<HTML>
<HEAD>
<TITLE>New Member Sign-up</TITLE>
<meta http-equiv="Content-Type" content="text/html; charset=windows-1252">
<META NAME="robots" CONTENT="noindex,nofollow">
<script language="JavaScript">

function ValidateForm(form)
{
if ((form.fname.value).length < 3)
{
alert("Please enter a valid First Name !");
form.fname.focus();
return (false);
};
if ((form.lname.value).length < 3)
{
alert("Please enter a valid Last Name !");
form.lname.focus();
return (false);
};

if ((form.email.value).length < 10 )
{
alert("Please enter a valid Email address !");
form.email.focus();
return (false);
};

// validate email -1


if (form.email.value.indexOf ('@',0) == -1 || form.email.value.indexOf ('.',0) == -1)
{
alert("Please type a valid Email address !");
form.email.focus();
return (false);
};

if (form.reemail.value != form.email.value)
{
alert("Please retype the same email address !");
form.reemail.focus();
return (false);
};

if ((form.userid.value).length < 6)
{
alert("Enter a Valid User ID\nMinimum 6 characters required!");
form.userid.focus();
return (false);
};

if ((form.passwd.value).length < 6)
{
alert("Enter a Valid Password !\nMinimum 6 characters required!");
form.passwd.focus();
return (false);
};

if (form.repw.value != form.pw.value)
{
alert("Please retype the same password !");
form.repasswd.focus();
return (false);
}

return (true);
};

</script>

</HEAD>
<BODY BGCOLOR="#C0C0C0">
<div align="center">
<table bgcolor="#FFFFFF" border="7" width="649" style="border-collapse:collapse" cellspacing="0" cellpadding="0" bordercolor="#000000">
<tr><td align="center" style="padding-left: 6" width="633">
  <p style="word-spacing: 0; margin-top: 0; margin-bottom: 0"><font face="Verdana,Arial,Helvetica"><center><u><b><font color="blue" size="4">-HEADING-</font></b></u>
  <font size="2">
  <br>
  &nbsp;
  </font></center></font>
  <p style="word-spacing: 0; margin-top: 0; margin-bottom: 0"><font face="Verdana,Arial,Helvetica"><center>
  <b><u><font size="4">New Member Sign-up Page</font></u></b></center></font>
 
  <p style="word-spacing: 0; margin-top: 0; margin-bottom: 0">&nbsp;
 
  <p style="word-spacing: 0; margin-top: 0; margin-bottom: 0">
 
<form action="signupcb-4033k174.cgi" method="post" name="Form" onsubmit="return ValidateForm(this)">

<div align="center">
  <center>
  <table border="0" width="403" cellspacing="0" cellpadding="0" style="border-collapse: collapse">
    <tr>
      <td width="195" valign="top" align="right" style="padding-right: 3"><b><font face="Verdana,Arial,Helvetica" size="2">
      ClickBank</font><font size="2"></font><font face="Verdana,Arial,Helvetica" size="2"> 
      Receipt:</font></b></td>
      <td width="192" valign="top" align="left" style="padding-left: 3"> <b>
      <font face="Verdana,Arial,Helvetica" size="2" color="#CC0000">-CBRECEIPT-</font></b></td>
    </tr>
    <tr>
      <td width="195" valign="top" align="right" style="padding-right: 3"><b><font face="Verdana,Arial,Helvetica" size="2">First
        Name:</font></b></td>
      <td width="192" valign="top" align="left" style="padding-left: 3"> <font face="Verdana,Arial,Helvetica">
      <input id="name1" name="fname" size="22" style="font-family: Verdana, Arial, Helvetica; font-size: 8pt" value="-FIRSTNAME-"></font></td>
    </tr>
    <tr>
      <td width="195" valign="top" align="right" style="padding-right: 3"><b><font face="Verdana,Arial,Helvetica" size="2">

      
Last Name:</font></b></td>
      <td width="192" valign="top" align="left" style="padding-left: 3"> <font face="Verdana,Arial,Helvetica"><input id="name" name="lname" value = "-LASTNAME-" size="22" style="font-family: Verdana, Arial, Helvetica; font-size: 8pt">

        </font>

      </td>
    </tr>
    <tr>
      <td width="195" valign="top" align="right" style="padding-right: 3"><b><font face="Verdana,Arial,Helvetica" size="2">

Email:</font></b></td>
      <td width="192" valign="top" align="left" style="padding-left: 3"><font face="Verdana,Arial,Helvetica">
      <input id="email" name="email" size="22" style="font-family: Verdana, Arial, Helvetica; font-size: 8pt" value="-CBEMAIL-">

        </font>

      </td>
    </tr>
    <tr>
      <td width="195" valign="top" align="right" style="padding-right: 3"><b><font face="Verdana,Arial,Helvetica" size="2">

Retype Email:</font></b></td>
      <td width="192" valign="top" align="left" style="padding-left: 3"><font face="Verdana,Arial,Helvetica"><input id="reemail" name="reemail" size="22" style="font-family: Verdana, Arial, Helvetica; font-size: 8pt">

        </font>

      </td>
    </tr>
    <tr>
      <td width="195" valign="top" align="right" style="padding-right: 3"><b><font face="Verdana,Arial,Helvetica" size="2">

User Id:</font></b></td>
      <td width="192" valign="top" align="left" style="padding-left: 3"><font face="Verdana,Arial,Helvetica"><input id="uid" name="userid" size="12" style="font-family: Verdana, Arial, Helvetica; font-size: 8pt; font-weight: bold">

        </font>

      </td>
    </tr>
    <tr>
      <td width="195" valign="top" align="right" style="padding-right: 3"><b><font face="Verdana,Arial,Helvetica" size="2">

Password:</font></b></td>
      <td width="192" valign="top" align="left" style="padding-left: 3"><font face="Verdana,Arial,Helvetica"><input type = "password" id="pw" name="passwd" size="12" style="font-family: Verdana, Arial, Helvetica; font-size: 8pt; font-weight: bold">

        </font>

      </td>
    </tr>
    <tr>
      <td width="195" valign="top" align="right" style="padding-right: 3"><b><font face="Verdana,Arial,Helvetica" size="2">

Retype Password:</font></b></td>
      <td width="192" valign="top" align="left" style="padding-left: 3"> <font face="Verdana,Arial,Helvetica"> <input type = "password" id="repw" name="repasswd" size="12" style="font-family: Verdana, Arial, Helvetica; font-size: 8pt; font-weight: bold">

        </font>

      </td>
    </tr>
    <tr>
      <td width="387" valign="top" align="center" colspan="2" style="padding-right: 0; padding-top: 2; padding-bottom: 2">
        <p align="center"><font face="Verdana,Arial,Helvetica">
        <input name="button" type="submit" value="Create New Account" style="border:3px solid #006699; font-family: Verdana, Arial, Helvetica; font-size: 10pt; font-weight: bold; padding-left:4; padding-right:4; padding-top:1; padding-bottom:1">

        </font></td>
    </tr>
  </table>
  </center>
</div>

<input type="hidden" name="CBRCPT" value="-CBRECEIPT-">
<input type="hidden" name="cbreceipt" value="-CBRECEIPT-">
<input type="hidden" name="cname" value="-FIRSTNAME- -LASTNAME-">
<input type="hidden" name="cemail" value="-CBEMAIL-">

</form> 

  <hr size="1">
  <p style="MARGIN-BOTTOM: 0px; MARGIN-TOP: 0px; WORD-SPACING: 0px"><b><font size="1"><font color="#000000" face="Verdana,Arial,Helvetica">We
  respect your privacy.&nbsp; The data being collected will not be forwarded to
  others</font><font color="black" face="Arial,Helvetica">.</font></font></b></p>
  <hr color="#000000" size="1">
  <p style="word-spacing: 0; margin-top: 0; margin-bottom: 0" align="center"><font size=2 color=black face="Verdana,Arial,Helvetica">You
  can contact our customer support team at:
  </font>
  <p style="word-spacing: 0; margin-top: 0; margin-bottom: 0" align="center"><font face="Verdana,Arial,Helvetica" size="2"><a href="mailto:-SUPPORT-"><b>-SUPPORT-</b></a></font>
  <p style="MARGIN-BOTTOM: 0px; MARGIN-TOP: 0px; WORD-SPACING: 0px"><b><font color="#808080" face="Verdana,Arial,Helvetica" size="1">Copyright
   -COMPANY-.&nbsp; All Rights Reserved.</font></b>

</td></tr>
</table>
</div>
<p align="center" style="word-spacing: 0; margin-top: 0; margin-bottom: 0">&nbsp;</p>
<p align="center" style="word-spacing: 0; margin-top: 0; margin-bottom: 0">
<font face="Verdana, Arial, Helvetica, sans-serif" size="2">Powered by </font><a href="http://www.membershipease.com/" target="_blank">
<font face="Verdana, Arial, Helvetica, sans-serif" size="2" color="#000000">MembershipEase - Instant Membership Site Creator</font></a></p>
</BODY>
</HTML>