document.write("<script language=\"javascript\" type=\"text/javascript\" src=\"http://www.drh9.com/statics/js/dialog.js\"></script><link href=\"http://www.drh9.com/statics/css/table_form.css\" rel=\"stylesheet\" type=\"text/css\" /><link href=\"http://www.drh9.com/statics/css/dialog.css\" rel=\"stylesheet\" type=\"text/css\" /><script type=\"text/javascript\" src=\"http://www.drh9.com/statics/js/dialog.js\"></script><form method=\"post\" action=\"http://www.drh9.com/index.php?m=formguide&c=index&a=show&formid=13&siteid=1\" name=\"myform\" id=\"myform\"><table class=\"table_form\" width=\"100%\" cellspacing=\"0\"><tbody> <tr>      <th width=\"120\"> <font color=\"red\">*</font> 您的姓名  </th>      <td><input type=\"text\" name=\"info[name]\" id=\"name\" size=\"50\" value=\"\"  class=\"input-text\"  >  <span style=\"color:#BD4D31;\">请输入您的姓名</span></td>    </tr><tr>      <th width=\"120\"> <font color=\"red\">*</font> 入住人姓名  </th>      <td><input type=\"text\" name=\"info[ruzhuname]\" id=\"ruzhuname\" size=\"50\" value=\"\"  class=\"input-text\"  >  <span style=\"color:#BD4D31;\">请输入入住人的姓名</span></td>    </tr><tr>      <th width=\"120\"> <font color=\"red\">*</font> 电话  </th>      <td><input type=\"text\" name=\"info[phone]\" id=\"phone\" size=\"50\" value=\"\"  class=\"input-text\"  >  <span style=\"color:#BD4D31;\">请输入您的手机号码</span></td>    </tr><tr>      <th width=\"120\"> 社会关系  </th>      <td><select name=\'info[guanxi]\' id=\'guanxi\'><option value=\"本人\" selected>本人</option><option value=\"亲属\" >亲属</option><option value=\"朋友\" >朋友</option><option value=\"团购\" >团购</option><option value=\"企业用户\" >企业用户</option></select>  <span style=\"color:#BD4D31;\">请选择您的社会关系</span></td>    </tr><tr>      <th width=\"120\"> <font color=\"red\">*</font> 您选择的服务  </th>      <td><select name=\'info[fuwu]\' id=\'fuwu\'><option value=\"VIP会员服务\" >VIP会员服务</option><option value=\"抗衰老\" >抗衰老</option><option value=\"养生康复\" >养生康复</option><option value=\"休闲疗养\" >休闲疗养</option><option value=\"养老\" >养老</option></select>  <span style=\"color:#BD4D31;\">请选择您需要的服务</span></td>    </tr><tr>      <th width=\"120\"> <font color=\"red\">*</font> 入住人数  </th>      <td><input type=\'text\' name=\'info[renshu]\' id=\'renshu\' value=\'1\' size=\'\'  class=\'input-text\'  >  <span style=\"color:#BD4D31;\">请填写入住人数（数字）</span></td>    </tr><tr>      <th width=\"120\"> <font color=\"red\">*</font> 您所在的地区  </th>      <td><input type=\"text\" name=\"info[suozaidiqu]\" id=\"suozaidiqu\" size=\"50\" value=\"\"  class=\"input-text\"  >  <span style=\"color:#BD4D31;\">请填写您所在的地区（越详细越好）</span></td>    </tr><tr>      <th width=\"120\"> <font color=\"red\">*</font> 预想入住地区  </th>      <td><input type=\"text\" name=\"info[ruzhuquyu]\" id=\"ruzhuquyu\" size=\"50\" value=\"\"  class=\"input-text\"  >  <span style=\"color:#BD4D31;\">请输入您最想入住的地区</span></td>    </tr><tr>      <th width=\"120\"> <font color=\"red\">*</font> 预计入住时间  </th>      <td><link rel=\"stylesheet\" type=\"text/css\" href=\"http://www.drh9.com/statics/js/calendar/jscal2.css\"/><link rel=\"stylesheet\" type=\"text/css\" href=\"http://www.drh9.com/statics/js/calendar/border-radius.css\"/><link rel=\"stylesheet\" type=\"text/css\" href=\"http://www.drh9.com/statics/js/calendar/win2k.css\"/><script type=\"text/javascript\" src=\"http://www.drh9.com/statics/js/calendar/calendar.js\"></script><script type=\"text/javascript\" src=\"http://www.drh9.com/statics/js/calendar/lang/en.js\"></script><input type=\"text\" name=\"info[ruzhushijian]\" id=\"ruzhushijian\" value=\"2024-05-02 19:34\" size=\"21\" class=\"date\" readonly>&nbsp;<script type=\"text/javascript\">Calendar.setup({weekNumbers: true,    inputField : \"ruzhushijian\",    trigger    : \"ruzhushijian\",    dateFormat: \"%Y-%m-%d %H:%M:%S\",    showTime: true,    minuteStep: 1,    onSelect   : function() {this.hide();}});        </script>  <span style=\"color:#BD4D31;\">请选择您预计入住的时间</span></td>    </tr><tr>      <th width=\"120\"> <font color=\"red\">*</font> 邮箱  </th>      <td><input type=\"text\" name=\"info[email]\" id=\"email\" size=\"50\" value=\"\"  class=\"input-text\"  >  <span style=\"color:#BD4D31;\">请输入您的邮箱</span></td>    </tr><tr>      <th width=\"120\"> <font color=\"red\">*</font> 康复环境要求  </th>      <td><select name=\'info[huanjingyaoqiu]\' id=\'huanjingyaoqiu\'><option value=\"山地\" >山地</option><option value=\"水边\" >水边</option><option value=\"丛林\" >丛林</option><option value=\"城市\" selected>城市</option></select>  <span style=\"color:#BD4D31;\">请选择您对环境的要求</span></td>    </tr><tr>      <th width=\"120\"> <font color=\"red\">*</font> 偏好菜肴  </th>      <td><input type=\"text\" name=\"info[pianhaocaiyao]\" id=\"pianhaocaiyao\" size=\"50\" value=\"\"  class=\"input-text\"  >  <span style=\"color:#BD4D31;\"></span></td>    </tr><tr>      <th width=\"120\"> <font color=\"red\">*</font> 血型  </th>      <td><input type=\"text\" name=\"info[xuexing]\" id=\"xuexing\" size=\"50\" value=\"\"  class=\"input-text\"  >  <span style=\"color:#BD4D31;\">请填写您的血型</span></td>    </tr><tr>      <th width=\"120\"> 备注  </th>      <td><textarea name=\'info[beizhu]\' id=\'beizhu\' style=\'width:54%;height:46px;\'   ></textarea>  <span style=\"color:#BD4D31;\">如有其它说明，请填写备注</span></td>    </tr><tr><td></td><td><div class=\"submit ib\"><input type=\"submit\" name=\"dosubmit\" id=\"dosubmit\" value=\" 提交 \"></div> </td></tr></tbody></table></form>");