document.write('<div id="out_table">');
document.write('<form action="//ashita-sanuki.jp/survey_result.php" method="post"><input type="hidden" name="csrf" value="24e87012db099360969bf32486a428b162e72cb9" />');
document.write('<div id="survey_title">');
document.write('現在お使いのテレビは？');
document.write('</div>');
document.write('<div id="survey_time">2008/09/04～2008/09/30</div>');
document.write('<div id="survey_brief">皆さんにお聞きします。<br />現在主にお使いのテレビを教えてください。<br />一言コメントにはテレビについて書き込み下さい。</div>');
document.write('<table class="survey_vote">');
document.write('<tr class="survey_vote"><td class="survey_vote"></td><td class="survey_vote"><label for="0">液晶テレビ</label></td></tr><tr class="survey_vote"><td class="survey_vote"></td><td class="survey_vote"><label for="1">プラズマテレビ</label></td></tr><tr class="survey_vote"><td class="survey_vote"></td><td class="survey_vote"><label for="2">ブラウン管テレビ</label></td></tr><tr class="survey_vote"><td class="survey_vote"></td><td class="survey_vote"><label for="3">パソコンでのテレビ視聴</label></td></tr><tr class="survey_vote"><td class="survey_vote"></td><td class="survey_vote"><label for="4">その他</label></td></tr><tr class="survey_vote"><td class="survey_vote"></td><td class="survey_vote"><label for="5">テレビは無い</label></td></tr>');
document.write('</table>');
document.write('');
document.write('<div id="vote_button">');
document.write('<p class="bt"></p>');
document.write('<p class="more"><a href="//ashita-sanuki.jp/survey_result.php?id=16">投票結果を見る</a></p>');
document.write('</div>');
document.write('<input type="hidden" name="id" value="16">');
document.write('</form>');
document.write('</div>');