] [[!Register? &activation=`0` &submittedResourceId=`65` &usernameField=`email` &emailField=`email`]][[$hsRegisterForm]] [
]
<div class="register">
<div class="registerMessage">[[+error.message]]</div>
<form name="reg_form" id="reg_form" class="form" action="[[~[[*id]]]]" method="post">
<input type="hidden" name="nospam:blank" value="" />
<h2>Login Info</h2>
<div class="col2">
<label for="email">Your Email</label>
</div>
<div class="col6 last">
<input type="text" name="email:required:required:minLength=6" id="email" value="[[+email]]" />
<label>*</label>
<span class="error">[[+error.email]]</span>
</div>
<div class="clear"></div>
<div class="col2">
<label for="password">Password</label>
</div>
<div class="col6 last">
<input type="password" name="password:required:minLength=6" id="password" value="[[+password]]" />
<label>*</label>
<span class="smlltxt">(Must be 6 characters or longer)</span>
<span class="error">[[+error.password]]</span>
</div>
<div class="clear"></div>
<div class="col2">
<label for="password_confirm">Confirm Password</label>
</div>
<div class="col6 last">
<input type="password" name="password_confirm:password_confirm=`password`" id="password_confirm" value="[[+password_confirm]]" />
<label>*</label>
<span class="error">[[+error.password_confirm]]</span>
</div>
<div class="clear"></div>
<h2>Contact Info</h2>
<div class="col2">
<label for="fullname">Your Full Name</label>
</div>
<div class="col6 last">
<input type="text" name="fullname:required" id="fullname" value="[[+fullname]]" />
<label>*</label>
<span class="error">[[+error.fullname]]</span>
</div>
<div class="clear"></div>
<div class="col2">
<label for="mobilephone">Mobile Number</label>
</div>
<div class="col6 last">
<input type="text" name="mobilephone:required" id="mobilephone" value="[[+mobilephone]]" />
<label>*</label>
<span class="error">[[+error.mobilephone]]</span>
</div>
<div class="clear"></div>
<h2>Billing Info</h2>
<div class="col2">
<label for="address">Billing Address</label>
</div>
<div class="col6 last">
<textarea name="address:required" id="address" rows="2">[[+address]]</textarea>
<label>*</label>
<span class="error">[[+error.address]]</span>
</div>
<div class="clear"></div>
<div class="col2">
<label for="city">City</label>
</div>
<div class="col6 last">
<input type="text" name="city" id="city" value="[[+city]]" />
</div>
<div class="clear"></div>
<div class="col2">
<label for="zip">Postal Code</label>
</div>
<div class="col6 last">
<input type="text" name="zip" id="zip" value="[[+zip]]" />
</div>
<div class="clear"></div>
<div class="col2">
<label for="state">County/Region</label>
</div>
<div class="col6 last">
<input type="text" name="state:required" id="state" value="[[+state]]" />
<label>*</label>
<span class="error">[[+error.state]]</span>
</div>
<div class="clear"></div>
<div class="col2">
<label for="country">Country</label>
</div>
<div class="col6 last">
<select name="country" id="country" title="Please indicate your country of residence">
<option value="Ireland"[[+country:ifequalto=`Ireland`:then=` selected="selected"`]]>Ireland</option>
<option value="United Kingdom"[[+country:ifequalto=`United Kingdom`:then=` selected="selected"`]]>United Kingdom</option>
</select>
<label>*</label>
</div>
<div class="clear"></div>
<h2>Delivery Info</h2>
<p>
<label for="chk_ship">My delivery info is the same as my billing info</label>
<input type="checkbox" id="chk_ship" value="The Same"/>
</p>
<div class="clear"></div>
<div class="col2">
<label for="ship_fullname">Name</label>
</div>
<div class="col6 last">
<input type="text" name="ship_fullname:required" id="ship_fullname" value="[[+ship_fullname]]"/>
<label>*</label>
<span class="error">[[+error.ship_fullname]]</span>
</div>
<div class="clear"></div>
<div class="col2">
<label for="ship_address">Address</label>
</div>
<div class="col6 last">
<textarea name="ship_address:required" id="ship_address" rows="2">[[+ship_address]]</textarea>
<label>*</label>
<span class="error">[[+error.ship_address]]</span>
</div>
<div class="clear"></div>
<div class="col2">
<label for="ship_city">City</label>
</div>
<div class="col6 last">
<input type="text" name="ship_city" id="ship_city" value="[[+ship_city]]" />
</div>
<div class="clear"></div>
<div class="col2">
<label for="ship_zip">Postal Code</label>
</div>
<div class="col6 last">
<input type="text" name="ship_zip" id="ship_zip" value="[[+ship_zip]]" />
</div>
<div class="clear"></div>
<div class="col2">
<label for="ship_state">County/Region</label>
</div>
<div class="col6 last">
<input type="text" name="ship_state:required" id="ship_state" value="[[+ship_state]]" />
<label>*</label>
<span class="error">[[+error.ship_state]]</span>
</div>
<div class="clear"></div>
<div class="col2">
<label for="ship_country">Country</label>
</div>
<div class="col6 last">
<select name="ship_country" id="ship_country" title="Please indicate the address you wish to have your current order shipped to">
<option value="Ireland"[[+ship_country:ifequalto=`Ireland`:then=` selected="selected"`]]>Ireland</option>
<option value="United Kingdom"[[+ship_country:ifequalto=`United Kingdom`:then=` selected="selected"`]]>United Kingdom</option>
</select>
<label>*</label>
</div>
<div class="clear"></div>
<div class="form-buttons">
<input type="submit" name="login-register-btn" value="Register" />
</div>
</form>
</div>
[