{error}
<div style="float:left;">
	<div class="formField rsform-block rsform-block-name">
		{Name:caption} (*)<br/>
		{Name:body}<br/>
		{Name:validation}
		{Name:description}<br/>
	</div>
	<div class="formField rsform-block rsform-block-email">
		{Email:caption} (*)<br/>
		{Email:body}<br/>
		{Email:validation}
		{Email:description}<br/>
	</div>
	<div class="formField rsform-block rsform-block-address">
		{Address:caption} (*)<br/>
		{Address:body}<br/>
		{Address:validation}
		{Address:description}<br/>
	</div>
	<div class="formField rsform-block rsform-block-city">
		{City:caption} (*)<br/>
		{City:body}<br/>
		{City:validation}
		{City:description}<br/>
	</div>
	<div class="formField rsform-block rsform-block-state" style="float:left;">
		{State:caption} (*)<br/>
		{State:body}<br/>
		{State:validation}
		{State:description}<br/>
	</div>
	<div class="formField rsform-block rsform-block-zip" style="float:left; margin-left:40px;">
		{Zip:caption} (*)<br/>
		{Zip:body}<br/>
		{Zip:validation}
		{Zip:description}<br/>
	</div>
        <br clear="both" />
	<div class="formField rsform-block rsform-block-phone">
		{Phone:caption} (*)<br/>
		{Phone:body}<br/>
		{Phone:validation}
		{Phone:description}<br/>
	</div>
	<div class="formField rsform-block rsform-block-desired-membership-level">
		{Desired Membership Level:caption} (*)<br/>
		{Desired Membership Level:body}<br/>
		{Desired Membership Level:validation}
		{Desired Membership Level:description}<br/>
	</div>
	<div class="formField rsform-block rsform-block-submit">
		{Submit:caption}<br/>
		{Submit:body}<br/>
		{Submit:validation}
		{Submit:description}<br/>
	</div>
</div>
<div style="float:left;width:275px;margin:10px 0px 0px 30px;text-align: justify;line-height:120%;">
The annual fee for ESP membership is billed on the first day precceding the month in which you sign the agreement. The annual estate planning consultation meeting may be scheduled for a mutually convenient date and time during the enrollment year..  We will send ESP members a reminder notice 30 days prior to thier renewal date, as well as a renewal invoice for timely, automatic renewal of your enrollment (for some, this might also serve as a reminder to add the annual consultation to the News Year's Resolution list).
</div>
<br clear="both" />
