document.write('<div id="out_table">');
document.write('<form action="//amamin.jp/survey_result.php" method="post"><input type="hidden" name="csrf" value="46033a0ba050e9571e8e9b58508d29129b5e3fc7" />');
document.write('<div id="survey_title">');
document.write('あなたの性別、年齢を教えてください！');
document.write('</div>');
document.write('<div id="survey_time">2010/05/28～2010/06/27</div>');
document.write('<div id="survey_brief">しーまブログを観覧されている皆様、性別、年齢層はどれくらいでしょうか？</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">10代（以下も含む）男</label></td></tr><tr class="survey_vote"><td class="survey_vote"></td><td class="survey_vote"><label for="1">20代男</label></td></tr><tr class="survey_vote"><td class="survey_vote"></td><td class="survey_vote"><label for="2">30代男</label></td></tr><tr class="survey_vote"><td class="survey_vote"></td><td class="survey_vote"><label for="3">40代男</label></td></tr><tr class="survey_vote"><td class="survey_vote"></td><td class="survey_vote"><label for="4">50代男</label></td></tr><tr class="survey_vote"><td class="survey_vote"></td><td class="survey_vote"><label for="5">60代男</label></td></tr><tr class="survey_vote"><td class="survey_vote"></td><td class="survey_vote"><label for="6">70代以上男</label></td></tr><tr class="survey_vote"><td class="survey_vote"></td><td class="survey_vote"><label for="7">10代（以下も含む）女</label></td></tr><tr class="survey_vote"><td class="survey_vote"></td><td class="survey_vote"><label for="8">20代女</label></td></tr><tr class="survey_vote"><td class="survey_vote"></td><td class="survey_vote"><label for="9">30代女</label></td></tr><tr class="survey_vote"><td class="survey_vote"></td><td class="survey_vote"><label for="10">40代女</label></td></tr><tr class="survey_vote"><td class="survey_vote"></td><td class="survey_vote"><label for="11">50代女</label></td></tr><tr class="survey_vote"><td class="survey_vote"></td><td class="survey_vote"><label for="12">60代女</label></td></tr><tr class="survey_vote"><td class="survey_vote"></td><td class="survey_vote"><label for="13">70代以上女</label></td></tr><tr class="survey_vote"><td class="survey_vote"></td><td class="survey_vote"><label for="14">ひ・み・つ</label></td></tr>');
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document.write('<p class="more"><a href="//amamin.jp/survey_result.php?id=4&page=3">投票結果を見る</a></p>');
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document.write('<input type="hidden" name="id" value="4">');
document.write('</form>');
document.write('</div>');