<!-- #declare:separator <hr> --> 
<!-- login form section-->
<form method="post" name="websignupfrm" action="[+action+]">
    <fieldset>
        <h3>User Details</h3>
        <p>Items marked by * are required</p>
		<label for="wsu_username">User name:* <input type="text" name="wsu_username" id="wsu_username" class="inputBox" size="20" maxlength="30" value="[+username+]" /></label>
        <label for="fullname">Full name: <input type="text" name="fullname" id="fullname" class="inputBox" size="20" maxlength="100" value="[+fullname+]" /></label>
		<label for="wsu_email">Email address:* <input type="text" name="wsu_email" id="wsu_email" class="inputBox" size="20" value="[+email+]" /></label>
	</fieldset>
	
	<fieldset>
	    <h3>Password</h3>
	    <label for="wsu_password">Password:* <input type="password" name="wsu_password" id="wsu_password" class="inputBox" size="20" /></label>
	    <label for="confirmpassword">Confirm password:* <input type="password" name="confirmpassword" id="confirmpassword" class="inputBox" size="20" /></label>
	</fieldset>
	
	<fieldset>
		<h3>Optional Account Profile Info</h3>
		<label for="country">Country:</label>
		<select size="1" name="country" id="country">
			<option value="" selected="selected">&nbsp;</option>
			<option value="1">Afghanistan</option>
			<option value="2">Albania</option>
			<option value="3">Algeria</option>
			<option value="4">American Samoa</option>
			<option value="5">Andorra</option>
			<option value="6">Angola</option>
			<option value="7">Anguilla</option>
			<option value="8">Antarctica</option>
			<option value="9">Antigua and Barbuda</option>
			<option value="10">Argentina</option>
			<option value="11">Armenia</option>
			<option value="12">Aruba</option>
			<option value="13">Australia</option>
			<option value="14">Austria</option>
			<option value="15">Azerbaijan</option>
			<option value="16">Bahamas</option>
			<option value="17">Bahrain</option>
			<option value="18">Bangladesh</option>
			<option value="19">Barbados</option>
			<option value="20">Belarus</option>
			<option value="21">Belgium</option>
			<option value="22">Belize</option>
			<option value="23">Benin</option>
			<option value="24">Bermuda</option>
			<option value="25">Bhutan</option>
			<option value="26">Bolivia</option>
			<option value="27">Bosnia and Herzegowina</option>
			<option value="28">Botswana</option>
			<option value="29">Bouvet Island</option>
			<option value="30">Brazil</option>
			<option value="31">British Indian Ocean Territory</option>
			<option value="32">Brunei Darussalam</option>
			<option value="33">Bulgaria</option>
			<option value="34">Burkina Faso</option>
			<option value="35">Burundi</option>
			<option value="36">Cambodia</option>
			<option value="37">Cameroon</option>
			<option value="38">Canada</option>
			<option value="39">Cape Verde</option>
			<option value="40">Cayman Islands</option>
			<option value="41">Central African Republic</option>
			<option value="42">Chad</option>
			<option value="43">Chile</option>
			<option value="44">China</option>
			<option value="45">Christmas Island</option>
			<option value="46">Cocos (Keeling) Islands</option>
			<option value="47">Colombia</option>
			<option value="48">Comoros</option>
			<option value="49">Congo</option>
			<option value="50">Cook Islands</option>
			<option value="51">Costa Rica</option>
			<option value="52">Cote D&#39;Ivoire</option>
			<option value="53">Croatia</option>
			<option value="54">Cuba</option>
			<option value="55">Cyprus</option>
			<option value="56">Czech Republic</option>
			<option value="57">Denmark</option>
			<option value="58">Djibouti</option>
			<option value="59">Dominica</option>
			<option value="60">Dominican Republic</option>
			<option value="61">East Timor</option>
			<option value="62">Ecuador</option>
			<option value="63">Egypt</option>
			<option value="64">El Salvador</option>
			<option value="65">Equatorial Guinea</option>
			<option value="66">Eritrea</option>
			<option value="67">Estonia</option>
			<option value="68">Ethiopia</option>
			<option value="69">Falkland Islands (Malvinas)</option>
			<option value="70">Faroe Islands</option>
			<option value="71">Fiji</option>
			<option value="72">Finland</option>
			<option value="73">France</option>
			<option value="74">France, Metropolitan</option>
			<option value="75">French Guiana</option>
			<option value="76">French Polynesia</option>
			<option value="77">French Southern Territories</option>
			<option value="78">Gabon</option>
			<option value="79">Gambia</option>
			<option value="80">Georgia</option>
			<option value="81">Germany</option>
			<option value="82">Ghana</option>
			<option value="83">Gibraltar</option>
			<option value="84">Greece</option>
			<option value="85">Greenland</option>
			<option value="86">Grenada</option>
			<option value="87">Guadeloupe</option>
			<option value="88">Guam</option>
			<option value="89">Guatemala</option>
			<option value="90">Guinea</option>
			<option value="91">Guinea-bissau</option>
			<option value="92">Guyana</option>
			<option value="93">Haiti</option>
			<option value="94">Heard and Mc Donald Islands</option>
			<option value="95">Honduras</option>
			<option value="96">Hong Kong</option>
			<option value="97">Hungary</option>
			<option value="98">Iceland</option>
			<option value="99">India</option>
			<option value="100">Indonesia</option>
			<option value="101">Iran (Islamic Republic of)</option>
			<option value="102">Iraq</option>
			<option value="103">Ireland</option>
			<option value="104">Israel</option>
			<option value="105">Italy</option>
			<option value="106">Jamaica</option>
			<option value="107">Japan</option>
			<option value="108">Jordan</option>
			<option value="109">Kazakhstan</option>
			<option value="110">Kenya</option>
			<option value="111">Kiribati</option>
			<option value="112">Korea, Democratic People&#39;s Republic of</option>
			<option value="113">Korea, Republic of</option>
			<option value="114">Kuwait</option>
			<option value="115">Kyrgyzstan</option>
			<option value="116">Lao People&#39;s Democratic Republic</option>
			<option value="117">Latvia</option>
			<option value="118">Lebanon</option>
			<option value="119">Lesotho</option>
			<option value="120">Liberia</option>
			<option value="121">Libyan Arab Jamahiriya</option>
			<option value="122">Liechtenstein</option>
			<option value="123">Lithuania</option>
			<option value="124">Luxembourg</option>
			<option value="125">Macau</option>
			<option value="126">Macedonia, The Former Yugoslav Republic of</option>
			<option value="127">Madagascar</option>
			<option value="128">Malawi</option>
			<option value="129">Malaysia</option>
			<option value="130">Maldives</option>
			<option value="131">Mali</option>
			<option value="132">Malta</option>
			<option value="133">Marshall Islands</option>
			<option value="134">Martinique</option>
			<option value="135">Mauritania</option>
			<option value="136">Mauritius</option>
			<option value="137">Mayotte</option>
			<option value="138">Mexico</option>
			<option value="139">Micronesia, Federated States of</option>
			<option value="140">Moldova, Republic of</option>
			<option value="141">Monaco</option>
			<option value="142">Mongolia</option>
			<option value="143">Montserrat</option>
			<option value="144">Morocco</option>
			<option value="145">Mozambique</option>
			<option value="146">Myanmar</option>
			<option value="147">Namibia</option>
			<option value="148">Nauru</option>
			<option value="149">Nepal</option>
			<option value="150">Netherlands</option>
			<option value="151">Netherlands Antilles</option>
			<option value="152">New Caledonia</option>
			<option value="153">New Zealand</option>
			<option value="154">Nicaragua</option>
			<option value="155">Niger</option>
			<option value="156">Nigeria</option>
			<option value="157">Niue</option>
			<option value="158">Norfolk Island</option>
			<option value="159">Northern Mariana Islands</option>
			<option value="160">Norway</option>
			<option value="161">Oman</option>
			<option value="162">Pakistan</option>
			<option value="163">Palau</option>
			<option value="164">Panama</option>
			<option value="165">Papua New Guinea</option>
			<option value="166">Paraguay</option>
			<option value="167">Peru</option>
			<option value="168">Philippines</option>
			<option value="169">Pitcairn</option>
			<option value="170">Poland</option>
			<option value="171">Portugal</option>
			<option value="172">Puerto Rico</option>
			<option value="173">Qatar</option>
			<option value="174">Reunion</option>
			<option value="175">Romania</option>
			<option value="176">Russian Federation</option>
			<option value="177">Rwanda</option>
			<option value="178">Saint Kitts and Nevis</option>
			<option value="179">Saint Lucia</option>
			<option value="180">Saint Vincent and the Grenadines</option>
			<option value="181">Samoa</option>
			<option value="182">San Marino</option>
			<option value="183">Sao Tome and Principe</option>
			<option value="184">Saudi Arabia</option>
			<option value="185">Senegal</option>
			<option value="186">Seychelles</option>
			<option value="187">Sierra Leone</option>
			<option value="188">Singapore</option>
			<option value="189">Slovakia (Slovak Republic)</option>
			<option value="190">Slovenia</option>
			<option value="191">Solomon Islands</option>
			<option value="192">Somalia</option>
			<option value="193">South Africa</option>
			<option value="194">South Georgia and the South Sandwich Islands</option>
			<option value="195">Spain</option>
			<option value="196">Sri Lanka</option>
			<option value="197">St. Helena</option>
			<option value="198">St. Pierre and Miquelon</option>
			<option value="199">Sudan</option>
			<option value="200">Suriname</option>
			<option value="201">Svalbard and Jan Mayen Islands</option>
			<option value="202">Swaziland</option>
			<option value="203">Sweden</option>
			<option value="204">Switzerland</option>
			<option value="205">Syrian Arab Republic</option>
			<option value="206">Taiwan</option>
			<option value="207">Tajikistan</option>
			<option value="208">Tanzania, United Republic of</option>
			<option value="209">Thailand</option>
			<option value="210">Togo</option>
			<option value="211">Tokelau</option>
			<option value="212">Tonga</option>
			<option value="213">Trinidad and Tobago</option>
			<option value="214">Tunisia</option>
			<option value="215">Turkey</option>
			<option value="216">Turkmenistan</option>
			<option value="217">Turks and Caicos Islands</option>
			<option value="218">Tuvalu</option>
			<option value="219">Uganda</option>
			<option value="220">Ukraine</option>
			<option value="221">United Arab Emirates</option>
			<option value="222">United Kingdom</option>
			<option value="223">United States</option>
			<option value="224">United States Minor Outlying Islands</option>
			<option value="225">Uruguay</option>
			<option value="226">Uzbekistan</option>
			<option value="227">Vanuatu</option>
			<option value="228">Vatican City State (Holy See)</option>
			<option value="229">Venezuela</option>
			<option value="230">Viet Nam</option>
			<option value="231">Virgin Islands (British)</option>
			<option value="232">Virgin Islands (U.S.)</option>
			<option value="233">Wallis and Futuna Islands</option>
			<option value="234">Western Sahara</option>
			<option value="235">Yemen</option>
			<option value="236">Yugoslavia</option>
			<option value="237">Zaire</option>
			<option value="238">Zambia</option>
			<option value="239">Zimbabwe</option>
			</select>
        </fieldset>
        
        <fieldset>
            <h3>Bot-Patrol</h3>
            <p>Enter the word/number combination shown in the image below.</p>
            <label>Form code:* 
            <input type="text" name="formcode" class="inputBox" size="20" /></label>
            <a href="[+action+]"><img align="top" src="manager/includes/veriword.php" width="148" height="60" alt="If you have trouble reading the code, click on the code itself to generate a new random code." style="border: 1px solid #039" /></a>
        </fieldset>
        
        <fieldset>
            <input type="submit" value="Submit" name="cmdwebsignup" />
	</fieldset>
</form>

<script language="javascript" type="text/javascript"> 
	var id = "[+country+]";
	var f = document.websignupfrm;
	var i = parseInt(id);	
	if (!isNaN(i)) f.country.options[i].selected = true;
</script>
<hr>
<!-- notification section -->
<p class="message">Signup completed successfully!<br />
Your account was created. A copy of your signup information was sent to your email address.</p>
