{% extends "memberships/base-wide.html" %} {% load styled_forms %} {% load base_filters %} {% block title %}{% endblock %} {% block meta_description %}{% endblock %} {% block meta_keywords %}{% endblock %} {% block meta_canonical_url %}{% endblock %} {% block extra_head %} {{ block.super }} {% endblock %} {% block content %}

{{ app.name }}

{{ app.description|safe|urlize }}

{{ form.non_field_errors }}
{% for field in form %} {% if field.errors %}
{{ field.label_tag }} {{ field.errors }}
{% endif %} {% endfor %}
{% csrf_token %}

{% trans 'All Fields' %}

 
{% trans 'Section 1: User Information' %}
Salutation
 
{% trans 'First Name' %}*
 
{% trans 'Initials' %}
 
{% trans 'Last Name' %}*
 
{% trans 'Display Name' %}
 
{% trans 'Company' %}
 
{% trans 'Title' %}
 
{% trans 'Functional Title' %}
 
{% trans 'Department' %}
 
{% trans 'Address' %}
 
{% trans 'Address 2' %}
 
{% trans 'City' %}
 
{% trans 'State' %}
 
{% trans 'Zip Code' %}
 
{% trans 'Country' %}
 
{% trans 'Address Type' %}
 
{% trans 'Phone' %}
 
{% trans 'Phone 2' %}
 
{% trans 'Work Phone' %}
 
{% trans 'Home Phone' %}
 
{% trans 'Mobile Phone' %}
 
{% trans 'Pager' %}
 
{% trans 'Fax' %}
 
{% trans 'E-mail' %}*
 
{% trans 'E-mail 2' %}
 
{% trans 'Web Site' %}
 
{% trans 'Web Site 2' %}
 
{% trans 'Hide in Search' %}
Yes    No
 
{% trans 'Hide Address' %}
{% trans 'Yes' %}    {% trans 'No' %}
 
{% trans 'Hide Email' %}
{% trans 'Yes' %}    {% trans 'No' %}
 
{% trans 'Hide Phone' %}
{% trans 'Yes' %}    {% trans 'No' %}
 
{% trans 'DOB' %}
{{ form.dob }}  
{% trans 'Gender' %}
 
{% trans 'Spouse' %}
 
{% trans 'User Name' %}
 
{% trans 'Password' %}

{% trans 'confirm password' %}
 
 
{% trans 'Section 2: Membership Information' %}
{% trans 'Corporate Membership ID' %}   
 
{% trans 'Certifications' %}
 
{% trans 'Work Experience' %}
{{ form.work_experience }}
{% trans 'Areas of Expertise' %} {{ form.areas_of_expertise }}
 
{% trans 'Affiliation Member Number' %}   
 
{% trans 'Primary Practice' %}
{% trans 'How long in practice?' %}   
 
{% trans 'License Number' %}
 
{% trans 'Licensed in State' %}
 
{% trans 'Chapter' %}    {{ form.chapter }}
 
{% trans 'Application Complete?' %}   {% trans 'Yes' %}    {% trans 'No' %}
 
{% trans 'Notes' %}
 
{% trans 'Home State' %}
 
{% trans 'Year Left Native Country' %}   
 
{% trans 'Network Sectors' %}
 
{% trans 'Networking' %}
 
{% trans 'Government Worker' %}
{% trans 'Yes' %}    {% trans 'No' %}
 
{% trans 'Government Agency' %}
{% trans 'Industry' %}
{{ form.industry }}  
{% trans 'Region' %}
{{ form.region }}  
{% trans 'Size of Company' %}
{% trans 'Referral Source' %}
 
{% trans 'Referral Source Other' %}   
 
{% trans 'Referral Source Member Name' %}
{% trans 'Referral Source Member Number' %}   
 
 
{% trans 'Section 3: Membership Type' %}
{% trans 'Membership Type' %}*
{{ form.membership_type }}
 
 
{% trans 'Section 4: Payment' %}
{% trans 'Payment Method %}*
{{ form.payment_method }}
 
{% trans 'Promotion Code' %}
 
 
{% trans 'Section 5: Education History' %}
{% trans 'Enter your Education History' %}
{% trans 'School' %}: {% trans 'Degree' %}:
{% trans 'Major' %}: {% trans 'Graduation Date' %}:
       
{% trans 'School' %}: {% trans 'Degree' %}:
{% trans 'Major' %}: {% trans 'Year Graduated' %}:
       
{% trans 'School' %}: {% trans 'Degree' %}:
{% trans 'Major' %}: {% trans 'Year Graduated' %}:
       
{% trans 'School' %}: {% trans 'Degree' %}:
{% trans 'Major' %}: {% trans 'Year Graduated' %}:
       
 
{% trans 'Section 6: Career History' %}
{% trans 'Enter your Career History' %}

{% trans 'Company Information' %}:
{% trans 'Name' %}:
{% trans 'Description' %}:
       
{% trans 'Position Information' %}:
Title:
{% trans 'Description' %}:
{% trans 'Start Date' %}: {% trans 'End Date' %}:

{% trans 'Company Information' %}:
Name:
{% trans 'Description' %}:
       
{% trans 'Position Information' %}:
Title:
{% trans 'Description' %}:
{% trans 'Start Date' %}: {% trans 'End Date' %}:

{% if request.user.profile.is_superuser %}
 
{% trans 'Section 7: Superuser Only' %}
{% trans 'Application Approved' %}   {% trans 'Yes' %}    {% trans 'No' %}
 
{% trans 'Admin Notes' %}
{{ form.admin_notes }}
 
{% trans 'Status' %}*
 
{% trans 'Status Detail' %}*
 
{% endif %}
 
 
 
 
{% endblock %} {% block extra_body %} {{ block.super }} {% endblock extra_body %}