<form class="phorm2" action="" method='post' id="sign_up_form">
				<ul class="shortLabels">
				<li><h2>Sign Up for Free Kiki Membership</h2></li>
  				<li>
    			<label for="account-first_name">First name:</label><input type="text" name="account[first_name]" value="<?php echo $account->firstName ?>" id="account-first_name">
    			 <label class="error" for="name" id="name_error" style="display:none;">This field is required.</label>
  				</li>
  				<li>
    			<label for="account-last_name">Last name:</label><input type="text" name="account[last_name]" value="<?php echo $account->lastName ?>" id="account-last_name">
  				</li>

  				<li>
    			<label for="account-email">Email:</label><input type="text" name="account[email]" value="<?php echo $account->email ?>" id="account-email">
  				</li>
  				<li>
            	<label for="billing-country" class="short">Country:</label>
            	<select title="country" id="billing-country" name="account[country]" class="billing_countries">
              	<?php foreach(Cart66Common::getCountries(true) as $code => $name): ?>
                <option value="<?php echo $name ?>" <?php if($code == $billingCountryCode) { echo 'selected="selected"'; } ?>><?php echo $name ?></option>
              	<?php endforeach; ?>
            	</select>
          		</li>

  				<li>
    			<label for="account-username">Username:</label><input type="text" name="account[username]" value="<?php echo $account->username ?>" id="account-username">
  				</li>
  				<li>
    			<label for="account-password">Password:</label><input type="password" name="account[password]" value="" id="account-password">
  				</li>
  				<li>
    			<label for="account-password2">&nbsp;</label><input type="password" name="account[password2]" value="" id="account-password2">
    			<p class="description">Repeat password</p>
  				</li>
  				<li>
  				<input type="checkbox" checked="" name="account[newsletter]" id="account-newsletter">Would you like to subscribe to our newsletter?
  				</li>
  				<input type=hidden value="new" name="fnewuser"/>
  				</ul>
  				<input type=submit class="button" value="Create Account" />
  				</form>