Putting code into Kuroi's Blank Sidebox

[dealbyethan.com]

Hi,

I am trying to get the following code to integrate and work properly in Kuroi's Blank Sidebox.

<script language="Javascript" type="text/javascript">

var fieldstocheck = new Array();
    fieldnames = new Array();

function checkform() {
  for (i=0;i<fieldstocheck.length;i++) {
    if (eval("document.subscribeform.elements['"+fieldstocheck[i]+"'].value") == "") {
      alert("Please enter your "+fieldnames[i]);
      eval("document.subscribeform.elements['"+fieldstocheck[i]+"'].focus()");
      return false;
    }
  }

  return true;
}


function addFieldToCheck(value,name) {
  fieldstocheck[fieldstocheck.length] = value;
  fieldnames[fieldnames.length] = name;
}

function compareEmail()
{
  return (document.subscribeform.elements["email"].value == document.subscribeform.elements["emailconfirm"].value);
}

</script><form method=post action="http://www.dealbyethan.com/newsletters/?p=subscribe&id=1" name="subscribeform" target="windowName" onsubmit="window.open('', this.target,
'dialog,modal,scrollbars=no,resizable=no,width=550,height=300,left=0,top=0');"><style type="text/css">
      div.adminmessage {
        width: 100%;
        border: 2px dashed #000000;
        padding: 10px;
        margin-bottom: 15px;
        background-color: #E7BE8F;

      }
      </style>

Email: <input type=text name=email value="" size="15">
  <script language="Javascript" type="text/javascript">addFieldToCheck("email","Email");</script>
        
        <input type="hidden" name="list[3]" value="signup"><input type="hidden" name="listname[3]" value="Mens Clothing"/><input type=submit name="subscribe" value="Subscribe" onClick="return checkform();">
    </form>

It's essentially a simple phplist subscription with a field and subcribe button. I put the code in tpl_blank_sidebox.php but it gave me this error. The above code works fine if it wasn't in a sidebox. Please advise. Thank you.

Parse error: syntax error, unexpected T_CONSTANT_ENCAPSED_STRING