<?php
require_once('header.php');
echo $page_content;

echo <<<EOJ
<form action="{$baseurl}{$filename}" method="post" name="signupform" class="grey lighten-3 form ajax" enctype="multipart/form-data">
	<input type="hidden" name="{$token_id}" value="{$token_value}" readonly />
	<input type="hidden" name="focus" value="{$en->encrypt('[SIGNUP]')}" readonly />
	<input type="hidden" name="zipcode" value="" readonly />
	<div class="progress grey lighten-2"><div class="indeterminate blue accent-4"></div></div>
	<div class="row">
		<div class="col s12 m12 l12 center-align"><h3>Signup Form</h3></div>
	</div>
	<div class="row">
		<div class="col s12 m6 l6">
			<label for="name">Name<span class="red-text right">*</span></label>
			<input type="text" name="name" id="name" />
		</div>
		<div class="col s12 m6 l6">
			<label for="email">Email<span class="red-text right">*</span></label>
			<input type="text" name="email" id="email" />
		</div>
	</div>
	<div class="row">
		<div class="col s12 m12 l12">
			<label for="password">Password<span class="red-text right">*</span></label>
			<input type="password" name="password" id="password" />
		</div>
	</div>
	<div class="row">
		<div class="col s12 m12 l12">
			<label for="confirmpassword">Confirm Password<span class="red-text right">*</span></label>
			<input type="password" name="confirmpassword" id="confirmpassword" />
		</div>
	</div>
	{$recaptcha}
	<div class="row">
		<div class="col s12 m12 l12">
			<button type="submit" name="submit" class="waves-effect btn-flat blue accent-4 white-text right" disabled>Submit</button>
		</div>
	</div>
</form>
<div class="smsg center-align"></div>
EOJ;
require_once('footer.php');
?>