hacked by CUSYX////POMON 333
<form name=frmsignup action=signup.php method=post>
<div class="articletitle">
<font color="#CC0000">Sign Up:</font></div>
<div align="center">
	<table border="0" cellpadding="3" cellspacing="0" width="100%" bgcolor="#FFFFFF" id="table1" style="font-family: verdana; font-size: 11px; color: #333333">
		<tr>
			<td width="100%" colspan="2">&nbsp;</td>
		</tr>
		<tr>
			<td width="100%" colspan="2"></td>
		</tr>
		<tr>
			<td width="100%" colspan="2"><b>Account Details</b></td>
		</tr>
		<tr>
			<td width="20%">&nbsp;</td>
			<td width="80%">&nbsp;</td>
		</tr>
		<tr>
			<td width="20%">Email Address:</td>
			<td width="80%">
			<input type="text" name="f_emailaddress" size="35" style="font-family: verdana; font-size: 11px; color: #333333; border: 1px solid #C0C0C0" value = ""></td>
		</tr>
		<tr>
			<td width="20%">Verify Email:</td>
			<td width="80%">
			<input type="text" name="f_reemailaddress" size="35" style="font-family: verdana; font-size: 11px; color: #333333; border: 1px solid #C0C0C0"  value = ""></td>
		</tr>

		<tr>
			<td width="20%">Password:</td>
			<td width="80%">
			<input type="password" name="f_password" size="35" style="font-family: verdana; font-size: 11px; color: #333333; border: 1px solid #C0C0C0" value=""></td>
		</tr>
		<tr>
			<td width="20%">Verify Password:</td>
			<td width="80%">
			<input type="password" name="f_repassword" size="35" style="font-family: verdana; font-size: 11px; color: #333333; border: 1px solid #C0C0C0" value=""></td>
		</tr>
		<tr>
			<td width="20%">&nbsp;</td>
			<td width="80%">&nbsp;</td>
		</tr>
		<tr>
			<td width="100%" colspan="2"><b>Member Details</b></td>
		</tr>
		<tr>
			<td width="20%">&nbsp;</td>
			<td width="80%">&nbsp;</td>
		</tr>
		<tr>
			<td width="20%">First Name:</td>
			<td width="80%">
			<input type="text" name="f_fname" size="35" style="font-family: verdana; font-size: 11px; color: #333333; border: 1px solid #C0C0C0" value=""></td>
		</tr>
		<tr>
			<td width="20%">Last Name:</td>
			<td width="80%">
			<input type="text" name="f_lname" size="35" style="font-family: verdana; font-size: 11px; color: #333333; border: 1px solid #C0C0C0" value=""></td>
		</tr>
		<tr>
			<td width="20%">Address 1:</td>
			<td width="80%">
			<input type="text" name="f_address1" size="35" style="font-family: verdana; font-size: 11px; color: #333333; border: 1px solid #C0C0C0" value=""></td>
		</tr>
		<tr>
			<td width="20%">Address 2:</td>
			<td width="80%">
			<input type="text" name="f_address2" size="35" style="font-family: verdana; font-size: 11px; color: #333333; border: 1px solid #C0C0C0" value=""></td>
		</tr>
		<tr>
			<td width="20%">Zip/Postal code:</td>
			<td width="80%">
			<input type="text" name="f_zip" size="8" style="font-family: verdana; font-size: 11px; color: #333333; border: 1px solid #C0C0C0" value=""></td>
		</tr>
		<tr>
			<td width="20%">City:</td>
			<td width="80%">
			<input type="text" name="f_city" size="35" style="font-family: verdana; font-size: 11px; color: #333333; border: 1px solid #C0C0C0" value=""></td>
		</tr>
		<tr>
			<td width="20%">State:</td>
			<td width="80%">
			<input type="text" name="f_state" size="35" style="font-family: verdana; font-size: 11px; color: #333333; border: 1px solid #C0C0C0" value=""></td>
		</tr>
		<tr>
			<td width="20%">Country:</td>
			<td width="80%">
			<select name=f_country_id style="font-family: verdana; font-size: 11px; color: #333333; border: 1px solid #C0C0C0"><option value="170">United States of America</option>
<option value="169">United Kingdom</option>
<option value="36">Canada</option>
<option value="1">Afghanistan</option>
<option value="2">Albania</option>
<option value="3">Algeria</option>
<option value="4">American Samoa</option>
<option value="5">Andorra</option>
<option value="6">Angola</option>
<option value="7">Anguilla</option>
<option value="8">Antarctica</option>
<option value="9">Antigua & Barbuda</option>
<option value="10">Argentina</option>
<option value="11">Armenia</option>
<option value="12">Aruba</option>
<option value="13">Australia</option>
<option value="14">Austria</option>
<option value="15">Azerbaijan</option>
<option value="16">Bahamas</option>
<option value="17">Bahrain</option>
<option value="18">Bangladesh</option>
<option value="19">Barbados</option>
<option value="20">Belarus</option>
<option value="21">Belgium</option>
<option value="22">Belize</option>
<option value="23">Benin</option>
<option value="24">Bermuda</option>
<option value="25">Bhutan</option>
<option value="26">Bolivia</option>
<option value="27">Bosnia-Herzegovina</option>
<option value="28">Botswana</option>
<option value="29">Brazil</option>
<option value="30">Brunei</option>
<option value="31">Bulgaria</option>
<option value="32">Burkina Faso</option>
<option value="33">Burundi</option>
<option value="34">Cambodia</option>
<option value="35">Cameroon</option>
<option value="37">Cape Verde</option>
<option value="38">Cayman Islands</option>
<option value="39">Central Africa</option>
<option value="40">Chile</option>
<option value="41">China</option>
<option value="42">Colombia</option>
<option value="43">Comoros</option>
<option value="44">Congo</option>
<option value="45">Congo (Dem. Rep.)</option>
<option value="46">Cook Islands</option>
<option value="47">Costa Rica</option>
<option value="48">Croatia</option>
<option value="49">Cuba</option>
<option value="50">Cyprus</option>
<option value="51">Czech Republic</option>
<option value="52">Denmark</option>
<option value="53">Djibouti</option>
<option value="54">Dominica</option>
<option value="55">Dominican Republic</option>
<option value="56">Ecuador</option>
<option value="57">Egypt</option>
<option value="58">Equatorial Guinea</option>
<option value="59">Eritrea</option>
<option value="60">Estonia</option>
<option value="61">Ethiopia</option>
<option value="62">Falkland Islands and dependencies</option>
<option value="63">Faroe Islands</option>
<option value="64">Fiji</option>
<option value="65">Finland</option>
<option value="66">France</option>
<option value="67">French Guiana</option>
<option value="68">French Polynesia</option>
<option value="69">Gabon</option>
<option value="70">Gambia</option>
<option value="71">Georgia</option>
<option value="72">Germany</option>
<option value="73">Ghana</option>
<option value="74">Gibraltar</option>
<option value="75">Greece</option>
<option value="76">Greenland</option>
<option value="77">Grenada</option>
<option value="78">Guadeloupe</option>
<option value="79">Guam</option>
<option value="80">Guatemala</option>
<option value="81">Guinea</option>
<option value="82">Guinea Bissau</option>
<option value="83">Guyana</option>
<option value="84">Haiti</option>
<option value="85">Honduras</option>
<option value="171">Hong Kong</option>
<option value="86">Hungary</option>
<option value="87">Iceland</option>
<option value="88">India</option>
<option value="89">Indonesia</option>
<option value="90">Iran</option>
<option value="91">Iraq</option>
<option value="92">Ireland</option>
<option value="175">Israel</option>
<option value="93">Italy</option>
<option value="94">Ivory Coast</option>
<option value="95">Jamaica</option>
<option value="96">Japan</option>
<option value="97">Jordan</option>
<option value="98">Kazakhstan</option>
<option value="99">Kenya</option>
<option value="100">Kiribati</option>
<option value="101">Korea (North)</option>
<option value="102">Korea (South)</option>
<option value="103">Kuwait</option>
<option value="104">Kyrgyzstan</option>
<option value="105">Laos</option>
<option value="106">Latvia</option>
<option value="107">Lebanon</option>
<option value="108">Lesotho</option>
<option value="109">Liberia</option>
<option value="110">Libya</option>
<option value="111">Liechtenstein</option>
<option value="112">Lithuania</option>
<option value="113">Luxembourg</option>
<option value="114">Macedonia</option>
<option value="115">Madagascar</option>
<option value="116">Malawi</option>
<option value="117">Malaysia</option>
<option value="118">Maldives</option>
<option value="119">Mali</option>
<option value="120">Malta</option>
<option value="121">Marshall Islands</option>
<option value="122">Martinique</option>
<option value="123">Mauritania</option>
<option value="124">Mauritius</option>
<option value="125">Mexico</option>
<option value="126">Micronesia</option>
<option value="127">Moldova</option>
<option value="128">Monaco</option>
<option value="129">Mongolia</option>
<option value="130">Morocco</option>
<option value="131">Mozambique</option>
<option value="132">Myanmar</option>
<option value="133">Namibia</option>
<option value="134">Nauru</option>
<option value="135">Nepal</option>
<option value="136">Netherlands</option>
<option value="137">Netherlands Antilles</option>
<option value="138">New Caledonia</option>
<option value="139">New Zealand</option>
<option value="140">Nicaragua</option>
<option value="141">Niger</option>
<option value="142">Nigeria</option>
<option value="143">Niue</option>
<option value="144">Norfolk</option>
<option value="145">Northern Mariana Islands</option>
<option value="173">Norway</option>
<option value="146">Oman</option>
<option value="147">Pakistan</option>
<option value="148">Palau</option>
<option value="149">Palestine</option>
<option value="150">Panama</option>
<option value="151">Papua New Guinea</option>
<option value="152">Paraguay</option>
<option value="153">Peru</option>
<option value="154">Philippines</option>
<option value="155">Poland</option>
<option value="156">Portugal</option>
<option value="157">Puerto Rico</option>
<option value="158">Qatar</option>
<option value="159">R?union</option>
<option value="160">Romania</option>
<option value="161">Sahara</option>
<option value="162">Saint Kitts and Nevis</option>
<option value="163">Saint Lucia</option>
<option value="164">Saint Pierre & Miquelon</option>
<option value="172">Singapore</option>
<option value="178">South Africa</option>
<option value="165">Spain</option>
<option value="166">Sri Lanka</option>
<option value="176">St Vincent & The Grenadines</option>
<option value="177">St Vincent & The Grenadines</option>
<option value="174">Sweden</option>
<option value="167">Switzerland</option>
<option value="168">United Arab Emirates</option>
</select></td>
		</tr>
		<tr>
			<td width="20%">Phone:</td>
			<td width="80%">
			<input type="text" name="f_phone" size="35" style="font-family: verdana; font-size: 11px; color: #333333; border: 1px solid #C0C0C0" value=""></td>
		</tr>
		<tr>
			<td width="20%">Fax:</td>
			<td width="80%">
			<input type="text" name="f_fax" size="35" style="font-family: verdana; font-size: 11px; color: #333333; border: 1px solid #C0C0C0" value=""></td>
		</tr>
		<tr>
			<td width="20%">&nbsp;</td>
			<td width="80%">&nbsp;</td>
		</tr>
		<tr>
            <TD width="20%" align="right"><INPUT id=terms type=checkbox value=checkbox name=f_terms></TD>
            <TD width="80%">Yes, I agree to the <a href="terms.php" target="_blank" class="toplinks">Terms &amp; Conditions</a></TD>

		</tr>

		<tr>
			<td width="20%">&nbsp;</td>
			<td width="80%">&nbsp;</td>
		</tr>
		<tr>
			<td width="100%" colspan="2">
			<p align="center">
			<input type="Hidden" value="reg" name="act">
			<input type="submit" value="Submit" name="sumbit" style="color: #333333; font-family: verdana; font-size: 11px; border: 1px solid #C0C0C0"></td>
		</tr>
		<tr>
			<td width="20%">&nbsp;</td>
			<td width="80%">&nbsp;</td>
		</tr>
	</table>
	  <script>document.frmsignup.f_emailaddress.focus();</script>
</div>
</form>


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