<h1>Join Red Tide</h1> <div class="redline" id="team"><h2>Registration <!--2008 2008--></h2></div> {if error} <div class="error"> <p>${error}</p> </div> {/if} <div class="highlightbox"> <p><strong>New Registrants:</strong> <a id="empty_form" href="javascript:void(0);">Click here</a> to register.</p> <p><strong>Previous Registrants:</strong> Enter your information below.</p> </div> <table class="regTable"> <tr> <td align="right"><strong>Email Address*</strong></td> <td> <input id="email" type="text" value="${email}" size="30"/> </td> </tr> <tr> <td align="right"><strong>Date of Birth: (mm dd yyyy) *</strong></td> <td><input id="dob_month" size="2" type="text" value="${month}"/> <input id="dob_day" size="2" type="text" value="${day}" class="daymonth"/> <input id="dob_year" size="4" type="text" value="${year}" class="year"/> </td> </tr> <tr> <td align="right"> <input type="submit" id="lookup_submit" value="look me up" class="clsButton" name="butSubmit"/> </td> </tr> </table> <h1>Join Red Tide</h1> <div class="redline" id="team"> <h2>Registration <!--2008 2008--></h2> </div> {if formvars.errors && formvars.errors.length > 0} <div class="error"> {for e in formvars.errors} <p>${e}</p> {/for} </div> {/if} <table class="regTable"> <tr> <td align="right"><strong>Email Address*</strong></td> <td><input name="email" id="email" size="30" value="${formvars.email}" type="text" /></td> </tr> <tr> <td align="right"><strong>USMS Number*</strong></td> <td><input name="usms" id="usms" size="20" value="${formvars.usms}" type="text" /></td> </tr> <tr> <td align="right"><strong>First Name*</strong></td> <td><input name="firstname" id="firstname" size="20" value="${formvars.firstname}" type="text" /></td> </tr> <tr> <td align="right"><strong>Middle Initial</strong></td> <td><input name="middle" id="middle" size="2" value="${formvars.middle}" type="text" /></td> </tr> <tr> <td align="right"><strong>Last Name*</strong></td> <td><input name="lastname" id="lastname" size="20" value="${formvars.lastname}" type="text" /></td> </tr> <tr> <td align="right"><strong>Date of Birth (mm/dd/yyyy)*</strong></td> <td><input name="dob_month" id="dob_month" size="2" value="${formvars.dob_month}" type="text" /> <input name="dob_day" id="dob_day" size="2" value="${formvars.dob_day}" type="text" /> <input name="dob_year" id="dob_year" size="4" value="${formvars.dob_year}" type="text" /> </td> </tr> <tr> <td align="right"><strong>Address*</strong></td> <td><input name="address" id="address" size="30" value="${formvars.address}" type="text"/></td> </tr> <tr> <td align="right"><strong>More Address</strong></td> <td><input name="address2" id="address2" size="30" value="${formvars.address2}" type="text"/></td> </tr> <tr> <td align="right"><strong>City*</strong></td> <td><input name="city" id="city" size="20" value="${formvars.city}" type="text" /></td> </tr> <tr> <td align="right"><strong>State*</strong></td> <td> <select name="state" id="state"> {for state in states} <option value="${state.id}">${state.code}</option> {forelse} {/for} </select> </td> </tr> <tr> <td align="right"><strong>Zip*</strong></td> <td><input name="zip" id="zip" size="16" value="${formvars.zip}" type="text" /></td> </tr> <tr> <td align="right"><strong>Gender*</strong></td> <td>{if formvars.gender == "M"} <input value="F" name="gender" id="f" type="radio">Female<br /> <input checked="1" value="M" name="gender" id="m" type="radio">Male {else} <input checked="1" value="F" name="gender" id="f" type="radio">Female<br /> <input value="M" name="gender" id="m" type="radio">Male {/if} </td> </tr> <tr> <td align="right"><strong>Telephone (Day)</strong></td> <td><input name="dayphone" id="dayphone" size="12" value="${formvars.dayphone}" type="text" /></td> </tr> <tr> <td align="right"><strong>Telephone (Evening)</strong></td> <td><input name="evephone" id="evephone" size="12" value="${formvars.evephone}" type="text" /></td> </tr> <tr> <td align="right"><strong>Payment Plan*</strong></td> <td><select name="plan" id="plan"> <option value="">---------</option> {for plan in plans} <option value="${plan.id}">${plan.name}</option> {forelse} {/for} </select> </td> </tr> <tr> <td></td> <td><input value="1" name="terms" id="terms" type="checkbox"> By checking this box you agree to<br /> Red Tide's <a id="terms_link" href="javascript:void(0);">terms and agreements</a>.</td> </tr> <tr> <td align="right"><input value="Register" id="register" class="clsButton" name="butSubmit" type="submit"></td> <td></td> </tr> </table> <h1>Join Red Tide</h1> <div class="redline" id="team"> <h2>Registration <!--2008 2008--></h2> </div> <table class="regTable"> <tr> <td align="right"><strong>Email Address: </strong></td> <td>${formvars.email}</td> </tr> <tr> <td align="right"><strong>USMS Number: </strong></td> <td>${formvars.usms}</td> </tr> <tr> <td align="right"><strong>First Name: </strong></td> <td>${formvars.firstname}</td> </tr> <tr> <td align="right"><strong>Middle Initial: </strong></td> <td>${formvars.middle}</td> </tr> <tr> <td align="right"><strong>Last Name: </strong></td> <td>${formvars.lastname}</td> </tr> <tr> <td align="right"><strong>Date of Birth (mm/dd/yyyy): </strong></td> <td>${formvars.dob_month}-${formvars.dob_day}-${formvars.dob_year}</td> </tr> <tr> <td align="right"><strong>Address: </strong></td> <td>${formvars.address}</td> </tr> <tr> <td align="right"><strong>More Address: </strong></td> <td>${formvars.address2}</td> </tr> <tr> <td align="right"><strong>City: </strong></td> <td>${formvars.city}</td> </tr> <tr> <td align="right"><strong>State: </strong></td> <td>${formvars.state.code}</td> </tr> <tr> <td align="right"><strong>Zip: </strong></td> <td>${formvars.zip}</td> </tr> <tr> <td align="right"><strong>Gender: </strong></td> <td>{if formvars.gender == "F"}Female{else}Male{/if}</td> </tr> <tr> <td align="right"><strong>Telephone (Day): </strong></td> <td>${formvars.dayphone}</td> </tr> <tr> <td align="right"><strong>Telephone (Evening): </strong></td> <td>${formvars.evephone}</td> </tr> <tr> <td align="right"><strong>Payment Plan: </strong></td> <td>${formvars.plan.name}</td> </tr> {if formvars.owed <= 0.0 && formvars.iscoach != "1"} <tr> <td colspan="2">'You do not owe anything at this time. If seems to be an error please <a href="mailto:help@redtidenyc.org?subject=[Red Tide] Registration Problem">contact us</a></td> </tr> {elseif formvars.owed > 0} <tr> <td align="right"><strong>Amount Owed: </strong></td> <td>${formvars.owed}</td> </tr> <tr> <td colspan="2" style="font-size: 10px;">Please remember that this amount may include the $40.00 annual fee (if you have not paid it this year) in addition the fee for the subscription you selected. If there are any errors, please correct them before you continue by clicking on the back button of your browser. Continue to payment page by clicking on the PayPal button below. Your registration will not be saved until you click the button.</td> </tr> <tr> <td colspan="2"><input type="image" id="submit" src="/media/img/x-click-but6.gif" border="0" alt="pay with PayPal"/></td> </tr> {elseif formvars.iscoach == "1"} <tr> <td colspan="2">Save your registration by clicking on the button below</td> </tr> <tr> <td colspan="2"><input type="submit" id="submit" value="Save Registration"/></td> </tr> {/if} </table>