document.write('<div style="width:198px; margin:0 0 1em 0; padding:0; background:#FFF3FE; border:1px solid #663366;">');
document.write('<div><img src="http://blog.nagano-ken.jp/img/index/title_survey.gif" alt="信州の常識 あなたはどっち？" title="信州の常識 あなたはどっち？" width="198" height="25" /></div>');
document.write('<div style="margin:10px; text-align:left; font-size:11px;">');
document.write('<form action="http://blog.nagano-ken.jp/survey_result.php" method="post">');
document.write('<div style="margin:0 0 0.5em 0;">');
document.write('信州といえば最初に何をイメージ？');
document.write('</div>');
document.write('<div style="margin:0 0 0.5em 0;">');
document.write('<div id="survey_brief">あなたがイメージする信州を教えてください。</div>');
document.write('</div>');
document.write('<table style="margin:0.5em 0;">');
document.write('<tr class="survey_vote"><td class="survey_vote"><input type="radio" name="survey_detail_no" value="41" id="0"></td><td class="survey_vote"><label for="0">お蕎麦</label></td></tr><tr class="survey_vote"><td class="survey_vote"><input type="radio" name="survey_detail_no" value="42" id="1"></td><td class="survey_vote"><label for="1">りんご</label></td></tr><tr class="survey_vote"><td class="survey_vote"><input type="radio" name="survey_detail_no" value="43" id="2"></td><td class="survey_vote"><label for="2">美しい山並み</label></td></tr><tr class="survey_vote"><td class="survey_vote"><input type="radio" name="survey_detail_no" value="44" id="3"></td><td class="survey_vote"><label for="3">おやき</label></td></tr><tr class="survey_vote"><td class="survey_vote"><input type="radio" name="survey_detail_no" value="45" id="4"></td><td class="survey_vote"><label for="4">野沢菜</label></td></tr><tr class="survey_vote"><td class="survey_vote"><input type="radio" name="survey_detail_no" value="46" id="5"></td><td class="survey_vote"><label for="5">それ以外</label></td></tr>');
document.write('</table>');
document.write('<div style="border-width:1px 0px 1px 0px;border-style:dotted;border-color:#ccc;padding:5px;margin-bottom:10px">一言コメント<br><input type="text" name="survey_detail_comment"></div>');
document.write('<div style="text-align:center;">');
document.write('<div style="margin:0.5em 0;"><input type="submit" name="survey_vote" value="投票する" class="button"></div>');
document.write('<p style="margin:0.5em 0;"><a href="http://blog.nagano-ken.jp/survey_result.php?id=3">投票結果を見る</a></p>');
document.write('<div>投票受付期間</div>');
document.write('<div id="survey_time">2010/09/01～2010/09/30</div>');
document.write('</div>');
document.write('<input type="hidden" name="id" value="3">');
document.write('</form>');
document.write('</div>');
document.write('</div>');