Mandatory fields are marked with *.

'form-signup']); ?>

Select a username and password

field($model, 'username')?> field($model, 'password')->passwordInput()?> field($model, 'passwordSecond')->passwordInput()?>

Contact information

field($model, 'form_of_address')->dropDownList( ['Mr'=>'Mr', 'Mrs'=>'Mrs'], ['prompt'=>'-----'])?> field($model, 'title')?> field($model, 'name')?> field($model, 'firstName')?> field($model, 'email')?> field($model, 'emailSecond')?>

Billing address

field($model, 'institution')?> field($model, 'division')?> field($model, 'streetPOBox')?> field($model, 'postalCode')?> field($model, 'locationCity')?> field($model, 'country')->dropDownList($countryList, ['prompt'=>'-----'])?>

Delivery address

field($model, 'deliveryInstitution')?> field($model, 'deliveryDivision')?> field($model, 'deliveryStreet')?> field($model, 'deliveryPostalCode')?> field($model, 'deliveryLocation')?> field($model, 'deliveryCountry')->dropDownList($countryList, ['prompt'=>'-----'])?> field($model, 'ipenMember')?> field($model, 'verifyCode')->widget(common\models\CaptchaRefreshable::className()) ?>

* mandatory field