<form method="post" action="forum/profile.php">
<table width="100%" cellpadding="3" cellspacing="1" border="0" class="forumline">
<tr><td class="catHead" height="28" colspan="4">
</td></tr>


<tr colspan="4">

<td class="row1" width="25%"><span class="genmed">Pick A Username You Want: *</span></td><td class="row2" width=25%><input type="text" class="post" style="width:150px" name="username" size="25" maxlength="20" value="" /></td>


<td class="row1" width=25%><span class="genmed">Your Email Address: *</span></td>      <td class="row2"><input type="text" class="post" style="width:150px" name="email" size="25" maxlength="255" value="" /></td>

</TR><TR colspan="4">

<td class="row1" width=25%><span class="genmed">Choose A Password: *</span><br /><span class="gensmall"></span></td><td class="row2"><input type="password" class="post" style="width: 150px" name="new_password" size="25" maxlength="100" value="" /></td>

<td class="row1" width=25%><span class="genmed">Confirm Your Password: * </span>
<br /><span class="gensmall"></span></td><td class="row2" width=25%> <input type="password" class="post" style="width: 150px" name="password_confirm" size="25" maxlength="100" value="" /></td>


</tr><tr colspan="4">

<td class="row1"><span class="genmed" width=25%>Your Gender: *</span></td><td class="row2" width=25% div align=left><input type="hidden"  name="gender" value="0" checked="checked"/><div align=left><span class="gen"></span><input type="radio" name="gender" value="1" /><span class="genmed">Male</span>&nbsp;&nbsp;<input type="radio" name="gender" value="2" /><span class="genmed">Female</span></td>


<input type="hidden" name="viewemail" value="0" checked="checked" />
<input type="hidden" name="hideonline" value="0" checked="checked" />
<input type="hidden" name="notifyreply" value="0" checked="checked" />

<input type="hidden" name="notifypm" value="1" checked="checked" />

<input type="hidden" name="popup_pm" value="1" checked="checked" />

<input type="hidden" name="attachsig" value="1" checked="checked" />

<input type="hidden" name="allowbbcode" value="1" checked="checked" />

<input type="hidden" name="allowhtml" value="0" checked="checked" />
<input type="hidden" name="allowsmilies" value="1" checked="checked" />

<input type="hidden" name="dateformat" value="D M d, Y g:i a" maxlength="14" class="post" />

<td class="row1" width=25%><span class="genmed">Now Click Submit: *</span></td><td class="row2" colspan="1" align="left" height="28" width=25%><input type="hidden" name="mode" value="register" />

<input type="hidden" name="agreed" value="true" />
<input type="hidden" name="coppa" value="0" />

<input type="submit" name="submit" value="Submit" class="liteoption" />&nbsp;&nbsp;
<input type="reset" value="Reset" name="reset" class="liteoption" /></td>

</tr></form>
</table>