/lenasys/trunk

<div id="regWrapper">

	<div id="regHeader">

		<span id="regHeader">

			Welcome to LenaSYS

		</span>

	</div>

	<div id="regformcontenttext">To complete your registration,</br>

		please enter your account information.</div>	

	<div id="regForm">

		<table>

			<tr>

				<td>Username:</td><td><?php $userName ?></td>

			</tr>

			<tr>

				<td>Full Name:</td><td><input id="fullName" type="text" name="fullName" placeholder="--Full name--"></td>

			</tr>

			<tr>

				<td>Social Security Number:</td><td><input id="ssn" type="text" name="ssn" placeholder="--YYMMDD-XXXX--"></td>

			</tr>

			<tr>

				<td>New Password:</td><td id="grayText"><input id="newPassword" type="text" name="password" placeholder="--Password--"></td>

			</tr>

			<tr>

				<td>Repeat Password:</td><td><input id="repeatPassword" type="text" name="repeatPassword" placeholder="--Repeat Password--"></td>

			</tr>

			<tr>

				<td>Password Hint:</td><td><input id="pHint" type="text" name="hint" placeholder="--Password Hint--"></td>

			</tr>	

			<tr>

				<td colspan="2"><div id="buttonposition"><input type="submit" value="Confirm"></div></td>

			</tr>	

		</table>

	</div>

</div>