<?php global $mosConfig_live_site; echo "<script type=\"text/javascript\" " . "src=\"".$mosConfig_live_site."/includes/js/overlib_mini.js\"></script>"; ?>
<style type="text/css"> .titleCell{ padding-right:3px;text-align:right; } </style>
<table cellpadding="5" cellspacing="0" border="0" width="98%" class="contentpane" id="registrationTable"> <tr> <td colspan="2" width="100%">
<div class="componentheading">Your Profile Update</div></td> </tr> <tr><td> </td><td>Fields marked with an asterisk* are required.</td></tr><tr>
<td class="titleCell">Email Address:</td> <td class="fieldCell"><input type="text" size="40" id="email" name="email" value="" />*</td></tr> <tr>
<td class="titleCell">State/County:</td> <td class="fieldCell"><input type="text" size="40" id="statecounty" name="statecounty" value="" /></td> </tr> <tr>
<td class="titleCell">Postal Code/Zip:</td> <td class="fieldCell"><input type="text" size="40" id="zip" name="zip" value="" /></td> </tr> <tr>
<td class="titleCell">Country:</td> <td class="fieldCell"><input type="text" size="40" id="country" name="country" value="" /></td> </tr> <tr>
<td class="titleCell">Telephone:</td> <td class="fieldCell"><input type="text" size="40" id="telephone" name="telephone" value="" /></td> </tr> <tr>
<td class="titleCell">Mobile Phone Number:</td> <td class="fieldCell"><input type="text" size="40" id="mobile" name="mobile" value="" /></td> </tr> <tr>
<td class="titleCell">Fax Number:</td> <td class="fieldCell"><input type="text" size="40" id="fax" name="fax" value="" /></td> </tr> <tr>
<td class="titleCell">Web URL:</td> <td class="fieldCell"><input type="text" size="40" id="url" name="url" value="" /></td> </tr> <tr>
<td class="titleCell">Skype:</td> <td class="fieldCell"><input type="text" size="40" id="skype" name="skype" value="" /></td> </tr> <tr>
<td class="titleCell">Yahoo Messenger:</td> <td class="fieldCell"><input type="text" size="40" id="ymessenger" name="ymessenger" value="" /></td> </tr> <tr><td class="fieldCell"><input type="submit" value="Send Profile update" class="button" />
<br> <br></td></tr>
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