<div style="width:50%;">
<input type="hidden" value="<?php echo(microtime(true)); ?>" id="reg_continue" class="req" />
<input type="hidden" value="<?php echo(microtime(true)); ?>" id="reg_affiliate_id" class="" />

<label>Username:</label><br />
<input type="text" class="comment-field req" name="reg_uname" id="reg_uname"/> <span class="check-result"></span>
<p class="hint"><strong>Required</strong> - pick a username</p>
<label>Date of birth:</label><br />
<select name="reg_dob_month" id="reg_dob_month" class="comment-field req" style="padding-right:5px;width:75px;">
	<option value="">Month</option>
	<?php for($i=1;$i<=12;$i++) {
		echo('<option value="'.$i.'">'.$i.'</option>');
	}
	?>
</select>

<select name="reg_dob_day" id="reg_dob_day" class="comment-field req" style="padding-right:5px;width:75px;">
	<option value="">Day</option>
	<?php for($i=1;$i<=31;$i++) {
		echo('<option value="'.$i.'">'.$i.'</option>');
	}
	?>
</select>
<select name="reg_dob_year" id="reg_dob_year" class="comment-field req" style="padding-right:5px;width:100px;">
	<option value="">Year</option>
	<?php
	$y=(date("Y",time())-18);

	for($i=1920;$i<=$y;$i++) {
		echo('<option value="'.$i.'">'.$i.'</option>');
	}
	?>
</select>

<p class="hint"><strong>Required</strong> - you must be aged 18 or over to use the site</p>

<label>Your Email Address:</label><br />
<input type="text" class="comment-field req" name="reg_email_address" id="reg_email_address"/> <span class="check-result"></span>
<p class="hint"><strong>Required</strong> - a valid email address</p>
<label>Confirm email address:</label><br />
<input type="text" class="comment-field req" name="reg_confirm_email_address" id="reg_confirm_email_address"/> <span class="check-result"></span>
<p class="hint"><strong>Required</strong> - email confirmation</p>
<label>Forename:</label><br />
<input type="text" class="comment-field req" name="reg_forename" id="reg_forename"/>
<p class="hint"><strong>Required</strong> - Your forname (and middle names should you wish)</p>
<label>Surname:</label><br />
<input type="text" class="comment-field req" name="reg_surname" id="reg_surname"/>
<p class="hint"><strong>Required</strong> - Your surname</p>
<label>Password:</label><br />
<input type="password" class="comment-field req" name="reg_password" id="reg_password"/>
<p class="hint"><strong>Required</strong> - make it strong!</p>
<label>Confirm Password:</label><br />
<input type="password" class="comment-field req" name="reg_confirm_password" id="reg_confirm_password"/>

<p class="hint"><strong>Required</strong> - confirm your password!</p>
<label>Tier:</label><br />
<select name="reg_tier" id="reg_tier" class="comment-field req" style="padding-right:5px;width:200px;">
	<option value="1">Free (limited functionality)</option>
    <option value="2">Bronze</option>
    <option value="3">Silver</option>
    <option value="4">Gold</option>
</select>
<p class="hint"><strong>Required</strong> - membership level!</p>

<div style="float: left;"><label>Security code:</label> <a class="new-captcha" href="#">new code?</a><br><img width="108" height="27" class="captcha" alt="security" src="/captcha"><strong>»</strong><input type="text" style="width: 100px; vertical-align: middle;" id="reg_security_code" name="reg_security_code" class="comment-field req"><p class="hint"><strong>Required</strong> - are you human? (not case sensitive)</p></div>
<div style="float:right;margin-top:2em;">
<input type="submit" value="Subscribe" class="button" style="width:75px;" /> </p>
</div>
<div class="clearfix"></div>
<input type="checkbox" class="req" name="reg_terms" /> I am aged 18 or over and have read & agree to the <a href="" class="link">Terms & Conditions</a> of this site
</div>