option value='Mali'>Mali</option> \
<option value='Malta'>Malta</option> \
<option value='Marshall Islands'>Marshall Islands</option> \
<option value='Martinique'>Martinique</option> \
<option value='Mauritania'>Mauritania</option> \
<option value='Mauritius'>Mauritius</option> \
<option value='Mayotte'>Mayotte</option> \
<option value='Mexico'>Mexico</option> \
<option value='Moldova'>Moldova</option> \
<option value='Monaco'>Monaco</option> \
<option value='Mongolia'>Mongolia</option> \
<option value='Montserrat'>Montserrat</option> \
<option value='Morocco'>Morocco</option> \
<option value='Mozambique'>Mozambique</option> \
<option value='Namibia'>Namibia</option> \
<option value='Nauru'>Nauru</option> \
<option value='Nepal'>Nepal</option> \
<option value='Netherlands'>Netherlands</option> \
<option value='Netherlands Antilles'>Netherlands Antilles</option> \
<option value='New Caledonia'>New Caledonia</option> \
<option value='New Zealand'>New Zealand</option> \
<option value='Nicaragua'>Nicaragua</option> \
<option value='Niger'>Niger</option> \
<option value='Nigeria'>Nigeria</option> \
<option value='Niue'>Niue</option> \
<option value='Norway'>Norway</option> \
<option value='Oman'>Oman</option> \
<option value='Pakistan'>Pakistan</option> \
<option value='Palau'>Palau</option> \
<option value='Panama'>Panama</option> \
<option value='Papua New Guinea'>Papua New Guinea</option> \
<option value='Paraguay'>Paraguay</option> \
<option value='Peru'>Peru</option> \
<option value='Philippines'>Philippines</option> \
<option value='Poland'>Poland</option> \
<option value='Portugal'>Portugal</option> \
<option value='Puerto Rico'>Puerto Rico</option> \
<option value='Qatar'>Qatar</option> \
<option value='Romania'>Romania</option> \
<option value='Russian Federation'>Russian Federation</option> \
<option value='Rwanda'>Rwanda</option> \
<option value='Saint Helena'>Saint Helena</option> \
<option value='Saint Kitts-Nevis'>Saint Kitts-Nevis</option> \
<option value='Saint Lucia'>Saint Lucia</option> \
<option value='Saint Pierre and Miquelon'>Saint Pierre and Miquelon</option> \
<option value='Saint Vincent and the Grenadines'>Saint Vincent and the Grenadines</option> \
<option value='San Marino'>San Marino</option> \
<option value='Saudi Arabia'>Saudi Arabia</option> \
<option value='Senegal'>Senegal</option> \
<option value='Seychelles'>Seychelles</option> \
<option value='Sierra Leone'>Sierra Leone</option> \
<option value='Singapore'>Singapore</option> \
<option value='Slovakia'>Slovakia</option> \
<option value='Slovenia'>Slovenia</option> \
<option value='Solomon Islands'>Solomon Islands</option> \
<option value='Somalia'>Somalia</option> \
<option value='South Africa'>South Africa</option> \
<option value='Spain'>Spain</option> \
<option value='Sri Lanka'>Sri Lanka</option> \
<option value='Sudan'>Sudan</option> \
<option value='Suriname'>Suriname</option> \
<option value='Svalbard'>Svalbard</option> \
<option value='Swaziland'>Swaziland</option> \
<option value='Sweden'>Sweden</option> \
<option value='Switzerland'>Switzerland</option> \
<option value='Syria'>Syria</option> \
<option value='Tahiti'>Tahiti</option> \
<option value='Taiwan'>Taiwan</option> \
<option value='Tajikistan'>Tajikistan</option> \
<option value='Tanzania'>Tanzania</option> \
<option value='Thailand'>Thailand</option> \
<option value='Togo'>Togo</option> \
<option value='Tonga'>Tonga</option> \
<option value='Trinidad and Tobago'>Trinidad and Tobago</option> \
<option value='Tunisia'>Tunisia</option> \
<option value='Turkey'>Turkey</option> \
<option value='Turkmenistan'>Turkmenistan</option> \
<option value='Turks and Caicos Islands'>Turks and Caicos Islands</option> \
<option value='Tuvalu'>Tuvalu</option> \
<option value='Uganda'>Uganda</option> \
<option value='Ukraine'>Ukraine</option> \
<option value='United Arab Emirates'>United Arab Emirates</option> \
<option value='Uruguay'>Uruguay</option> \
<option value='Uzbekistan'>Uzbekistan</option> \
<option value='Vanuatu'>Vanuatu</option> \
<option value='Vatican City State'>Vatican City State</option> \
<option value='Venezuela'>Venezuela</option> \
<option value='Vietnam'>Vietnam</option> \
<option value='Virgin Islands (U.S.)'>Virgin Islands (U.S.)</option> \
<option value='Wallis and Futuna'>Wallis and Futuna</option> \
<option value='Western Sahara'>Western Sahara</option> \
<option value='Western Samoa'>Western Samoa</option> \
<option value='Yemen'>Yemen</option> \
<option value='Yugoslavia'>Yugoslavia</option> \
<option value='Zambia'>Zambia</option> \
<option value='Zimbabwe'>Zimbabwe</option> \
</select> \
</div> \
</div> \
<div id='quick_search_state' class='quick_search'> \
<label for='state'> </label> \
<div id='quick_search_state_left' class='quick_search_left'> State </div> \
<div id='quick_search_state_right' class='quick_search_right'> \
<!-- <select id='state' class='quick_search' onchange='javascript:document.quicksearch.action.value=\"load_cities\";document.quicksearch.city.value=\"\";document.quicksearch.template_used.value=\"quick_search\";document.quicksearch.submit();' name='state' gtbfieldid='4'> --> \
<select id='state' class='quick_search' name='state' gtbfieldid='4'> \
<option value=''>All States</option> \
<option value='Nationwide'>Nationwide</option> \
<option value='Alabama'>Alabama</option> \
<option value='Alaska'>Alaska</option> \
<option value='Arizona'>Arizona</option> \
<option value='Arkansas'>Arkansas</option> \
<option value='California'>California</option> \
<option value='Colorado'>Colorado</option> \
<option value='Connecticut'>Connecticut</option> \
<option value='Delaware'>Delaware</option> \
<option value='Florida'>Florida</option> \
<option value='Georgia'>Georgia</option> \
<option value='Hawaii'>Hawaii</option> \
<option value='Idaho'>Idaho</option> \
<option value='Illinois'>Illinois</option> \
<option value='Indiana'>Indiana</option> \
<option value='Iowa'>Iowa</option> \
<option value='Kansas'>Kansas</option> \
<option value='Kentucky'>Kentucky</option> \
<option value='Louisiana'>Louisiana</option> \
<option value='Maine'>Maine</option> \
<option value='Maryland'>Maryland</option> \
<option value='Massachusetts'>Massachusetts</option> \
<option value='Michigan'>Michigan</option> \
<option value='Minnesota'>Minnesota</option> \
<option value='Mississippi'>Mississippi</option> \
<option value='Missouri'>Missouri</option> \
<option value='Montana'>Montana</option> \
<option value='Nebraska'>Nebraska</option> \
<option value='Nevada'>Nevada</option> \
<option value='New Hampshire'>New Hampshire</option> \
<option value='New Jersey'>New Jersey</option> \
<option value='New Mexico'>New Mexico</option> \
<option value='New York'>New York</option> \
<option value='North Carolina'>North Carolina</option> \
<option value='North Dakota'>North Dakota</option> \
<option value='Ohio'>Ohio</option> \
<option value='Oklahoma'>Oklahoma</option> \
<option value='Oregon'>Oregon</option> \
<option value='Pennsylvania'>Pennsylvania</option> \
<option value='Rhode Island'>Rhode Island</option> \
<option value='South Carolina'>South Carolina</option> \
<option value='South Dakota'>South Dakota</option> \
<option value='Tennessee'>Tennessee</option> \
<option value='Texas'>Texas</option> \
<option value='Utah'>Utah</option> \
<option value='Vermont'>Vermont</option> \
<option value='Virginia'>Virginia</option> \
<option value='Washington'>Washington</option> \
<option value='West Virginia'>West Virginia</option> \
<option value='Wisconsin'>Wisconsin</option> \
<option value='Wyoming'>Wyoming</option> \
<option value='Other'>Other</option> \
</select> \
</div> \
</div> \
<input id='city' type='hidden' value='' name='city'/> \
<!-- \
<div id='quick_search_city' class='quick_search'> \
<label for='city'> </label> \
<div id='quick_search_city_left' class='quick_search_left'> Select City </div> \
<div id='quick_search_city_right' class='quick_search_right'> \
<select id='city' class='quick_search' name='city' gtbfieldid='5'> \
<option value=''>All Cities</option> \
</select> \
</div> \
</div> \
--> \
<div class='quick_search_submit'> \
<input class='quick_search' type='submit' value='Search'/> \
</div> \
</form>");

}