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<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>
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