I've placed the code for the page in the Private Message area. Below is the relevant code from the form:
<li class="formItem">
<div class="formGroup">
<label class="groupHeader" for="Registration_Authorization_field">Authorization</label>
<div class="lineGroup">
<div class="fullColumnGroup">
<div class="errorGroup">
<div class="fieldPair">
<div class="fieldGroup"> <span id="Registration_Authorization_field_Spry">
<label class="checklabel" for="Registration_Authorization_field" onblur="hideServerError('Registration_Authorization_field_ServerError');"><img id="capt1" src="webassist/captcha/wavt_captchasecurityimages.php?width=200&height=50&field=Security_Code_1&bgcolor=FFFFFF&transparent=1&bgimage=&gridfreq=20&gridcolor=000000&gridorder=behind&noisefreq=20&noisecolor=1B2C5D&noiseorder=behind&characters=5&charheight=&font=fonts/MOM_T___.TTF&textcolor=1B2C5D" alt="security code" width="200" height="50" /><img src="webassist/captcha/images/refresh.png" height="18" onclick="document.getElementById('capt1').src+='&ref=1'" /><br />
<span class="requiredIndicator"> *</span><input id="Security_Code_1" name="Security_Code_1" type="text" value="" /> </label>
<?php
if (ValidatedField('advocacysignup','advocacysignup')) {
if ((strpos((",".ValidatedField("advocacysignup","advocacysignup").","), "," . "4" . ",") !== false || "4" == "")) {
if (!(false)) {
?>
<span class="serverInvalidState" id="Security_Code_1">Please enter the security code </span>
<?php //WAFV_Conditional newslettersignup.php advocacysignup(4:)
}
}
}?>
<br />
<span class="SecurityRequiredMsg">Enter the security code shown above</span> </span></div>
</div>
</div>
</div>
<div class="fullColumnGroup">
<div class="errorGroup">
<div class="fieldPair">
<div class="fieldGroup"> <span id="Registration_Authorization_field_Spry">
<label class="checklabel" for="Registration_Authorization_field" onblur="hideServerError('Registration_Authorization_field_ServerError');">
<span class="requiredIndicator"> *</span><input type="checkbox" name="Registration_Authorization_field" id="Registration_Authorization_field" value="1" class="formCheckboxField_Standard" <?php if (!(strcmp((isset($_GET["invalid"])?ValidatedField("advocacysignup","Registration_Authorization_field"):""),""))) {echo "unchecked=\"unchecked\"";} ?> tabindex="4" />
</label>
<span class="checkboxRequiredMsg">Please agree to our terms</span> </span> <input name="Content" type="hidden" id="Content" value="please include me in your email newsletter list" /><input name="pgSrc" type="hidden" id="pgSrc" value="6" /><input id="regDate" name="regDate" type="hidden" value="<?php echo(date("Y-m-d H:i:s")); ?>" /></div>
</div>
</div>
</div>
</div>
</div>
</li>