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<title>MMC-15:2013 | Clemson University</title>
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<script language='JavaScript' type='text/javascript' src='../../netfxx.net/website/HDWRegistrationAndLogin/validatescripts.js.php'></script>
</head>
<body>
<table width="645" border="0" cellpadding="10" cellspacing="0">
<tbody>
<tr>
<td height="576"><form action="http://www.abtechsci.com/HDWRegistrationAndLogin/RegistrationAndLogin.php" method="post" name="mmc-15reg" id="mmc-15reg" onsubmit="return HDW_validate_registration(this)">
<label></label>
<table class="personal_table">
<tbody>
<tr>
<td height="27" colspan="2" bgcolor="#E2E2E2" class="style61">Pre-registration required prior to payment</td>
</tr>
<tr>
<td height="27" colspan="2" bgcolor="#E2E2E2" class="style60"> Please select a username and password.</td>
</tr>
<tr>
<td width="178" class="style31">Username</td>
<td width="402" class="style31"><input type="text" name="username2" /></td>
</tr>
<tr>
<td class="style31">Password</td>
<td class="style31"><label>
<input type="text" name="Password" />
</label></td>
</tr>
<tr>
<td class="style31">Password again </td>
<td class="style31"><label>
<input type="text" name="Password again" />
</label></td>
</tr>
<tr bgcolor="#E2E2E2">
<td height="31" colspan="2" class="style60">Personal Information:</td>
</tr>
<tr>
<td class="style31">Attendee's FIRST NAME*</td>
<td class="style31"><input name="firstname" type="text" />
LAST NAME*
<input name="lastname" type="text" /> </td>
</tr>
<tr>
<td class="style31">First Time Attending?</td>
<td class="style31"><select name="first_time" class="small">
<option value="Yes">Yes</option>
<option value="No" selected="selected">No</option>
</select> </td>
</tr>
<tr>
<td class="style31">Your Affiliation? </td>
<td class="style31"><select name="dept" class="medium">
<option value="University" selected="selected">University</option>
<option value="Industry">Industry</option>
<option value="Foundation">Foundation</option>
<option value="Nat_lab">National / Government Laboratory</option>
<option value="Other">Other</option>
</select> </td>
</tr>
<tr>
<td class="style31">Title</td>
<td class="style31"><input name="title" class="short" type="text" /> </td>
</tr>
<tr>
<td class="style31">Preferred Name</td>
<td class="style31"><input name="preferred_name" type="text" /> </td>
</tr>
<tr>
<td class="style31">Organization</td>
<td class="style31"><input name="organization" type="text" /> </td>
</tr>
<tr>
<td class="style31">Street Address*</td>
<td class="style31"><input name="street_address" type="text" /></td>
</tr>
<tr>
<td class="style31">City*</td>
<td class="style31"><input name="city" type="text" /> </td>
</tr>
<tr>
<td class="style31">State*</td>
<td class="style31"><input name="state" class="ultra_tiny" type="text" /></td>
</tr>
<tr>
<td class="style31">Zip*</td>
<td class="style31"><input name="zip" class="small" type="text" /></td>
</tr>
<tr>
<td class="style31">Country*</td>
<td class="style31"><label>
<select name="Country">
<option value="" selected="selected">Select Country</option>
<option value="United States">United States</option>
<option value="United Kingdom">United Kingdom</option>
<option value="Afghanistan">Afghanistan</option>
<option value="Albania">Albania</option>
<option value="Algeria">Algeria</option>
<option value="American Samoa">American Samoa</option>
<option value="Andorra">Andorra</option>
<option value="Angola">Angola</option>
<option value="Anguilla">Anguilla</option>
<option value="Antarctica">Antarctica</option>
<option value="Antigua and Barbuda">Antigua and Barbuda</option>
<option value="Argentina">Argentina</option>
<option value="Armenia">Armenia</option>
<option value="Aruba">Aruba</option>
<option value="Australia">Australia</option>
<option value="Austria">Austria</option>
<option value="Azerbaijan">Azerbaijan</option>
<option value="Bahamas">Bahamas</option>
<option value="Bahrain">Bahrain</option>
<option value="Bangladesh">Bangladesh</option>
<option value="Barbados">Barbados</option>
<option value="Belarus">Belarus</option>
<option value="Belgium">Belgium</option>
<option value="Belize">Belize</option>
<option value="Benin">Benin</option>
<option value="Bermuda">Bermuda</option>
<option value="Bhutan">Bhutan</option>
<option value="Bolivia">Bolivia</option>
<option value="Bosnia and Herzegovina">Bosnia and Herzegovina</option>
<option value="Botswana">Botswana</option>
<option value="Bouvet Island">Bouvet Island</option>
<option value="Brazil">Brazil</option>
<option value="British Indian Ocean Territory">British Indian Ocean Territory</option>
<option value="Brunei Darussalam">Brunei Darussalam</option>
<option value="Bulgaria">Bulgaria</option>
<option value="Burkina Faso">Burkina Faso</option>
<option value="Burundi">Burundi</option>
<option value="Cambodia">Cambodia</option>
<option value="Cameroon">Cameroon</option>
<option value="Canada">Canada</option>
<option value="Cape Verde">Cape Verde</option>
<option value="Cayman Islands">Cayman Islands</option>
<option value="Central African Republic">Central African Republic</option>
<option value="Chad">Chad</option>
<option value="Chile">Chile</option>
<option value="China">China</option>
<option value="Christmas Island">Christmas Island</option>
<option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands</option>
<option value="Colombia">Colombia</option>
<option value="Comoros">Comoros</option>
<option value="Congo">Congo</option>
<option value="Congo, The Democratic Republic of The">Congo, The Democratic Republic of The</option>
<option value="Cook Islands">Cook Islands</option>
<option value="Costa Rica">Costa Rica</option>
<option value="Cote D'ivoire">Cote D'ivoire</option>
<option value="Croatia">Croatia</option>
<option value="Cuba">Cuba</option>
<option value="Cyprus">Cyprus</option>
<option value="Czech Republic">Czech Republic</option>
<option value="Denmark">Denmark</option>
<option value="Djibouti">Djibouti</option>
<option value="Dominica">Dominica</option>
<option value="Dominican Republic">Dominican Republic</option>
<option value="Ecuador">Ecuador</option>
<option value="Egypt">Egypt</option>
<option value="El Salvador">El Salvador</option>
<option value="Equatorial Guinea">Equatorial Guinea</option>
<option value="Eritrea">Eritrea</option>
<option value="Estonia">Estonia</option>
<option value="Ethiopia">Ethiopia</option>
<option value="Falkland Islands (Malvinas)">Falkland Islands (Malvinas)</option>
<option value="Faroe Islands">Faroe Islands</option>
<option value="Fiji">Fiji</option>
<option value="Finland">Finland</option>
<option value="France">France</option>
<option value="French Guiana">French Guiana</option>
<option value="French Polynesia">French Polynesia</option>
<option value="French Southern Territories">French Southern Territories</option>
<option value="Gabon">Gabon</option>
<option value="Gambia">Gambia</option>
<option value="Georgia">Georgia</option>
<option value="Germany">Germany</option>
<option value="Ghana">Ghana</option>
<option value="Gibraltar">Gibraltar</option>
<option value="Greece">Greece</option>
<option value="Greenland">Greenland</option>
<option value="Grenada">Grenada</option>
<option value="Guadeloupe">Guadeloupe</option>
<option value="Guam">Guam</option>
<option value="Guatemala">Guatemala</option>
<option value="Guinea">Guinea</option>
<option value="Guinea-bissau">Guinea-bissau</option>
<option value="Guyana">Guyana</option>
<option value="Haiti">Haiti</option>
<option value="Heard Island and Mcdonald Islands">Heard Island and Mcdonald Islands</option>
<option value="Holy See (Vatican City State)">Holy See (Vatican City State)</option>
<option value="Honduras">Honduras</option>
<option value="Hong Kong">Hong Kong</option>
<option value="Hungary">Hungary</option>
<option value="Iceland">Iceland</option>
<option value="India">India</option>
<option value="Indonesia">Indonesia</option>
<option value="Iran, Islamic Republic of">Iran, Islamic Republic of</option>
<option value="Iraq">Iraq</option>
<option value="Ireland">Ireland</option>
<option value="Israel">Israel</option>
<option value="Italy">Italy</option>
<option value="Jamaica">Jamaica</option>
<option value="Japan">Japan</option>
<option value="Jordan">Jordan</option>
<option value="Kazakhstan">Kazakhstan</option>
<option value="Kenya">Kenya</option>
<option value="Kiribati">Kiribati</option>
<option value="Korea, Democratic People's Republic of">Korea, Democratic People's Republic of</option>
<option value="Korea, Republic of">Korea, Republic of</option>
<option value="Kuwait">Kuwait</option>
<option value="Kyrgyzstan">Kyrgyzstan</option>
<option value="Lao People's Democratic Republic">Lao People's Democratic Republic</option>
<option value="Latvia">Latvia</option>
<option value="Lebanon">Lebanon</option>
<option value="Lesotho">Lesotho</option>
<option value="Liberia">Liberia</option>
<option value="Libyan Arab Jamahiriya">Libyan Arab Jamahiriya</option>
<option value="Liechtenstein">Liechtenstein</option>
<option value="Lithuania">Lithuania</option>
<option value="Luxembourg">Luxembourg</option>
<option value="Macao">Macao</option>
<option value="Macedonia, The Former Yugoslav Republic of">Macedonia, The Former Yugoslav Republic of</option>
<option value="Madagascar">Madagascar</option>
<option value="Malawi">Malawi</option>
<option value="Malaysia">Malaysia</option>
<option value="Maldives">Maldives</option>
<option value="Mali">Mali</option>
<option value="Malta">Malta</option>
<option value="Marshall Islands">Marshall Islands</option>
<option value="Martinique">Martinique</option>
<option value="Mauritania">Mauritania</option>
<option value="Mauritius">Mauritius</option>
<option value="Mayotte">Mayotte</option>
<option value="Mexico">Mexico</option>
<option value="Micronesia, Federated States of">Micronesia, Federated States of</option>
<option value="Moldova, Republic of">Moldova, Republic of</option>
<option value="Monaco">Monaco</option>
<option value="Mongolia">Mongolia</option>
<option value="Montserrat">Montserrat</option>
<option value="Morocco">Morocco</option>
<option value="Mozambique">Mozambique</option>
<option value="Myanmar">Myanmar</option>
<option value="Namibia">Namibia</option>
<option value="Nauru">Nauru</option>
<option value="Nepal">Nepal</option>
<option value="Netherlands">Netherlands</option>
<option value="Netherlands Antilles">Netherlands Antilles</option>
<option value="New Caledonia">New Caledonia</option>
<option value="New Zealand">New Zealand</option>
<option value="Nicaragua">Nicaragua</option>
<option value="Niger">Niger</option>
<option value="Nigeria">Nigeria</option>
<option value="Niue">Niue</option>
<option value="Norfolk Island">Norfolk Island</option>
<option value="Northern Mariana Islands">Northern Mariana Islands</option>
<option value="Norway">Norway</option>
<option value="Oman">Oman</option>
<option value="Pakistan">Pakistan</option>
<option value="Palau">Palau</option>
<option value="Palestinian Territory, Occupied">Palestinian Territory, Occupied</option>
<option value="Panama">Panama</option>
<option value="Papua New Guinea">Papua New Guinea</option>
<option value="Paraguay">Paraguay</option>
<option value="Peru">Peru</option>
<option value="Philippines">Philippines</option>
<option value="Pitcairn">Pitcairn</option>
<option value="Poland">Poland</option>
<option value="Portugal">Portugal</option>
<option value="Puerto Rico">Puerto Rico</option>
<option value="Qatar">Qatar</option>
<option value="Reunion">Reunion</option>
<option value="Romania">Romania</option>
<option value="Russian Federation">Russian Federation</option>
<option value="Rwanda">Rwanda</option>
<option value="Saint Helena">Saint Helena</option>
<option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option>
<option value="Saint Lucia">Saint Lucia</option>
<option value="Saint Pierre and Miquelon">Saint Pierre and Miquelon</option>
<option value="Saint Vincent and The Grenadines">Saint Vincent and The Grenadines</option>
<option value="Samoa">Samoa</option>
<option value="San Marino">San Marino</option>
<option value="Sao Tome and Principe">Sao Tome and Principe</option>
<option value="Saudi Arabia">Saudi Arabia</option>
<option value="Senegal">Senegal</option>
<option value="Serbia and Montenegro">Serbia and Montenegro</option>
<option value="Seychelles">Seychelles</option>
<option value="Sierra Leone">Sierra Leone</option>
<option value="Singapore">Singapore</option>
<option value="Slovakia">Slovakia</option>
<option value="Slovenia">Slovenia</option>
<option value="Solomon Islands">Solomon Islands</option>
<option value="Somalia">Somalia</option>
<option value="South Africa">South Africa</option>
<option value="South Georgia and The South Sandwich Islands">South Georgia and The South Sandwich Islands</option>
<option value="Spain">Spain</option>
<option value="Sri Lanka">Sri Lanka</option>
<option value="Sudan">Sudan</option>
<option value="Suriname">Suriname</option>
<option value="Svalbard and Jan Mayen">Svalbard and Jan Mayen</option>
<option value="Swaziland">Swaziland</option>
<option value="Sweden">Sweden</option>
<option value="Switzerland">Switzerland</option>
<option value="Syrian Arab Republic">Syrian Arab Republic</option>
<option value="Taiwan, Province of China">Taiwan, Province of China</option>
<option value="Tajikistan">Tajikistan</option>
<option value="Tanzania, United Republic of">Tanzania, United Republic of</option>
<option value="Thailand">Thailand</option>
<option value="Timor-leste">Timor-leste</option>
<option value="Togo">Togo</option>
<option value="Tokelau">Tokelau</option>
<option value="Tonga">Tonga</option>
<option value="Trinidad and Tobago">Trinidad and Tobago</option>
<option value="Tunisia">Tunisia</option>
<option value="Turkey">Turkey</option>
<option value="Turkmenistan">Turkmenistan</option>
<option value="Turks and Caicos Islands">Turks and Caicos Islands</option>
<option value="Tuvalu">Tuvalu</option>
<option value="Uganda">Uganda</option>
<option value="Ukraine">Ukraine</option>
<option value="United Arab Emirates">United Arab Emirates</option>
<option value="United Kingdom">United Kingdom</option>
<option value="United States">United States</option>
<option value="United States Minor Outlying Islands">United States Minor Outlying Islands</option>
<option value="Uruguay">Uruguay</option>
<option value="Uzbekistan">Uzbekistan</option>
<option value="Vanuatu">Vanuatu</option>
<option value="Venezuela">Venezuela</option>
<option value="Viet Nam">Viet Nam</option>
<option value="Virgin Islands, British">Virgin Islands, British</option>
<option value="Virgin Islands, U.S.">Virgin Islands, U.S.</option>
<option value="Wallis and Futuna">Wallis and Futuna</option>
<option value="Western Sahara">Western Sahara</option>
<option value="Yemen">Yemen</option>
<option value="Zambia">Zambia</option>
<option value="Zimbabwe">Zimbabwe</option>
</select>
</label></td>
</tr>
<tr>
<td class="style31">Phone Number</td>
<td class="style31"> (
<input name="phone_area_code" type="text" class="tiny" size="6" />
)
<input name="phone_number" class="short" type="text" /> </td>
</tr>
<tr>
<td class="style31">Email Address*</td>
<td class="style31"><input name="email_address" type="text" /> </td>
</tr>
<tr>
<td class="style1"> </td>
</tr>
<tr>
<td colspan="2" class="style31"><small>Spouses of attendees are welcome to complete a <strong><u>SEPARATE</u></strong> registration for the
conference at a reduced rate. Registered spouses can enjoy all of the workshops,
meals, events and happenings at the MMC-15 Biannual Conference, including the Banquet.</small></td>
</tr>
<tr>
<td class="style31">Spouse's FIRST NAME</td>
<td class="style31"><input name="spousefirstname" type="text" />
LAST NAME
<input name="spouselastname" type="text" /> </td>
</tr>
<tr>
<td class="style31">Spouse’s Email Address</td>
<td class="style31"><input id="spouse_email" name="spouse_email" type="text" /> </td>
</tr>
<tr>
<td class="style31"> </td>
<td class="style31"> </td>
</tr>
<tr bgcolor="#E2E2E2">
<td height="26" colspan="2" bgcolor="#E2E2E2" class="style31"> <strong> Registrations</strong></td>
</tr>
</tbody>
</table>
<span class="style31">
<input type="text" name="username" />
</span>
<table width="585" class="smart_table">
<colgroup>
<col />
<col />
<col />
<col width="80px" />
<col />
</colgroup>
<tbody>
<tr>
<td width="145" class="style31"><input class="first_representative_registration sum_qty" id="first_representative_registration" name="registration_type" value="first_representative_registration" type="radio" /> </td>
<td width="28" class="style31">$785</td>
<td width="268" class="style31">MMC-15 Standard Delegate Registration<br /> </td>
<td width="69" class="style31">Subtotal:</td>
<td width="51" class="registration_subtotal reg_type style1"></td>
</tr>
<tr>
<td class="style31"><input class="non-ABACC_registration sum_qty" id="non-ABACC_registration" name="registration_type" checked="checked" value="non-ABACC_registration" type="radio" /> </td>
<td class="style31">$650</td>
<td class="style31">MMC-15 Author / Academic Delegate Registration</td>
<td class="style31">Subtotal:</td>
<td class="style31">$650</td>
</tr>
</tbody>
<tr>
<td class="style31"><input class="first_representative_registration sum_qty" id="radio" name="registration_type" value="first_representative_registration" type="radio" /> </td>
<td class="style31">$350</td>
<td class="style31">MMC-15 Student Delegate Registration<br /> </td>
<td class="style31">Subtotal:</td>
<td class="registration_subtotal reg_type style1"></td>
</tr>
<tr>
<td class="style31"><input class="first_representative_registration sum_qty" id="radio2" name="registration_type" value="first_representative_registration" type="radio" /> </td>
<td class="style31">$250</td>
<td class="style31">MMC-15 Spouse Registration</td>
<td class="style31">Subtotal:</td>
<td class="registration_subtotal style1"></td>
</tr>
<tr>
<td class="style31"><input class="discount_special discount_code" name="discount_code" id="discount_code" style="width: 80px;" type="text" /> </td>
<td class="style1"> </td>
<td class="style31">Applicable Discount Code</td>
<td class="style31">Credit</td>
<td class="style31" style="color: green;">$<span id="discount_code_active">0</span> Credit</td>
</tr>
<tr>
<td class="style1"> </td>
<td class="style1"> </td>
<td class="style31">OPTIONAL ACTIVITIES </td>
<td class="style1"> </td>
<td class="style1" style="color: green;"> </td>
</tr>
<tr>
<td class="style31"><input class="cpe_credits_participant sum_qty sum_checkbox" id="cpe_credits_participant" name="cpe_credits_participants" value="1" type="checkbox" /> </td>
<td class="style31">$25</td>
<td class="style31"><a href="http://www.milb.com/index.jsp?sid=t428" target="_blank">Local Baseball Game</a></td>
<td class="style31">Subtotal:</td>
<td class="registration_subtotal style1"></td>
</tr>
<tr>
<td class="style31"><input class="registering_spouse sum_qty sum_checkbox" id="registering_spouse" name="spouse" value="1" type="checkbox" /> </td>
<td class="style31">$5</td>
<td class="style31"><a href="http://www.bmwusfactory.com/zentrum/" target="_blank">BMW Factory Tour</a></td>
<td class="style31">Subtotal:</td>
<td class="registration_subtotal style1"></td>
</tr>
<tr>
<td class="style31"><input class="registering_business360 sum_qty sum_checkbox" id="registering_business360" name="business360" value="1" type="checkbox" /> </td>
<td class="style31">$59</td>
<td class="style31">Golf: Clemson's <a href="http://www.clemson.edu/centers-institutes/madren/golf/" target="_blank">Walker Course</a> </td>
<td class="style31">Subtotal:</td>
<td class="registration_subtotal style1"></td>
</tr>
<tr>
<td class="style31"><input class="registering_business360 sum_qty sum_checkbox" id="registering_business360" name="business360" value="1" type="checkbox" /> </td>
<td class="style31">$25</td>
<td class="style31">Recreational Boating on Lake Hartwell</td>
<td class="style31">Subtotal:</td>
<td class="registration_subtotal style1"></td>
</tr>
<tr>
<td class="style31"><input class="banquet_guests sum_qty" id="banquet_guests" name="banquet_guests" type="text" /> </td>
<td class="style31">$75</td>
<td class="style31">Banquet Guest Tickets—Each registration receives one complimentary
ticket. Additional guests are $75 each.</td>
<td class="style31">Subtotal:</td>
<td class="style31">$0</td>
</tr>
</table>
<hr />
<table cellspacing="px">
<tbody>
<tr>
<td colspan="5" class="style31"><strong>Pre-conference Events</strong><br />
You may choose as many as you like.</td>
</tr>
<tr>
<td class="style31"><input class="radio_button" name="board_president_feduciary_responsibility" value="1" type="checkbox" /> </td>
<td colspan="3" class="style1"> </td>
<td class="style1"> </td>
<td class="style31"><em><strong>FREE</strong></em></td>
</tr>
<tr>
<td class="style31"><input class="radio_button" name="abhe_team_training" value="1" type="checkbox" /> </td>
<td colspan="3" class="style1"> </td>
<td class="style1"> </td>
<td class="style31"><em><strong>FREE</strong></em></td>
</tr>
<tr>
<td class="style31"><input class="radio_button" name="tracs_team_training" value="1" type="checkbox" /> </td>
<td colspan="3" class="style1"> </td>
<td class="style1"> </td>
<td class="style31"><em><strong>FREE</strong></em></td>
</tr>
<tr>
<td colspan="5" class="style31"><strong>Post-conference Events</strong><br />
You may choose one.</td>
</tr>
<tr>
<td class="style31"><input class="radio_button" name="post_conference_event" value="ABHE_Financial_Accreditation_Seminar" type="radio" /> </td>
<td colspan="3" class="style1"> </td>
<td class="style1"> </td>
<td class="style31"><em><strong>FREE</strong></em></td>
</tr>
<tr>
<td class="style31"><input class="radio_button" name="post_conference_event" value="CCCU_Institutions_Roundtable" type="radio" /> </td>
<td colspan="3" class="style1"> </td>
<td class="style1"> </td>
<td class="style31"><em><strong>FREE</strong></em></td>
</tr>
<tr>
<td class="style31"><input class="radio_button" name="post_conference_event" checked="checked" value="none" type="radio" /> </td>
<td colspan="3" class="style1"> </td>
<td class="style1"> </td>
<td class="style31"><em><strong>FREE</strong></em></td>
</tr>
</tbody>
</table>
<hr />
<h4 class="style31">Payment Information</h4>
<p class="style1"> <span class="style31"><strong>Total Due:</strong> <span id="total_due">$599</span></span> </p>
<table width="609">
<tbody>
<tr>
<td class="style31"><input name="payment_method" class="radio_button" value="credit_card" checked="checked" type="radio" /> </td>
<td width="351" class="style31">Pay Now</td>
</tr>
<tr>
<td class="style1"></td>
<td class="style31">Name on Credit Card*</td>
<td width="181" class="style31"><input name="credit_card_name" type="text" /> </td>
</tr>
<tr>
<td class="style1"></td>
<td class="style31">Credit Card Number (No spaces or dashes)*</td>
<td class="style31"><input name="credit_card_number" type="text" /> </td>
</tr>
<tr>
<td class="style1"></td>
<td class="style31">Credit Card Security Code (three-digit number located on the back
of your credit card.)*</td>
<td class="style31"><input name="credit_card_security_code" type="text" /> </td>
</tr>
<tr>
<td class="style1"></td>
<td class="style31">Credit Card Expiration Date (Format: mm/yy)</td>
<td class="style31"><input name="credit_card_expiration_month" class="ultra_tiny" type="text" />
/
<input name="credit_card_expiration_year" class="ultra_tiny" type="text" /> </td>
</tr>
<tr>
<td class="style1"> </td>
</tr>
<tr>
<td class="radio_button style1"> </td>
<td class="style1"> </td>
</tr>
<tr>
<td class="style1"> </td>
</tr>
</tbody>
</table>
<p class="style31"><strong>NOTE:</strong> Please review your submission before clicking "Register."</p>
<div class="style1" id="error" style="-webkit-border-radius: 10px;-moz-border-radius: 10px;border-radius: 10px;display:none;background-color:#EDABAB;padding:10px;margin-bottom:10px;"></div>
<span class="style31">
<input name="option" value="com_conferenceregistration" type="hidden" />
<input name="view" value="default" type="hidden" />
<input name="task" value="register" type="hidden" />
<input name="submit" type="submit" value="Register" />
</span>
<table border="0" cellpadding="3" cellspacing="0" width="565">
<tbody>
<tr>
<td width="263" class="style1"> </td>
<td width="290" class="style1"> </td>
</tr>
</tbody>
</table>
<p> </p>
<p> </p>
<input type="hidden" name="hdwtablename" id="hdwtablename" value="1" />
<input type="hidden" name="hdwusername" id="hdwusername" value="username" />
<input type="hidden" name="hdwpassword" id="hdwpassword" value="Password" />
<input type="hidden" name="hdwconfirm" id="hdwconfirm" value="Password again" />
<input type="hidden" name="hdwok" id="hdwok" value="http://www.abtechsci.com/register-success.html" />
<input type="hidden" name="hdwemail" id="hdwemail" value="aguiseppi+http://macromolecularcomplexes.org" />
<input type="hidden" name="hdwnook" id="hdwnook" value="http://www.abtechsci.com/register-failed.html" />
<input type="hidden" name="hdwactivation_email" id="hdwactivation_email" value="email_address" />
</form> </td>
</tr>
<tr>
<td width="645" height="576"><h4 class="style31"> </h4>
<p><span class="style31"><br />
</span> </p></td>
</tr>
</tbody>
</table>
</body>
</html>