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<strong>To register for this workshop, please complete the following information:<br /> </strong>
<form name="form1" method="post" action="/cdc/workshops/workshop1.php">
<table width="100%" border="1" cellspacing="0" cellpadding="0" style="border-collapse: collapse">
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<td width="25%"><strong>First Name<span style="color:#FF0000;"><span lang="en-us">*</span></span></strong></td>
<td width="75%"><strong><input type="text" name="FirstName" size="20" maxlength="20" value="" /></strong></td>
</tr>
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<td width="25%"><strong>Last Name<span style="color:#FF0000;"><span lang="en-us">*</span></span></strong></td>
<td width="75%"><strong><input type="text" name="LastName" size="20" maxlength="20" value="" /></strong></td>
</tr>
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<td width="25%"><strong>E-mail Address<span style="color:#FF0000;"><span lang="en-us">*</span></span></strong></td>
<td width="75%"><strong><input type="text" name="EmailAddress" size="20" maxlength="125" value="" /><span lang="en-us">(e.g. john@fau.edu)</span></strong></td>
</tr>
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<td width="25%"><strong>Phone Number<span style="color:#FF0000;">*</span></strong></td>
<td width="75%"><strong><input type="text" name="PhoneNumber" size="20" maxlength="10" value="" /><span lang="en-us">(e.g. 5615554444)</span></strong></td>
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<td width="25%"><span style="color:#FF0000; font-size:12px;"><span lang="en-us"><strong> <br /> * Required Fields</strong></span></span></td>
<td width="75%"></td>
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<p><strong>(Please wait <span lang="en-us">a few moments</span> before clicking the <span lang="en-us">Register</span> button again if the first attempt fails<span lang="en-us">.</span>)</strong></p>
<p><strong> <input type="submit" name="submit" value="Register" /></strong></p>
</form>
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