162 lines
5 KiB
Plaintext
162 lines
5 KiB
Plaintext
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<HTML>
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<HEAD>
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<link rel=stylesheet type="text/css" href="mmsobshe.css">
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<TITLE>Please enter the following information to create your profile.</TITLE>
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<META http-equiv="Content-Type" content="text/html; charset=iso-8859-1">
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</HEAD>
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<BODY onload="window.parent.UserInfoLoadMe()">
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<img class=gradient src="../images/watermrk.gif" tabindex=-1>
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<img id="StageImage" class=flag>
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<SPAN CLASS="pageTitle">
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Please enter the following information<br>
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to create your profile.
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</SPAN>
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<SPAN CLASS="contents">
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Your name is required to continue
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<br>
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<table class="fontStyle" width="98%" border="0" cellspacing="0" cellpadding="0">
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<tr>
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<td width="22%">
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<LABEL FOR="edt_FirstName">Name</LABEL>
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<BR>
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<input type="text" id="edt_FirstName" size="20">
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</td>
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<td width="22%">
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<LABEL FOR="edt_MiddleInitial">Initial</LABEL>
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<BR>
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<input type="text" id="edt_MiddleInitial" size="20">
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</td>
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<td width="22%">
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<LABEL FOR="edt_LastName">Last Name</LABEL>
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<BR>
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<input type="text" id="edt_LastName" size="20">
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</td>
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</tr>
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<tr>
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<td colspan="3">
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<LABEL FOR="edt_PrimaryEmail">Primary e-mail address (if you have one)</LABEL>
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<br>
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<input type="text" id="edt_PrimaryEmail" size="20">
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</td>
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</tr>
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<tr STYLE="display:none">
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<td colspan="3">
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<LABEL FOR="edt_SecondaryEmail">Secondary e-mail address (if you have one)</LABEL>
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<br>
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<input type="text" id="edt_SecondaryEmail" size="20">
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</td>
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</tr>
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<td colspan="3" STYLE="display:none">
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<LABEL FOR="edt_CompanyName">Company Name</LABEL>
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<BR>
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<input type="text" id="edt_CompanyName" size="20">
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</td>
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</tr>
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<tr>
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<td colspan="3">
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<LABEL FOR="txt_Address">Mailing Address</LABEL>
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<BR>
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<TEXTAREA rows="2" cols="45" STYLE="overflow:hidden" id="txt_Address">
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</TEXTAREA>
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</td>
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</tr>
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<tr>
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<td width="22%">
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<LABEL FOR="edt_City">City</LABEL>
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<BR>
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<input type="text" id="edt_City" size="20">
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</td>
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<td width="11%">
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<LABEL FOR="sel_State">State</LABEL>
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<BR>
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<select id="sel_State">
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<option value=notset selected>
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<option value="AL">AL
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<option value="AK">AK
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<option value="AZ">AZ
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<option value="AR">AR
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<option value="CA">CA
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<option value="CO">CO
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<option value="CT">CT
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<option value="DC">DC
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<option value="DE">DE
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<option value="FL">FL
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<option value="GA">GA
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<option value="HI">HI
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<option value="ID">ID
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<option value="IL">IL
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<option value="IN">IN
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<option value="IA">IA
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<option value="KS">KS
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<option value="KY">KY
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<option value="LA">LA
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<option value="ME">ME
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<option value="MD">MD
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<option value="MA">MA
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<option value="MI">MI
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<option value="MN">MN
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<option value="MS">MS
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<option value="MO">MO
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<option value="MT">MT
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<option value="NE">NE
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<option value="NV">NV
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<option value="NH">NH
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<option value="NJ">NJ
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<option value="NM">NM
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<option value="NY">NY
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<option value="NC">NC
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<option value="ND">ND
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<option value="OH">OH
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<option value="OK">OK
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<option value="OR">OR
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<option value="PA">PA
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<option value="PR">PR
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<option value="RI">RI
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<option value="SC">SC
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<option value="SD">SD
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<option value="TN">TN
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<option value="TX">TX
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<option value="UT">UT
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<option value="VT">VT
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<option value="VA">VA
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<option value="WA">WA
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<option value="WV">WV
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<option value="WI">WI
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<option value="WY">WY
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</option>
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</select>
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</td>
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<td width="21%">
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<LABEL FOR="edt_Zip">ZIP Code</LABEL>
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<BR>
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<input type="text" id="edt_Zip" size="5">
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</td>
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</tr>
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<tr>
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<td width="22%">
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<LABEL FOR="edt_AreaCode">Primary telephone number</LABEL>
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<BR>
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<input type="text" id="edt_AreaCode" size="3">
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<input type="text" id="edt_Prefix" size="3">
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<input type="text" id="edt_Number" size="4">
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</td>
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</tr>
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</table>
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</SPAN>
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<SPAN CLASS="navbar">
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<HR NOSHADE CLASS="blackBar">
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<button id=btnBack class=backButton onclick="window.parent.GoBack(window.parent.CKPT_USERINFO)">
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< Back
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</button>
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<button id=btnNext class=nextButton onclick="window.parent.GoNext(window.parent.CKPT_USERINFO)">
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Next >
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</button>
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</SPAN>
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</BODY>
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</HTML>
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