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document.write('<div style="padding: 10px; font-family: arial; font-size: 15px; color: #000; background: #eee">Which GOP Candidate are you supporting in the April 30th Senate Primary?</div>');
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        document.write('<div style="vertical-align: middle; padding: 3px 0"><label style="font-weight: normal"><input type="radio" name="vote" value="865276" /> &nbsp; Gabriel Gomez</label></div>');
        document.write('<div style="vertical-align: middle; padding: 3px 0"><label style="font-weight: normal"><input type="radio" name="vote" value="865277" /> &nbsp; Michael Sullivan</label></div>');
        document.write('<div style="vertical-align: middle; padding: 3px 0"><label style="font-weight: normal"><input type="radio" name="vote" value="865278" /> &nbsp; Dan Winslow?</label></div>');
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document.write('<input type="submit" value="Submit My Vote"><br /><br />');
document.write('<a href="http://www.websitegoodies.com/pollresults.php?id=103814" target="_blank">View Results</a>');
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