<?php
/*
  www.oscGold.com (C) Kamelia-Net Jacek Krysiak
  modul oscGold wer 4.0
*/
?>

<table border="0" width="100%" cellspacing="0" cellpadding="0">

 <!-- Naglowek BOF -->
 <tr>
  <td>
   <?php
   $info_box_contents = array();
   $info_box_contents[] = array('text' => NAVBAR_TITLE);
   new contentBoxHeading($info_box_contents);
   ?>
  </td>
 </tr>
 <tr>
  <td><?php echo tep_draw_separator('pixel_trans.gif', '100%', '1'); ?></td>
 </tr>
 <!-- Naglowek EOF -->

 <tr>
  <td>
   <table border="0" width="100%" cellspacing="1" cellpadding="2" class="infoBox">
    <tr class="infoBoxContents">
     <td>
      <table border="0" width="100%" cellspacing="0" cellpadding="2">
       <tr>
	    <td CLASS="main"><?php echo TEXT_ORIGIN_EXPLAIN_TOP; ?></td>
       </tr>
       <tr>
        <td><?php echo tep_draw_separator('pixel_trans.gif', '100%', '10'); ?></td>
       </tr>
	   <tr>
	    <td>
				 <fieldset>
		     <legend><?php echo NAVBAR_TITLE; ?></legend>
         <form NAME="newsletter" ACTION="<?php echo tep_href_link(FILENAME_NEWSLETTERS_SUBSCRIBE, '', 'NONSSL'); ?>" METHOD="post" onSubmit="return verify(this);">
         <input type="hidden" name="submitted" value="true">
         <table cellspacing=2 cellpadding=2 border=0 width="75%" class="topBarTitle">
          <tr>
           <td class="main"><?php echo TEXT_EMAIL; ?>&nbsp;&nbsp;&nbsp;</td>
           <td>&nbsp;</td>
           <td><input type="text" name="Email" value="" size="25" maxlength="50"></td>
          </tr>
          <tr>
           <td CLASS="main"><?php echo TEXT_EMAIL_FORMAT; ?>&nbsp;&nbsp;&nbsp;</td>
           <td>&nbsp;</td>
           <td CLASS="main"><input type="radio" name="email_type" value="HTML"><?php echo TEXT_EMAIL_HTML; ?></input> - <input type="radio" name="email_type" value="TEXT" checked><?php echo TEXT_EMAIL_TXT; ?></input></td>
          </tr>
          <tr>
           <td CLASS="main"><?php echo TEXT_GENDER; ?>&nbsp;&nbsp;&nbsp;</td>
           <td>&nbsp;</td>
           <td CLASS="main"><input type="radio" name="gender" value="m"  checked><?php echo TEXT_GENDER_MR; ?></input> - <input type="radio" name="gender" value="f"><?php echo TEXT_GENDER_MRS; ?></input></td>
          </tr>
          <tr>
           <td CLASS="main"><?php echo TEXT_FIRST_NAME; ?>&nbsp;&nbsp;&nbsp;</td>
           <td>&nbsp;</td>
           <td><input type="text" name="firstname" value="" size="25" maxlength="50"></td>
          </tr>
          <tr>
           <td CLASS="main"><?php echo TEXT_LAST_NAME; ?>&nbsp;&nbsp;&nbsp;</td>
           <td>&nbsp;</td>
					 <td class="main"><input type="text" name="lastname" value="" size="25" maxlength="50"></td>
          </tr>
          <tr>
           <td class="main"><?php echo ENTRY_COUNTRY; ?></td>
            <td>&nbsp;</td>
            <td class="main"><?php  echo tep_get_country_list('country',  $subscribers_country_id ) . '&nbsp;' ;?></td>
          </tr>
         </table>
				 </fieldset>
        </td>
       </tr>
	  </table>
	 </td>
	</tr>
   </table>
  </td>
 </tr>
 
 <!-- Przyciski BOF -->
 <tr>
  <td><?php echo tep_draw_separator('pixel_trans.gif', '100%', '3'); ?></td>
 </tr>
 <tr>
  <td>
   <table border="0" width="100%" cellspacing="1" cellpadding="2" class="infoBox">
    <tr class="infoBoxContents">
     <td>
      <table border="0" width="100%" cellspacing="0" cellpadding="2">
       <tr>
        <td width="10"><?php echo tep_draw_separator('pixel_trans.gif', '10', '1'); ?></td>
        <td><?php echo '<a href="' . tep_href_link(FILENAME_DEFAULT, '', 'NONSSL') . '">' . tep_image_button('button_back.gif', IMAGE_BUTTON_CONTINUE) . '</a>'; ?></td>
        <td align="right"><?php echo tep_image_submit('button_continue.gif', IMAGE_BUTTON_CONTINUE); ?></td>
        <td width="10"><?php echo tep_draw_separator('pixel_trans.gif', '10', '1'); ?></td>
      </tr>
      </table>
     </td>
    </tr>
   </table>
  </td>
 </tr>
 <!-- Przyciski EOF -->

</table>
</form>