<?

/*
FlexCMS (http://www.flexcms.com)
Flexible, Powerful, Affordable.

Contents of this file are protected by the copyright
notice found at http://www.flexcms.com/flex/pages/copyright.html,
and its usage is subject to the terms of the licensing agreement 
available at http://www.flexcms.com/flex/pages/license.html
*/



	// ========================================================================================
	// Registration Form Fields
	// ========================================================================================
	
	$PageTitle = '<img src="'.$ImagesURL.'/admin/admincp_settings.gif" width="23" height="20"> '.$MsgText[0][61];
	$BrowserTitle = $MsgText[0][61];
	$LocationBar = '<a href="'.$IndexURL.'">'.$MsgText[0][1].'</a> > <a href="'.$MainURL.'/options.html">'.$MsgText[0][4].'</a> > '.$MsgText[0][61];
	
	if ($LoggedIn == 'y') {
		
		ReadPermissions();
		Global $Permissions;
		
		if ($Permissions[13] == 'y') {
			
			$RegFormOpts = explode('%%', $Settings['RegFormOpts']);
			
			// positions 0,1,2 are the names of the three custom fields
			for ($i = 3; $i < count($RegFormOpts); $i++) {
				if ($RegFormOpts[$i] != '') {
					$Checked[$i-2][$RegFormOpts[$i]] = ' checked';
				}
				else {
					$Checked[$i-2]['d'] = ' checked';
				}
			}
			
			for ($i = count($RegFormOpts); $i <= 52; $i++) {
				$Checked[$i-2]['d'] = ' checked';
			}
			
			$Custom1Title = $RegFormOpts[0];
			$Custom2Title = $RegFormOpts[1];
			$Custom3Title = $RegFormOpts[2];
			
			
		
			$PageContents = $MsgText[0][413].'<br><br><form action="'.$MainURL.'/admin/registration-save" method="post">
			
			<table width="100%" border="0" cellspacing="0" cellpadding="10">
			
			<tr><td><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'"><b>'.$MsgText[0][414].'</b></td><td><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'"><b>'.$MsgText[0][415].'</b></td><td align="center"><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'"><b>'.$MsgText[0][416].'</b></td></tr>


			<tr><td><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'">'.$MsgText[0][99].'</td><td><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'"><input type="text" name="sample" size="20" maxlength="40"></td><td align="center"><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'"><img src="'.$ImagesURL.'/admin/spacer.gif" border="0" alt="" width="120" height="1"><br>['.$MsgText[0][417].']</td></tr>

			<tr><td><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'">'.$MsgText[0][420].'</td><td><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'"><input type="text" name="sample" size="35" maxlength="50"><br><input type="text" name="sample" size="35" maxlength="50"></td><td align="center"><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'">['.$MsgText[0][417].']</td></tr>

			<tr><td><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'">'.$MsgText[0][421].'</td><td><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'"><input type="password" name="sample" size="20" maxlength="40"><br><input type="password" name="sample" size="20" maxlength="40"></td><td align="center"><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'">['.$MsgText[0][417].']</td></tr>

			
			<tr><td><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'">'.$MsgText[0][100].'</td><td><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'"><input type="text" name="sample" size="20" maxlength="40"></td><td align="center"><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'"><input type="radio" name="status1" value="Required"'.$Checked[1]['r'].'> '.$MsgText[0][417].'<br><input type="radio" name="status1" value="Optional"'.$Checked[1]['o'].'> '.$MsgText[0][418].'&nbsp;<br><input type="radio" name="status1" value="Disabled"'.$Checked[1]['d'].'> '.$MsgText[0][419].'</td></tr>

			<tr><td><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'">'.$MsgText[0][101].'</td><td><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'"><input type="text" name="sample" size="20" maxlength="40"></td><td align="center"><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'"><input type="radio" name="status2" value="Required"'.$Checked[2]['r'].'> '.$MsgText[0][417].'<br><input type="radio" name="status2" value="Optional"'.$Checked[2]['o'].'> '.$MsgText[0][418].'&nbsp;<br><input type="radio" name="status2" value="Disabled"'.$Checked[2]['d'].'> '.$MsgText[0][419].'</td></tr>

			<tr><td><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'">'.$MsgText[0][102].'</td><td><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'"><input type="text" name="sample" size="35" maxlength="50"></td><td align="center"><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'"><input type="radio" name="status3" value="Required"'.$Checked[3]['r'].'> '.$MsgText[0][417].'<br><input type="radio" name="status3" value="Optional"'.$Checked[3]['o'].'> '.$MsgText[0][418].'&nbsp;<br><input type="radio" name="status3" value="Disabled"'.$Checked[3]['d'].'> '.$MsgText[0][419].'</td></tr>

			<tr><td><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'">'.$MsgText[0][422].' 1</td><td><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'"><input type="text" name="sample" size="30" maxlength="40"></td><td align="center"><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'"><input type="radio" name="status4" value="Required"'.$Checked[4]['r'].'> '.$MsgText[0][417].'<br><input type="radio" name="status4" value="Optional"'.$Checked[4]['o'].'> '.$MsgText[0][418].'&nbsp;<br><input type="radio" name="status4" value="Disabled"'.$Checked[4]['d'].'> '.$MsgText[0][419].'</td></tr>

			<tr><td><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'">'.$MsgText[0][422].' 2</td><td><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'"><input type="text" name="sample" size="30" maxlength="40"></td><td align="center"><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'"><input type="radio" name="status5" value="Required"'.$Checked[5]['r'].'> '.$MsgText[0][417].'<br><input type="radio" name="status5" value="Optional"'.$Checked[5]['o'].'> '.$MsgText[0][418].'&nbsp;<br><input type="radio" name="status5" value="Disabled"'.$Checked[5]['d'].'> '.$MsgText[0][419].'</td></tr>

			<tr><td><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'">'.$MsgText[0][422].' 3</td><td><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'"><input type="text" name="sample" size="30" maxlength="40"></td><td align="center"><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'"><input type="radio" name="status6" value="Required"'.$Checked[6]['r'].'> '.$MsgText[0][417].'<br><input type="radio" name="status6" value="Optional"'.$Checked[6]['o'].'> '.$MsgText[0][418].'&nbsp;<br><input type="radio" name="status6" value="Disabled"'.$Checked[6]['d'].'> '.$MsgText[0][419].'</td></tr>

			<tr><td><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'">'.$MsgText[0][422].' 4</td><td><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'"><input type="text" name="sample" size="30" maxlength="40"></td><td align="center"><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'"><input type="radio" name="status7" value="Required"'.$Checked[7]['r'].'> '.$MsgText[0][417].'<br><input type="radio" name="status7" value="Optional"'.$Checked[7]['o'].'> '.$MsgText[0][418].'&nbsp;<br><input type="radio" name="status7" value="Disabled"'.$Checked[7]['d'].'> '.$MsgText[0][419].'</td></tr>

			<tr><td><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'">'.$MsgText[0][104].'</td><td><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'"><input type="text" name="sample" size="20" maxlength="40"></td><td align="center"><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'"><input type="radio" name="status8" value="Required"'.$Checked[8]['r'].'> '.$MsgText[0][417].'<br><input type="radio" name="status8" value="Optional"'.$Checked[8]['o'].'> '.$MsgText[0][418].'&nbsp;<br><input type="radio" name="status8" value="Disabled"'.$Checked[8]['d'].'> '.$MsgText[0][419].'</td></tr>

			<tr><td><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'">'.$MsgText[0][105].'</td><td><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'"><input type="text" name="sample" size="25" maxlength="40"></td><td align="center"><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'"><input type="radio" name="status9" value="Required"'.$Checked[9]['r'].'> '.$MsgText[0][417].'<br><input type="radio" name="status9" value="Optional"'.$Checked[9]['o'].'> '.$MsgText[0][418].'&nbsp;<br><input type="radio" name="status9" value="Disabled"'.$Checked[9]['d'].'> '.$MsgText[0][419].'</td></tr>

			<tr><td><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'">'.$MsgText[0][106].'</td><td><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'"><input type="text" name="sample" size="10" maxlength="15"></td><td align="center"><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'"><input type="radio" name="status10" value="Required"'.$Checked[10]['r'].'> '.$MsgText[0][417].'<br><input type="radio" name="status10" value="Optional"'.$Checked[10]['o'].'> '.$MsgText[0][418].'&nbsp;<br><input type="radio" name="status10" value="Disabled"'.$Checked[10]['d'].'> '.$MsgText[0][419].'</td></tr>

			<tr><td><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'">'.$MsgText[0][107].'</td><td><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'"><select name="sample"><option value="AF">Afghanistan<option value="AL">Albania<option value="DZ">Algeria<option value="AS">American Samoa<option value="AD">Andorra<option value="AO">Angola<option value="AI">Anguilla<option value="AQ">Antarctica<option value="AG">Antigua and Barbuda<option value="AR">Argentina<option value="AM">Armenia<option value="AW">Aruba<option value="AU">Australia<option value="AT">Austria<option value="AZ">Azerbaijan<option value="BS">Bahamas<option value="BH">Bahrain<option value="BD">Bangladesh<option value="BB">Barbados<option value="BY">Belarus<option value="BE">Belgium<option value="BZ">Belize<option value="BJ">Benin<option value="BM">Bermuda<option value="BT">Bhutan<option value="BO">Bolivia<option value="BA">Bosnia and Herzegovina<option value="BW">Botswana<option value="BV">Bouvet Island<option value="BR">Brazil<option value="IO">British Indian Ocean Territory<option value="BN">Brunei Darussalam<option value="BG">Bulgaria<option value="BF">Burkina Faso<option value="BI">Burundi<option value="KH">Cambodia<option value="CM">Cameroon<option value="CA">Canada<option value="CV">Cape Verde<option value="KY">Cayman Islands<option value="CF">Central African Republic<option value="TD">Chad<option value="CL">Chile<option value="CN">China<option value="CX">Christmas Island<option value="CC">Cocos (Keeling) Islands<option value="CO">Colombia<option value="KM">Comoros<option value="CG">Congo<option value="CK">Cook Islands<option value="CR">Costa Rica<option value="CI">Cote D\'Ivoire (Ivory Coast)<option value="HR">Croatia (Hrvatska)<option value="CU">Cuba<option value="CY">Cyprus<option value="CZ">Czech Republic<option value="CS">Czechoslovakia (former)<option value="DK">Denmark<option value="DJ">Djibouti<option value="DM">Dominica<option value="DO">Dominican Republic<option value="TP">East Timor<option value="EC">Ecuador<option value="EG">Egypt<option value="SV">El Salvador<option value="GQ">Equatorial Guinea<option value="ER">Eritrea<option value="EE">Estonia<option value="ET">Ethiopia<option value="FK">Falkland Islands (Malvinas)<option value="FO">Faroe Islands<option value="FJ">Fiji<option value="FI">Finland<option value="FR">France<option value="GF">French Guiana<option value="PF">French Polynesia<option value="TF">French Southern Territories<option value="GA">Gabon<option value="GM">Gambia<option value="GE">Georgia<option value="DE">Germany<option value="GH">Ghana<option value="GI">Gibraltar<option value="GR">Greece<option value="GL">Greenland<option value="GD">Grenada<option value="GP">Guadeloupe<option value="GU">Guam<option value="GT">Guatemala<option value="GN">Guinea<option value="GW">Guinea-Bissau<option value="GY">Guyana<option value="HT">Haiti<option value="HM">Heard and McDonald Islands<option value="HN">Honduras<option value="HK">Hong Kong<option value="HU">Hungary<option value="IS">Iceland<option value="IN">India<option value="ID">Indonesia<option value="IR">Iran<option value="IQ">Iraq<option value="IE">Ireland<option value="IM">Isle of Man<option value="IL">Israel<option value="IT">Italy<option value="JM">Jamaica<option value="JP">Japan<option value="DQ">Jarvis Island<option value="JO">Jordan<option value="KZ">Kazakhstan<option value="KE">Kenya<option value="KI">Kiribati<option value="KP">Korea (North)<option value="KR">Korea (South)<option value="KW">Kuwait<option value="KG">Kyrgyzstan<option value="LA">Laos<option value="LV">Latvia<option value="LB">Lebanon<option value="LS">Lesotho<option value="LR">Liberia<option value="LY">Libya<option value="LI">Liechtenstein<option value="LT">Lithuania<option value="LU">Luxembourg<option value="MO">Macau<option value="MK">Macedonia<option value="MG">Madagascar<option value="MW">Malawi<option value="MY">Malaysia<option value="MV">Maldives<option value="ML">Mali<option value="MT">Malta<option value="MH">Marshall Islands<option value="MQ">Martinique<option value="MR">Mauritania<option value="MU">Mauritius<option value="YT">Mayotte<option value="MX">Mexico<option value="FM">Micronesia<option value="MD">Moldova<option value="MC">Monaco<option value="MN">Mongolia<option value="MS">Montserrat<option value="MA">Morocco<option value="MZ">Mozambique<option value="MM">Myanmar<option value="NA">Namibia<option value="NR">Nauru<option value="NP">Nepal<option value="NL">Netherlands<option value="AN">Netherlands Antilles<option value="NT">Neutral Zone<option value="NC">New Caledonia<option value="NZ">New Zealand (Aotearoa)<option value="NI">Nicaragua<option value="NE">Niger<option value="NG">Nigeria<option value="NU">Niue<option value="NF">Norfolk Island<option value="MP">Northern Mariana Islands<option value="NO">Norway<option value="OM">Oman<option value="PK">Pakistan<option value="PW">Palau<option value="PA">Panama<option value="PG">Papua New Guinea<option value="PY">Paraguay<option value="PE">Peru<option value="PH">Philippines<option value="PN">Pitcairn<option value="PL">Poland<option value="PT">Portugal<option value="PR">Puerto Rico<option value="QA">Qatar<option value="RE">Reunion<option value="RO">Romania<option value="RU">Russian Federation<option value="RW">Rwanda<option value="KN">Saint Kitts and Nevis<option value="LC">Saint Lucia<option value="VC">Saint Vincent and the Grenadines<option value="WS">Samoa<option value="SM">San Marino<option value="ST">Sao Tome and Principe<option value="SA">Saudi Arabia<option value="SN">Senegal<option value="SC">Seychelles<option value="SL">Sierra Leone<option value="SG">Singapore<option value="SK">Slovak Republic<option value="SI">Slovenia<option value="SB">Solomon Islands<option value="SO">Somalia<option value="ZA">South Africa<option value="GS">South Georgia and South Sandwich Isls.<option value="ES">Spain<option value="LK">Sri Lanka<option value="SH">St. Helena<option value="PM">St. Pierre and Miquelon<option value="SD">Sudan<option value="SR">Suriname<option value="SJ">Svalbard and Jan Mayen Islands<option value="SZ">Swaziland<option value="SE">Sweden<option value="CH">Switzerland<option value="SY">Syria<option value="TW">Taiwan<option value="TJ">Tajikistan<option value="TZ">Tanzania<option value="TH">Thailand<option value="TG">Togo<option value="TK">Tokelau<option value="TO">Tonga<option value="TT">Trinidad and Tobago<option value="TN">Tunisia<option value="TR">Turkey<option value="TM">Turkmenistan<option value="TC">Turks and Caicos Islands<option value="TV">Tuvalu<option value="UM">US Minor Outlying Islands<option value="SU">USSR (former)<option value="UG">Uganda<option value="UA">Ukraine<option value="AE">United Arab Emirate<option value="UK">United Kingdom<option value="US" SELECTED>United States<option value="UY">Uruguay<option value="UZ">Uzbekistan<option value="VU">Vanuatu<option value="VA">Vatican City State (Holy See)<option value="VE">Venezuela<option value="VN">Viet Nam<option value="VG">Virgin Islands (British)<option value="VI">Virgin Islands (U.S.)<option value="WF">Wallis and Futuna Islands<option value="EH">Western Sahara<option value="YE">Yemen<option value="YU">Yugoslavia<option value="ZR">Zaire<option value="ZM">Zambia<option value="ZW">Zimbabwe</select></td><td align="center"><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'"><input type="radio" name="status11" value="Required"'.$Checked[11]['r'].'> '.$MsgText[0][417].'<br><input type="radio" name="status11" value="Optional"'.$Checked[11]['o'].'> '.$MsgText[0][418].'&nbsp;<br><input type="radio" name="status11" value="Disabled"'.$Checked[11]['d'].'> '.$MsgText[0][419].'</td></tr>

			<tr><td><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'">'.$MsgText[0][108].'</td><td><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'"><input type="text" name="sample" size="15" maxlength="20"></td><td align="center"><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'"><input type="radio" name="status12" value="Required"'.$Checked[12]['r'].'> '.$MsgText[0][417].'<br><input type="radio" name="status12" value="Optional"'.$Checked[12]['o'].'> '.$MsgText[0][418].'&nbsp;<br><input type="radio" name="status12" value="Disabled"'.$Checked[12]['d'].'> '.$MsgText[0][419].'</td></tr>

			<tr><td><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'">'.$MsgText[0][109].'</td><td><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'"><input type="text" name="sample" size="15" maxlength="20"></td><td align="center"><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'"><input type="radio" name="status13" value="Required"'.$Checked[13]['r'].'> '.$MsgText[0][417].'<br><input type="radio" name="status13" value="Optional"'.$Checked[13]['o'].'> '.$MsgText[0][418].'&nbsp;<br><input type="radio" name="status13" value="Disabled"'.$Checked[13]['d'].'> '.$MsgText[0][419].'</td></tr>

			<tr><td><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'">'.$MsgText[0][110].'</td><td><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'"><input type="text" name="sample" size="15" maxlength="20"></td><td align="center"><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'"><input type="radio" name="status14" value="Required"'.$Checked[14]['r'].'> '.$MsgText[0][417].'<br><input type="radio" name="status14" value="Optional"'.$Checked[14]['o'].'> '.$MsgText[0][418].'&nbsp;<br><input type="radio" name="status14" value="Disabled"'.$Checked[14]['d'].'> '.$MsgText[0][419].'</td></tr>

			<tr><td><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'">'.$MsgText[0][111].'</td><td><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'"><input type="text" name="sample" size="15" maxlength="20"></td><td align="center"><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'"><input type="radio" name="status15" value="Required"'.$Checked[15]['r'].'> '.$MsgText[0][417].'<br><input type="radio" name="status15" value="Optional"'.$Checked[15]['o'].'> '.$MsgText[0][418].'&nbsp;<br><input type="radio" name="status15" value="Disabled"'.$Checked[15]['d'].'> '.$MsgText[0][419].'</td></tr>

			<tr><td><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'">'.$MsgText[0][112].'</td><td><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'"><input type="text" name="sample" size="35" maxlength="70"></td><td align="center"><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'"><input type="radio" name="status16" value="Required"'.$Checked[16]['r'].'> '.$MsgText[0][417].'<br><input type="radio" name="status16" value="Optional"'.$Checked[16]['o'].'> '.$MsgText[0][418].'&nbsp;<br><input type="radio" name="status16" value="Disabled"'.$Checked[16]['d'].'> '.$MsgText[0][419].'</td></tr>

			<tr><td><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'">'.$MsgText[0][113].'</td><td><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'"><input type="text" name="sample" size="35" maxlength="50"></td><td align="center"><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'"><input type="radio" name="status17" value="Required"'.$Checked[17]['r'].'> '.$MsgText[0][417].'<br><input type="radio" name="status17" value="Optional"'.$Checked[17]['o'].'> '.$MsgText[0][418].'&nbsp;<br><input type="radio" name="status17" value="Disabled"'.$Checked[17]['d'].'> '.$MsgText[0][419].'</td></tr>

			<tr><td><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'">'.$MsgText[0][423].' 1<br><input type="text" name="Custom1Title" size="20" value="'.$Custom1Title.'"></td><td><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'"><input type="text" name="sample" size="35" maxlength="50"></td><td align="center"><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'"><input type="radio" name="status18" value="Required"'.$Checked[18]['r'].'> '.$MsgText[0][417].'<br><input type="radio" name="status18" value="Optional"'.$Checked[18]['o'].'> '.$MsgText[0][418].'&nbsp;<br><input type="radio" name="status18" value="Disabled"'.$Checked[18]['d'].'> '.$MsgText[0][419].'</td></tr>

			<tr><td><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'">'.$MsgText[0][423].' 2<br><input type="text" name="Custom2Title" size="20" value="'.$Custom2Title.'"></td><td><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'"><input type="text" name="sample" size="35" maxlength="50"></td><td align="center"><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'"><input type="radio" name="status19" value="Required"'.$Checked[19]['r'].'> '.$MsgText[0][417].'<br><input type="radio" name="status19" value="Optional"'.$Checked[19]['o'].'> '.$MsgText[0][418].'&nbsp;<br><input type="radio" name="status19" value="Disabled"'.$Checked[19]['d'].'> '.$MsgText[0][419].'</td></tr>

			<tr><td><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'">'.$MsgText[0][423].' 3<br><input type="text" name="Custom3Title" size="20" value="'.$Custom3Title.'"></td><td><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'"><input type="text" name="sample" size="35" maxlength="50"></td><td align="center"><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'"><input type="radio" name="status20" value="Required"'.$Checked[20]['r'].'> '.$MsgText[0][417].'<br><input type="radio" name="status20" value="Optional"'.$Checked[20]['o'].'> '.$MsgText[0][418].'&nbsp;<br><input type="radio" name="status20" value="Disabled"'.$Checked[20]['d'].'> '.$MsgText[0][419].'</td></tr>



			<tr><td><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'"></td><td><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'"></td><td align="center"><font face="'.$FontFace.'" size="2" color="'.$Colors['Text'].'"></td></tr>

			
			
			
			</table>
			
			<br><br><br>
			
			<div align="center"><input type="submit" value="'.$MsgText[0][123].'"></div></form>';
			
			
						

		}
		else {
		
			$PageContents = $MsgText[0][97];
		
		}

	}
	else {
	
		RedirectToLogin();
	
	}

	// ========================================================================================




?>
