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<!DOCTYPE html>
<html>
<head>
<meta http-equiv="Content-type" content="text/html; charset=UTF-8" />
<meta http-equiv="X-UA-Compatible" content="IE=edge" />
<title>Michael Ammar Magic Newsetter Sign up Form</title>
<script src="/javascripts/prototype.js?1389302745" type="text/javascript"></script>
<script src="/javascripts/forms.js?1389302745" type="text/javascript"></script>
</head>
<body>
<style>
/* Base */
body {
color: #3a3a3a;
margin: 0;
padding: 0;
background-color: #eef6ff;
font-family: arial, helvetica, sans-serif;
font-size: 12px;
}

form {
margin: 0;
padding: 0;
}

label {
font-weight: bold;
}

a:link, a:visited {
color: #2787d1;
}

a:hover {
color: #00a0ff;
}

div#container {
width: 744px;
margin: 20px auto 0 auto;
background-color: #ffffff;
border: 3px solid #b0c2d1;
border-top-width: 1px;
}

div#messages {
margin-bottom: 20px;
}

div#error_messages {
border-left: 4px solid #ff0000;
background-color: #ffdddd;
padding: 10px;
}

div#success_messages {
border-left: 4px solid #0ecd00;
background-color: #cdeb8b;
padding: 10px;
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div#warning_messages {
border-left: 4px solid #ffff00;
background-color: #fffad9;
padding: 10px;
}

div#messages ul {
padding-left: 14px;
}

div#messages ul li {
margin-bottom: 4px;
padding: 0;
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div.section {
margin-bottom: 30px;
}

h1.title {
margin: 0;
padding: 20px 30px 10px;
font-size: 24px;
color: #d23509;
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h2.section-title {
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padding: 0 0 2px 0;
color: #1c4565;
font-size: 14px;
font-weight: bold;
border-bottom: 1px solid #d5e0e8;
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div.inner {
padding: 0 30px 30px;
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p.description {
color: #858585;
margin: 0 0 10px 0;
padding: 0;
}

div#footer {
margin: 4px auto;
width: 750px;
text-align: center;
color: #a6a6a6;
}

div#footer a:link,
div#footer a:visited {
color: #7299be;
text-decoration: none;
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div#footer a:hover {
text-decoration: underline;
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input.text {
padding: 3px;
border: 2px solid #adc2d1;
outline: none;
color: #3a3a3a;
font-size: 12px;
margin: 0;
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input.text:focus {
border: 2px solid #0090ff;
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fieldset {
border: 0;
padding: 20px 0 0 0;
margin: 0;
background-color: #f7f7f7;
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table.form {
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border: 0;
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table.form tr th {
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text-align: right;
vertical-align: middle;
font-size: 14px;
color: #a6a6a6;
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table.form tr th.fields-header {
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table.form tr td {
padding: 0 0 14px 0;
vertical-align: middle;
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table.form tr td label {
font-size: 11px;
display: block;
padding-bottom: 2px;
}

div.form-tools {
padding: 6px 30px;
border-top: 1px solid #dddddd;
background-color: #ededed;
text-align: right;
}

/* Profile */

table.profile-form {
margin: 10px 0 20px 0;
width: 100%;
border-collapse: collapse;
border: none;
}

table.profile-form tr td {
padding: 4px 0 4px 0;
}

table.profile-form tr th {
line-height: 22px;
width: 150px;
padding: 4px 10px 4px 0;
text-align: right;
vertical-align: top;
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table.profile-form ul {
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margin: 2px 0 0 0;
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table.profile-form ul li label {
font-weight: normal;
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ul#list-memberships {
list-style: none;
padding: 0 30px;
margin: 0;
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ul#list-memberships li {
margin-bottom: 3px;
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ul#list-memberships li label {
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div#unsubscribe-section {
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background-color: #fffedf;
border-top: 1px solid #f1ee98;
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table#unsubscribe-table {
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table#unsubscribe-table tr td {
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/* Share */

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width: 500px;
font-size: 13px;
}

ul#share-social-list {
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padding: 0 90px;
overflow: hidden;
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ul#share-social-list li {
width: 242px;
margin-bottom: 10px;
float: left;
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ul#share-social-list li a:link,
ul#share-social-list li a:visited {
display: block;
text-decoration: none;
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padding-left: 36px;
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background-repeat: no-repeat;
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ul#share-social-list li a:hover {
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ul#share-social-list li a#share-social-twitter:link,
ul#share-social-list li a#share-social-twitter:visited {
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ul#share-social-list li a#share-social-facebook:link,
ul#share-social-list li a#share-social-facebook:visited {
background-image: url(/images/forms/share/facebook_32.png);
}

ul#share-social-list li a#share-social-myspace:link,
ul#share-social-list li a#share-social-myspace:visited {
background-image: url(/images/forms/share/myspace_32.png);
}

ul#share-social-list li a#share-social-linkedin:link,
ul#share-social-list li a#share-social-linkedin:visited {
background-image: url(/images/forms/share/linkedin_32.png);
}

span#subject {
font-weight: bold;
font-size: 14px;
}
</style>
<div id="container">
<h1 class="title">Sign up Form</h1>
<form action="{{{form_url}}}" method="post">
<div class="inner">
{{{messages}}}


<table class="profile-form">
<tr>
<th>
<label for="person_email_address">Email address</label> <span class="required">*</span>
</th>
<td>
<input id="person_email_address" name="person[email_address]" size="30" type="text" value="{{{email_address}}}" />
</td>
</tr>
<tr>
<th>
<label for="person_first_name">First name</label>

</th>
<td>
<input id="person_first_name" name="person[first_name]" size="30" type="text" value="{{{first_name}}}" />
</td>
</tr>
<tr>
<th>
<label for="person_country">Country</label>

</th>
<td>
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<option value="" {{{country_}}}></option>
<option value="Afghanistan" {{{country_afghanistan}}}>Afghanistan</option>
<option value="Albania" {{{country_albania}}}>Albania</option>
<option value="Algeria" {{{country_algeria}}}>Algeria</option>
<option value="American Samoa" {{{country_american_samoa}}}>American Samoa</option>
<option value="Andorra" {{{country_andorra}}}>Andorra</option>
<option value="Angola" {{{country_angola}}}>Angola</option>
<option value="Anguilla" {{{country_anguilla}}}>Anguilla</option>
<option value="Antarctica" {{{country_antarctica}}}>Antarctica</option>
<option value="Antigua And Barbuda" {{{country_antigua_and_barbuda}}}>Antigua And Barbuda</option>
<option value="Argentina" {{{country_argentina}}}>Argentina</option>
<option value="Armenia" {{{country_armenia}}}>Armenia</option>
<option value="Aruba" {{{country_aruba}}}>Aruba</option>
<option value="Australia" {{{country_australia}}}>Australia</option>
<option value="Austria" {{{country_austria}}}>Austria</option>
<option value="Azerbaijan" {{{country_azerbaijan}}}>Azerbaijan</option>
<option value="Bahamas" {{{country_bahamas}}}>Bahamas</option>
<option value="Bahrain" {{{country_bahrain}}}>Bahrain</option>
<option value="Bangladesh" {{{country_bangladesh}}}>Bangladesh</option>
<option value="Barbados" {{{country_barbados}}}>Barbados</option>
<option value="Belarus" {{{country_belarus}}}>Belarus</option>
<option value="Belgium" {{{country_belgium}}}>Belgium</option>
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<option value="Benin" {{{country_benin}}}>Benin</option>
<option value="Bermuda" {{{country_bermuda}}}>Bermuda</option>
<option value="Bhutan" {{{country_bhutan}}}>Bhutan</option>
<option value="Bolivia" {{{country_bolivia}}}>Bolivia</option>
<option value="Bosnia and Herzegowina" {{{country_bosnia_and_herzegowina}}}>Bosnia and Herzegowina</option>
<option value="Botswana" {{{country_botswana}}}>Botswana</option>
<option value="Bouvet Island" {{{country_bouvet_island}}}>Bouvet Island</option>
<option value="Brazil" {{{country_brazil}}}>Brazil</option>
<option value="British Indian Ocean Territory" {{{country_british_indian_ocean_territory}}}>British Indian Ocean Territory</option>
<option value="Brunei Darussalam" {{{country_brunei_darussalam}}}>Brunei Darussalam</option>
<option value="Bulgaria" {{{country_bulgaria}}}>Bulgaria</option>
<option value="Burkina Faso" {{{country_burkina_faso}}}>Burkina Faso</option>
<option value="Burma" {{{country_burma}}}>Burma</option>
<option value="Burundi" {{{country_burundi}}}>Burundi</option>
<option value="Cambodia" {{{country_cambodia}}}>Cambodia</option>
<option value="Cameroon" {{{country_cameroon}}}>Cameroon</option>
<option value="Canada" {{{country_canada}}}>Canada</option>
<option value="Cape Verde" {{{country_cape_verde}}}>Cape Verde</option>
<option value="Cayman Islands" {{{country_cayman_islands}}}>Cayman Islands</option>
<option value="Central African Republic" {{{country_central_african_republic}}}>Central African Republic</option>
<option value="Chad" {{{country_chad}}}>Chad</option>
<option value="Chile" {{{country_chile}}}>Chile</option>
<option value="China" {{{country_china}}}>China</option>
<option value="Christmas Island" {{{country_christmas_island}}}>Christmas Island</option>
<option value="Cocos (Keeling) Islands" {{{country_cocos_keeling_islands}}}>Cocos (Keeling) Islands</option>
<option value="Colombia" {{{country_colombia}}}>Colombia</option>
<option value="Comoros" {{{country_comoros}}}>Comoros</option>
<option value="Congo" {{{country_congo}}}>Congo</option>
<option value="Congo, the Democratic Republic of the" {{{country_congo_the_democratic_republic_of_the}}}>Congo, the Democratic Republic of the</option>
<option value="Cook Islands" {{{country_cook_islands}}}>Cook Islands</option>
<option value="Costa Rica" {{{country_costa_rica}}}>Costa Rica</option>
<option value="Cote d'Ivoire" {{{country_cote_divoire}}}>Cote d'Ivoire</option>
<option value="Croatia" {{{country_croatia}}}>Croatia</option>
<option value="Cuba" {{{country_cuba}}}>Cuba</option>
<option value="Cyprus" {{{country_cyprus}}}>Cyprus</option>
<option value="Czech Republic" {{{country_czech_republic}}}>Czech Republic</option>
<option value="Denmark" {{{country_denmark}}}>Denmark</option>
<option value="Djibouti" {{{country_djibouti}}}>Djibouti</option>
<option value="Dominica" {{{country_dominica}}}>Dominica</option>
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<option value="East Timor" {{{country_east_timor}}}>East Timor</option>
<option value="Ecuador" {{{country_ecuador}}}>Ecuador</option>
<option value="Egypt" {{{country_egypt}}}>Egypt</option>
<option value="El Salvador" {{{country_el_salvador}}}>El Salvador</option>
<option value="England" {{{country_england}}}>England</option>
<option value="Equatorial Guinea" {{{country_equatorial_guinea}}}>Equatorial Guinea</option>
<option value="Eritrea" {{{country_eritrea}}}>Eritrea</option>
<option value="Espana" {{{country_espana}}}>Espana</option>
<option value="Estonia" {{{country_estonia}}}>Estonia</option>
<option value="Ethiopia" {{{country_ethiopia}}}>Ethiopia</option>
<option value="Falkland Islands" {{{country_falkland_islands}}}>Falkland Islands</option>
<option value="Faroe Islands" {{{country_faroe_islands}}}>Faroe Islands</option>
<option value="Fiji" {{{country_fiji}}}>Fiji</option>
<option value="Finland" {{{country_finland}}}>Finland</option>
<option value="France" {{{country_france}}}>France</option>
<option value="French Guiana" {{{country_french_guiana}}}>French Guiana</option>
<option value="French Polynesia" {{{country_french_polynesia}}}>French Polynesia</option>
<option value="French Southern Territories" {{{country_french_southern_territories}}}>French Southern Territories</option>
<option value="Gabon" {{{country_gabon}}}>Gabon</option>
<option value="Gambia" {{{country_gambia}}}>Gambia</option>
<option value="Georgia" {{{country_georgia}}}>Georgia</option>
<option value="Germany" {{{country_germany}}}>Germany</option>
<option value="Ghana" {{{country_ghana}}}>Ghana</option>
<option value="Gibraltar" {{{country_gibraltar}}}>Gibraltar</option>
<option value="Great Britain" {{{country_great_britain}}}>Great Britain</option>
<option value="Greece" {{{country_greece}}}>Greece</option>
<option value="Greenland" {{{country_greenland}}}>Greenland</option>
<option value="Grenada" {{{country_grenada}}}>Grenada</option>
<option value="Guadeloupe" {{{country_guadeloupe}}}>Guadeloupe</option>
<option value="Guam" {{{country_guam}}}>Guam</option>
<option value="Guatemala" {{{country_guatemala}}}>Guatemala</option>
<option value="Guinea" {{{country_guinea}}}>Guinea</option>
<option value="Guinea-Bissau" {{{country_guineabissau}}}>Guinea-Bissau</option>
<option value="Guyana" {{{country_guyana}}}>Guyana</option>
<option value="Haiti" {{{country_haiti}}}>Haiti</option>
<option value="Heard and Mc Donald Islands" {{{country_heard_and_mc_donald_islands}}}>Heard and Mc Donald Islands</option>
<option value="Honduras" {{{country_honduras}}}>Honduras</option>
<option value="Hong Kong" {{{country_hong_kong}}}>Hong Kong</option>
<option value="Hungary" {{{country_hungary}}}>Hungary</option>
<option value="Iceland" {{{country_iceland}}}>Iceland</option>
<option value="India" {{{country_india}}}>India</option>
<option value="Indonesia" {{{country_indonesia}}}>Indonesia</option>
<option value="Ireland" {{{country_ireland}}}>Ireland</option>
<option value="Israel" {{{country_israel}}}>Israel</option>
<option value="Italy" {{{country_italy}}}>Italy</option>
<option value="Iran" {{{country_iran}}}>Iran</option>
<option value="Iraq" {{{country_iraq}}}>Iraq</option>
<option value="Jamaica" {{{country_jamaica}}}>Jamaica</option>
<option value="Japan" {{{country_japan}}}>Japan</option>
<option value="Jordan" {{{country_jordan}}}>Jordan</option>
<option value="Kazakhstan" {{{country_kazakhstan}}}>Kazakhstan</option>
<option value="Kenya" {{{country_kenya}}}>Kenya</option>
<option value="Kiribati" {{{country_kiribati}}}>Kiribati</option>
<option value="Korea, Republic of" {{{country_korea_republic_of}}}>Korea, Republic of</option>
<option value="Korea (South)" {{{country_korea_south}}}>Korea (South)</option>
<option value="Kuwait" {{{country_kuwait}}}>Kuwait</option>
<option value="Kyrgyzstan" {{{country_kyrgyzstan}}}>Kyrgyzstan</option>
<option value="Lao People's Democratic Republic" {{{country_lao_peoples_democratic_republic}}}>Lao People's Democratic Republic</option>
<option value="Latvia" {{{country_latvia}}}>Latvia</option>
<option value="Lebanon" {{{country_lebanon}}}>Lebanon</option>
<option value="Lesotho" {{{country_lesotho}}}>Lesotho</option>
<option value="Liberia" {{{country_liberia}}}>Liberia</option>
<option value="Liechtenstein" {{{country_liechtenstein}}}>Liechtenstein</option>
<option value="Lithuania" {{{country_lithuania}}}>Lithuania</option>
<option value="Luxembourg" {{{country_luxembourg}}}>Luxembourg</option>
<option value="Macau" {{{country_macau}}}>Macau</option>
<option value="Macedonia" {{{country_macedonia}}}>Macedonia</option>
<option value="Madagascar" {{{country_madagascar}}}>Madagascar</option>
<option value="Malawi" {{{country_malawi}}}>Malawi</option>
<option value="Malaysia" {{{country_malaysia}}}>Malaysia</option>
<option value="Maldives" {{{country_maldives}}}>Maldives</option>
<option value="Mali" {{{country_mali}}}>Mali</option>
<option value="Malta" {{{country_malta}}}>Malta</option>
<option value="Marshall Islands" {{{country_marshall_islands}}}>Marshall Islands</option>
<option value="Martinique" {{{country_martinique}}}>Martinique</option>
<option value="Mauritania" {{{country_mauritania}}}>Mauritania</option>
<option value="Mauritius" {{{country_mauritius}}}>Mauritius</option>
<option value="Mayotte" {{{country_mayotte}}}>Mayotte</option>
<option value="Mexico" {{{country_mexico}}}>Mexico</option>
<option value="Micronesia, Federated States of" {{{country_micronesia_federated_states_of}}}>Micronesia, Federated States of</option>
<option value="Moldova, Republic of" {{{country_moldova_republic_of}}}>Moldova, Republic of</option>
<option value="Monaco" {{{country_monaco}}}>Monaco</option>
<option value="Mongolia" {{{country_mongolia}}}>Mongolia</option>
<option value="Montserrat" {{{country_montserrat}}}>Montserrat</option>
<option value="Morocco" {{{country_morocco}}}>Morocco</option>
<option value="Mozambique" {{{country_mozambique}}}>Mozambique</option>
<option value="Myanmar" {{{country_myanmar}}}>Myanmar</option>
<option value="Namibia" {{{country_namibia}}}>Namibia</option>
<option value="Nauru" {{{country_nauru}}}>Nauru</option>
<option value="Nepal" {{{country_nepal}}}>Nepal</option>
<option value="Netherlands" {{{country_netherlands}}}>Netherlands</option>
<option value="Netherlands Antilles" {{{country_netherlands_antilles}}}>Netherlands Antilles</option>
<option value="New Caledonia" {{{country_new_caledonia}}}>New Caledonia</option>
<option value="New Zealand" {{{country_new_zealand}}}>New Zealand</option>
<option value="Nicaragua" {{{country_nicaragua}}}>Nicaragua</option>
<option value="Niger" {{{country_niger}}}>Niger</option>
<option value="Nigeria" {{{country_nigeria}}}>Nigeria</option>
<option value="Niue" {{{country_niue}}}>Niue</option>
<option value="Norfolk Island" {{{country_norfolk_island}}}>Norfolk Island</option>
<option value="Northern Ireland" {{{country_northern_ireland}}}>Northern Ireland</option>
<option value="Northern Mariana Islands" {{{country_northern_mariana_islands}}}>Northern Mariana Islands</option>
<option value="Norway" {{{country_norway}}}>Norway</option>
<option value="Oman" {{{country_oman}}}>Oman</option>
<option value="Pakistan" {{{country_pakistan}}}>Pakistan</option>
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<option value="Panama" {{{country_panama}}}>Panama</option>
<option value="Papua New Guinea" {{{country_papua_new_guinea}}}>Papua New Guinea</option>
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<option value="Philippines" {{{country_philippines}}}>Philippines</option>
<option value="Pitcairn" {{{country_pitcairn}}}>Pitcairn</option>
<option value="Poland" {{{country_poland}}}>Poland</option>
<option value="Portugal" {{{country_portugal}}}>Portugal</option>
<option value="Puerto Rico" {{{country_puerto_rico}}}>Puerto Rico</option>
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<option value="Rwanda" {{{country_rwanda}}}>Rwanda</option>
<option value="Saint Kitts and Nevis" {{{country_saint_kitts_and_nevis}}}>Saint Kitts and Nevis</option>
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<option value="Serbia and Montenegro" {{{country_serbia_and_montenegro}}}>Serbia and Montenegro</option>
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<option value="Sierra Leone" {{{country_sierra_leone}}}>Sierra Leone</option>
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<option value="South Georgia and the South Sandwich Islands" {{{country_south_georgia_and_the_south_sandwich_islands}}}>South Georgia and the South Sandwich Islands</option>
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<option value="St. Helena" {{{country_st_helena}}}>St. Helena</option>
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<option value="Svalbard and Jan Mayen Islands" {{{country_svalbard_and_jan_mayen_islands}}}>Svalbard and Jan Mayen Islands</option>
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<option value="Togo" {{{country_togo}}}>Togo</option>
<option value="Tokelau" {{{country_tokelau}}}>Tokelau</option>
<option value="Tonga" {{{country_tonga}}}>Tonga</option>
<option value="Trinidad" {{{country_trinidad}}}>Trinidad</option>
<option value="Trinidad and Tobago" {{{country_trinidad_and_tobago}}}>Trinidad and Tobago</option>
<option value="Tunisia" {{{country_tunisia}}}>Tunisia</option>
<option value="Turkey" {{{country_turkey}}}>Turkey</option>
<option value="Turkmenistan" {{{country_turkmenistan}}}>Turkmenistan</option>
<option value="Turks and Caicos Islands" {{{country_turks_and_caicos_islands}}}>Turks and Caicos Islands</option>
<option value="Tuvalu" {{{country_tuvalu}}}>Tuvalu</option>
<option value="Uganda" {{{country_uganda}}}>Uganda</option>
<option value="Ukraine" {{{country_ukraine}}}>Ukraine</option>
<option value="United Arab Emirates" {{{country_united_arab_emirates}}}>United Arab Emirates</option>
<option value="United Kingdom" {{{country_united_kingdom}}}>United Kingdom</option>
<option value="United States" {{{country_united_states}}}>United States</option>
<option value="United States Minor Outlying Islands" {{{country_united_states_minor_outlying_islands}}}>United States Minor Outlying Islands</option>
<option value="Uruguay" {{{country_uruguay}}}>Uruguay</option>
<option value="Uzbekistan" {{{country_uzbekistan}}}>Uzbekistan</option>
<option value="Vanuatu" {{{country_vanuatu}}}>Vanuatu</option>
<option value="Vatican City State (Holy See)" {{{country_vatican_city_state_holy_see}}}>Vatican City State (Holy See)</option>
<option value="Venezuela" {{{country_venezuela}}}>Venezuela</option>
<option value="Viet Nam" {{{country_viet_nam}}}>Viet Nam</option>
<option value="Virgin Islands (British)" {{{country_virgin_islands_british}}}>Virgin Islands (British)</option>
<option value="Virgin Islands (U.S.)" {{{country_virgin_islands_us}}}>Virgin Islands (U.S.)</option>
<option value="Wales" {{{country_wales}}}>Wales</option>
<option value="Wallis and Futuna Islands" {{{country_wallis_and_futuna_islands}}}>Wallis and Futuna Islands</option>
<option value="Western Sahara" {{{country_western_sahara}}}>Western Sahara</option>
<option value="Yemen" {{{country_yemen}}}>Yemen</option>
<option value="Zambia" {{{country_zambia}}}>Zambia</option>
<option value="Zimbabwe" {{{country_zimbabwe}}}>Zimbabwe</option>
<option value="Other" {{{country_other}}}>Other</option>
</select>
</td>
</tr>
<tr id="person_country_other_div" {{{country_other_display}}}>
<th></th>
<td>
<div class="other">Please specify...</div>
<div><input id="person_country_other" name="person[country_other]" size="30" type="text" value="{{{country_other_text}}}" /></div>
</td>
</tr>
<tr>
<th>
<label for="person_postal_code">Postal code</label>

</th>
<td>
<input id="person_postal_code" name="person[postal_code]" size="30" type="text" value="{{{postal_code}}}" />
</td>
</tr>
<tr>
<th>
<label for="person_stateprovince">State/province</label>

</th>
<td>
<select id="person_stateprovince" name="person[stateprovince]" onchange="window.document.getElementById(&#x27;person_stateprovince_other_div&#x27;).style.display=this.value==&#x27;Other&#x27;?&#x27;&#x27;:&#x27;none&#x27;;window.document.getElementById(&#x27;person_stateprovince_other&#x27;).focus()">
<option value="" {{{stateprovince_}}}></option>
<option value="Alabama" {{{stateprovince_alabama}}}>Alabama</option>
<option value="Alaska" {{{stateprovince_alaska}}}>Alaska</option>
<option value="Arizona" {{{stateprovince_arizona}}}>Arizona</option>
<option value="Arkansas" {{{stateprovince_arkansas}}}>Arkansas</option>
<option value="California" {{{stateprovince_california}}}>California</option>
<option value="Colorado" {{{stateprovince_colorado}}}>Colorado</option>
<option value="Connecticut" {{{stateprovince_connecticut}}}>Connecticut</option>
<option value="Delaware" {{{stateprovince_delaware}}}>Delaware</option>
<option value="Florida" {{{stateprovince_florida}}}>Florida</option>
<option value="Georgia" {{{stateprovince_georgia}}}>Georgia</option>
<option value="Hawaii" {{{stateprovince_hawaii}}}>Hawaii</option>
<option value="Idaho" {{{stateprovince_idaho}}}>Idaho</option>
<option value="Illinois" {{{stateprovince_illinois}}}>Illinois</option>
<option value="Indiana" {{{stateprovince_indiana}}}>Indiana</option>
<option value="Iowa" {{{stateprovince_iowa}}}>Iowa</option>
<option value="Kansas" {{{stateprovince_kansas}}}>Kansas</option>
<option value="Kentucky" {{{stateprovince_kentucky}}}>Kentucky</option>
<option value="Louisiana" {{{stateprovince_louisiana}}}>Louisiana</option>
<option value="Maine" {{{stateprovince_maine}}}>Maine</option>
<option value="Maryland" {{{stateprovince_maryland}}}>Maryland</option>
<option value="Massachusetts" {{{stateprovince_massachusetts}}}>Massachusetts</option>
<option value="Michigan" {{{stateprovince_michigan}}}>Michigan</option>
<option value="Minnesota" {{{stateprovince_minnesota}}}>Minnesota</option>
<option value="Mississippi" {{{stateprovince_mississippi}}}>Mississippi</option>
<option value="Missouri" {{{stateprovince_missouri}}}>Missouri</option>
<option value="Montana" {{{stateprovince_montana}}}>Montana</option>
<option value="Nebraska" {{{stateprovince_nebraska}}}>Nebraska</option>
<option value="Nevada" {{{stateprovince_nevada}}}>Nevada</option>
<option value="New Hampshire" {{{stateprovince_new_hampshire}}}>New Hampshire</option>
<option value="New Jersey" {{{stateprovince_new_jersey}}}>New Jersey</option>
<option value="New Mexico" {{{stateprovince_new_mexico}}}>New Mexico</option>
<option value="New York" {{{stateprovince_new_york}}}>New York</option>
<option value="North Carolina" {{{stateprovince_north_carolina}}}>North Carolina</option>
<option value="North Dakota" {{{stateprovince_north_dakota}}}>North Dakota</option>
<option value="Ohio" {{{stateprovince_ohio}}}>Ohio</option>
<option value="Oklahoma" {{{stateprovince_oklahoma}}}>Oklahoma</option>
<option value="Oregon" {{{stateprovince_oregon}}}>Oregon</option>
<option value="Pennsylvania" {{{stateprovince_pennsylvania}}}>Pennsylvania</option>
<option value="Puerto Rico" {{{stateprovince_puerto_rico}}}>Puerto Rico</option>
<option value="Rhode Island" {{{stateprovince_rhode_island}}}>Rhode Island</option>
<option value="South Carolina" {{{stateprovince_south_carolina}}}>South Carolina</option>
<option value="South Dakota" {{{stateprovince_south_dakota}}}>South Dakota</option>
<option value="Tennessee" {{{stateprovince_tennessee}}}>Tennessee</option>
<option value="Texas" {{{stateprovince_texas}}}>Texas</option>
<option value="Utah" {{{stateprovince_utah}}}>Utah</option>
<option value="Vermont" {{{stateprovince_vermont}}}>Vermont</option>
<option value="Virginia" {{{stateprovince_virginia}}}>Virginia</option>
<option value="Washington" {{{stateprovince_washington}}}>Washington</option>
<option value="Washington D.C." {{{stateprovince_washington_dc}}}>Washington D.C.</option>
<option value="West Virginia" {{{stateprovince_west_virginia}}}>West Virginia</option>
<option value="Wisconsin" {{{stateprovince_wisconsin}}}>Wisconsin</option>
<option value="Wyoming" {{{stateprovince_wyoming}}}>Wyoming</option>
<option value="Other" {{{stateprovince_other}}}>Other</option>
</select>
</td>
</tr>
<tr id="person_stateprovince_other_div" {{{stateprovince_other_display}}}>
<th></th>
<td>
<div class="other">Please specify...</div>
<div><input id="person_stateprovince_other" name="person[stateprovince_other]" size="30" type="text" value="{{{stateprovince_other_text}}}" /></div>
</td>
</tr>
<tr>
<th>
<label for="person_city">City</label>

</th>
<td>
<input id="person_city" name="person[city]" size="30" type="text" value="{{{city}}}" />
</td>
</tr>
<tr>
<th>
<label for="person_address2">Address2</label>

</th>
<td>
<input id="person_address2" name="person[address2]" size="30" type="text" value="{{{address2}}}" />
</td>
</tr>
<tr>
<th>
<label for="person_address1">Address1</label>

</th>
<td>
<input id="person_address1" name="person[address1]" size="30" type="text" value="{{{address1}}}" />
</td>
</tr>
<tr>
<th>
<label for="person_company">Company</label>

</th>
<td>
<input id="person_company" name="person[company]" size="30" type="text" value="{{{company}}}" />
</td>
</tr>
<tr>
<th>
<label for="person_title">Title</label>

</th>
<td>
<input id="person_title" name="person[title]" size="30" type="text" value="{{{title}}}" />
</td>
</tr>
<tr>
<th>
<label for="person_last_name">Last name</label>

</th>
<td>
<input id="person_last_name" name="person[last_name]" size="30" type="text" value="{{{last_name}}}" />
</td>
</tr>
<tr>
<th>
<label for="person_phone_number">Phone number</label>

</th>
<td>
<input id="person_phone_number" name="person[phone_number]" size="30" type="text" value="{{{phone_number}}}" />
</td>
</tr>
<tr>
<th>Email Format</th>
<td>
<select id="person_email_content_format" name="person[email_content_format]"><option value="html" selected="selected">HTML</option>
<option value="text">Text</option></select>
</td>
</tr>
</table>

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<input name="commit" type="submit" value="Sign Up" />
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