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	document.write('<form name=xlaapmform329_5 method=post target=xlaapmxe action=http:\/\/www.hampshirereview.com\/xpm\/xlaabsolute2.asp?p=329 style=margin:0;><table width=100% cellspacing=1 cellpadding=2><tr align=left><td colspan=2 valign=top><font  style=\"font-family:helvetica;font-size:12;color:#000000;\"><b>Do you plan on getting a flu shot this year?<\/b><\/font><\/td><\/tr><tr><td><\/td><td><input type=hidden name=answer1 value=\'\'><\/td><\/tr><tr><td width=0 valign=top align=left><input type=\'radio\' name=\'ans1\' onclick=\'javascript:xlaapmform329_5.answer1.value=1278\'><\/td><td width=100%><font  style=\"font-family:helvetica;font-size:12;color:#000000;\">Yes<\/font><\/td><\/tr><tr><td width=0 valign=top align=left><input type=\'radio\' name=\'ans1\' onclick=\'javascript:xlaapmform329_5.answer1.value=1279\'><\/td><td width=100%><font  style=\"font-family:helvetica;font-size:12;color:#000000;\">No<\/font><\/td><\/tr><tr><td width=0 valign=top align=left><input type=\'radio\' name=\'ans1\' onclick=\'javascript:xlaapmform329_5.answer1.value=1280\'><\/td><td width=100%><font  style=\"font-family:helvetica;font-size:12;color:#000000;\">I haven’t decided<\/font><\/td><\/tr><tr><td>&nbsp;<\/td><td>&nbsp;<\/td><\/tr><tr><td align=center colspan=2><input type=button onclick=\"javascript:xlaapmsubmit329_5()\" name=Submit value=\'Submit Vote\' style=\"font-family:helvetica;font-size:12;color:#000000;\"\'><input type=hidden name=totalquestions value=1><\/td><\/tr><\/table><input type=hidden name=dopoll value=329><input type=hidden name=z value=\'5\'><\/form>');