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NewAuthRegistration.html
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<html>
<head>
<title>ILLiad - New Authenticated User Registration</title>
<#INCLUDE filename="include_head.html">
<script type="text/javascript" src="js/userNotificationPreferences.js"></script>
</head>
<body id="type-b">
<div id="wrap">
<#INCLUDE filename="include_header.html">
<div id="content-wrap">
<#INCLUDE filename="include_menu.html">
<div id="content">
<form action="illiad.dll" method="post" name="NewAuthRegistration" class="f-wrap-request">
<input type="hidden" name="ILLiadForm" value="NewAuthRegistration">
<#FORMSTATE>
<div class="req"><b>*</b> Indicates required field</div>
<fieldset>
<h3>Change Personal Information</h3>
<label for="FirstName">
<span class="field">
<span class="req">*</span>
<span class="<#ERROR name="ERRORFirstName">"><b>First Name</b></span>
</span>
<input id="FirstName" name="FirstName" type="text" size="40" class="f-name" value="<#PARAM name="FirstName">"><br />
</label>
<label for="LastName">
<span class="field">
<span class="req">*</span>
<span class="<#ERROR name="ERRORLastName">"><b>Last Name</b></span>
</span>
<input id="LastName" name="LastName" type="text" size="40" class="f-name" value="<#PARAM name="LastName">"><br />
</label>
<label for="SSN">
<span class="field">
<span class="req">*</span>
<span class="<#ERROR name="ERRORSSN">"><b>ID Number</b></span>
</span>
<input id="SSN" name="SSN" type="text" size="40" class="f-name" value="<#PARAM name="SSN">"><br />
</label>
<label for="EMailAddress">
<span class="field">
<span class="req">*</span>
<span class="<#ERROR name="ERROREMailAddress">"><b>E-Mail Address</b></span>
</span>
<input id="EMailAddress" name="EMailAddress" type="text" size="40" class="f-name" value="<#PARAM name="EMailAddress">"><br />
</label>
<label for="Phone">
<span class="field">
<span class="req">*</span>
<span class="<#ERROR name="ERRORPhone">"><b>Daytime Phone</b></span>
</span>
<input id="Phone" name="Phone" type="text" size="40" class="f-name" value="<#PARAM name="Phone">"><br />
</label>
<label for="MobilePhone">
<span class="field">
<span class="<#ERROR name=" errormobilephone">"><b>Mobile Phone</b></span>
</span>
<input id="MobilePhone" name="MobilePhone" type="text" size="40" class="f-name" value="<#PARAM name="MobilePhone">"><br />
</label>
<label for="WebDeliveryGroup">
<span class="field">
<span class="<#ERROR name="ERRORWebDeliveryGroup">"><b>Preferred Electronic Delivery if Possible (PDF file via web)</b></span>
</span>
<select id="WebDeliveryGroup" name="WebDeliveryGroup" size="1" class="f-name">
<option selected><#PARAM name="WebDeliveryGroup"></option>
<option>Yes</option>
<option>No</option>
</select><br />
</label>
<label for="Address">
<span class="field">
<span class="req">*</span>
<span class="<#ERROR name="ERRORAddress">"><b>Primary Address Line 1</b></span>
</span>
<input id="Address" name="Address" type="text" size="40" class="f-name" value="<#PARAM name="Address">"><br />
</label>
<label for="Address2">
<span class="field">
<span class="<#ERROR name="ERRORAddress2">"><b>Primary Address Line 2</b></span>
</span>
<input id="Address2" name="Address2" type="text" size="40" class="f-name" value="<#PARAM name="Address2">"><br />
</label>
<label for="City">
<span class="field">
<span class="req">*</span>
<span class="<#ERROR name="ERRORCity">"><b>Primary Address City</b></span>
</span>
<input id="City" name="City" type="text" size="40" class="f-name" value="<#PARAM name="City">"><br />
</label>
<label for="State">
<span class="field">
<span class="req">*</span>
<span class="<#ERROR name="ERRORState">"><b>Primary Address State</b></span>
</span>
<select id="State" name="State" size="1" class="f-name">
<#OPTION name="custom" groupname="State" selectedValue="<#PARAM name=State>" defaultValue="" defaultName="" />
</select><br />
</label>
<label for="Zip">
<span class="field">
<span class="req">*</span>
<span class="<#ERROR name="ERRORZip">"><b>Primary Address Zip</b></span>
</span>
<input id="Zip" name="Zip" type="text" size="40" class="f-name" value="<#PARAM name="Zip">"><br />
</label>
<label for="SAddress">
<span class="field">
<span class="<#ERROR name="ERRORSAddress">"><b>Secondary Address Line 1</b></span>
</span>
<input id="SAddress" name="SAddress" type="text" size="40" class="f-name" value="<#PARAM name="SAddress">"><br />
</label>
<label for="SAddress2">
<span class="field">
<span class="<#ERROR name="ERRORSAddress2">"><b>Secondary Address Line 2</b></span>
</span>
<input id="SAddress2" name="SAddress2" type="text" size="40" class="f-name" value="<#PARAM name="SAddress2">"><br />
</label>
<label for="SCity">
<span class="field">
<span class="<#ERROR name="ERRORSCity">"><b>Secondary Address City</b></span>
</span>
<input id="SCity" name="SCity" type="text" size="40" class="f-name" value="<#PARAM name="SCity">"><br />
</label>
<label for="SState">
<span class="field">
<span class="<#ERROR name="ERRORSState">"><b>Secondary Address State</b></span>
</span>
<select id="SState" name="SState" size="1" class="f-name">
<#OPTION name="custom" groupname="State" selectedValue="<#PARAM name=SState>" defaultValue="" defaultName="" />
</select><br />
</label>
<label for="SZip">
<span class="field">
<span class="<#ERROR name="ERRORSZip">"><b>Secondary Address Zip</b></span>
</span>
<input id="SZip" name="SZip" type="text" size="40" class="f-name" value="<#PARAM name="SZip">"><br />
</label>
<label for="StatusGroup">
<span class="field">
<span class="req">*</span>
<span class="<#ERROR name="ERRORStatus">"><b>Status</b></span>
</span>
<select id="StatusGroup" name="StatusGroup" size="1" class="f-name">
<#OPTION name="custom" groupname="StatusGroup" selectedValue="<#PARAM name=StatusGroup>" defaultValue="" defaultName="" />
</select><br />
</label>
<label for="Department">
<span class="field">
<span class="req">*</span>
<span class="<#ERROR name="ERRORDepartment">"><b>Department</b></span>
</span>
<select id="Department" name="Department" size="1" class="f-name">
<#OPTION name="custom" groupname="Department" selectedValue="<#PARAM name=Department>" defaultValue="" defaultName=""/>
</select><br />
</label>
<label for="AuthorizedUsers">
<span class="field">
<span class="<#ERROR name="ERRORAuthorizedUsers">"><b>Authorized Users</b></span><br />
<span class="note">List the full names of anyone you wish to be allowed to pick up your ILL items.<br />An ID will be REQUIRED to pick items up.</span>
</span>
<textarea id="AuthorizedUsers" name="AuthorizedUsers" rows="2" cols="40" class="f-name"><#PARAM name="AuthorizedUsers"></textarea><br />
</label>
<label for="NVTGC">
<span class="field">
<span class="<#ERROR name="ERRORNVTGC">"><b>Delivery Location</b></span>
</span>
<select id="NVTGC" name="NVTGC" size="1" class="f-name">
<#OPTION name="custom" groupname="NVTGC" selectedValue="<#PARAM name=NVTGC>" defaultValue="" defaultName=""/>
</select><br />
</label>
<label for="DeliveryGroup">
<span class="field">
<span class="<#ERROR name="ERRORDeliveryGroup">"><b>Preferred Article Delivery Method</b></span>
</span>
<select id="DeliveryGroup" name="DeliveryGroup" size="1" class="f-name">
<option selected><#PARAM name="DeliveryGroup"></option>
<option>Hold for Pickup</option>
<option>Mail to Address</option>
</select><br />
</label>
<label for="LoanDeliveryGroup">
<span class="field">
<span class="<#ERROR name="ERRORLoanDeliveryGroup">"><b>Preferred Loan Delivery Method</b></span>
</span>
<select id="DeliveryGroup" name="LoanDeliveryGroup" size="1" class="f-name">
<option selected><#PARAM name="LoanDeliveryGroup"></option>
<option>Hold for Pickup</option>
<option>Mail to Address</option>
</select><br />
</label>
<#include filename="include_notification_preferences.html"><br />
<div class="f-submit-wrap" align="right">
<input type="submit" name="SubmitButton" value="Submit Information" class="f-submit" />
<input type="submit" name="SubmitButton" value="Cancel - Exit to Main Menu" class="f-submit" />
</div>
</fieldset>
<input type="hidden" id="BillingCategory" name="BillingCategory" value="<#PARAM name="BillingCategory">">
</form>
<#INCLUDE filename="include_footer.html">
</div>
</div>
</div>
</body>
</html>