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<!-- BEGIN main_block -->
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<!-- BEGIN message_block -->
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{MESSAGE_VALUE}
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<!-- END message_block -->
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<hr />
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<div class="account">
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<div class="signup">
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<form name="signup" action="{ACTION_URL}" method="post">
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<input type="hidden" name="action" value="send" />
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<input type="hidden" name="submitted_when" value="{SET_TIME}" />
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<!-- BEGIN asp_block -->
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<p class="{DISPLAY_ASP}" id="pot">
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<label>If you're human leave this blank:</label>
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<input name="robotest" id="robotest" class="robotest" />
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<label for="email-address">Leave this field email-address blank:</label>
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<input id="email-address" name="email-address" size="60" value="" /><br />
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<label for="name">Leave this field name blank:</label>
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<input id="name" name="name" size="60" value="" /><br />
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<label for="full_name">Leave this field full_name blank:</label>
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<input id="full_name" name="full_name" size="60" value="" /><br />
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</p>
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<!-- END asp_block -->
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<h3>{HEADING_SIGNUP}</h3>
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<table>
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<tr>
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<td>{TEXT_USERNAME}:</td>
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<td class="input">
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<input type="text" name="login_name" value="{DISPLAY_USER}" />
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</td>
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</tr>
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<tr>
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<td>{TEXT_DISPLAY_NAME}:</td>
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<td class="input">
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<input type="text" name="display_name" value="{DISPLAY_NAME}" />
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</td>
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</tr>
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<tr>
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<td>{TEXT_EMAIL}:</td>
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<td class="input">
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<input type="text" name="email" value="{EMAIL}" />
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</td>
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</tr>
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<tr>
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<td>{TEXT_LANGUAGE}:</td>
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<td class="input">
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<select name="language" id="language">
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<!-- BEGIN language_list_block -->
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<option value="{CODE}"{SELECTED} style="background: url({FLAG}.png) no-repeat center left; padding-left: 20px;">{NAME} ({CODE})</option>
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<!-- END language_list_block -->
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</select>
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</td>
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</tr>
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<!-- BEGIN password_block -->
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<tr>
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<td colspan="2"><div class="note">{HELP_SIGNUP_REMEMBER_PASSWORD}</div></td>
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</tr>
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<tr>
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<td>{TEXT_NEW_PASSWORD}:</td>
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<td class="input">
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<input type="password" name="new_password_1" />
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</td>
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</tr>
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<tr>
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<td>{TEXT_RETYPE_NEW_PASSWORD}:</td>
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<td class="input">
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<input type="password" name="new_password_2" />
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</td>
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</tr>
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<!-- END password_block -->
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<!-- BEGIN captcha_block -->
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<tr>
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<td class="field_title">{TEXT_VERIFICATION}:</td>
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<td class="input">{CAPTCHA}</td>
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</tr>
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<!-- END captcha_block -->
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<tr>
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<td colspan="2"> </td>
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</tr>
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<tr>
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<td colspan="2" class="button">
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<button type="submit" name="submit" value="">{TEXT_SIGNUP}</button>
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<button type="reset" name="reset" value="reset">{TEXT_RESET}</button>
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<button type="button" value="cancel" onclick="javascript:window.location='{HTTP_REFERER}';">{TEXT_CANCEL}</button>
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</td>
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</tr>
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</table>
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</form>
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</div>
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</div>
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<!-- END main_block -->
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