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<#INCLUDE filename="include_header.html">
<#INCLUDE filename="include_menu.html">
<form action="illiad.dll" class="lib-form"method="post" name="ChangeUserInformation">
<input name="ILLiadForm" type="hidden" value="ChangeUserInformation">
<input name="NotifyGroup" type="hidden" value="E-Mail">
<input name="WebDeliveryGroup" type="hidden" value="Yes">
<h2>Manage Your Account</h2>
<div class="row">
<!-- First Name input -->
<div class="span1">
<label for="FirstName"><span class="req">*</span> <span class="<#ERROR name="ERRORFirstName">">First Name</span></label>
<input id="FirstName" name="FirstName" tabindex="1" type="text" value="<#PARAM name="FirstName">">
</div>
<!-- Last Name input -->
<div class="span1">
<label for="LastName"><span class="req">*</span> <span class="<#ERROR name="ERRORLastName">">Last Name</span>
<input id="LastName" name="LastName" tabindex="2" type="text" value="<#PARAM name="LastName">">
</div>
</div>
<div class="row">
<!-- Email input -->
<div class="span1">
<label for="EMailAddress"><span class="req">*</span> <span class="<#ERROR name="ERROREMailAddress">">Email Address</span></label>
<input id="EMailAddress" name="EMailAddress" tabindex="4" type="text"value="<#PARAM name="EMailAddress">">
</div>
<!-- Phone input -->
<div class="span1">
<label for="Phone"><span class="<#ERROR name="ERRORPhone">">Phone</span></label>
<input id="Phone" name="Phone" tabindex="5" type="text" value="<#PARAM name="Phone">">
</div>
</div>
<!-- Pickup Location Selector -->
<div class="row">
<div class="span1">
<label for="StatusGroup"><span class="req">*</span> <span class="<#ERROR name="ERRORStatus">">Status</span></label>
<select id="StatusGroup" name="StatusGroup" tabindex="3">
<optgroup label="Current status">
<option selected><#PARAM name="StatusGroup"></option>
</optgroup>
<optgroup label="Select new status">
<option>Undergraduate</option>
<option>Faculty</option>
<option>Graduate</option>
<option>Staff</option>
</optgroup>
</select>
</div>
<div class="span2">
<label for="NVTGC"><span class="req">*</span> <span class="<#ERROR name="ERRORNVTGC">">Preferred Pickup Location</span></label>
<select id="NVTGC" name="NVTGC" tabindex="6">
<optgroup label="Select new pickup location">
<option value="JHZ" selected>Zumberge Library @ Allendale</option>
<option value="STEEL">Steelcase Library @ De Vos</option>
<option value="FREY">Frey Learning Center @ CHS</option>
<option value="AWRI">Annis Water Research Institute</option>
<option value="VARI">VanAndel Research Institute</option>
</optgroup>
<optgroup label="Distance Education?">
<option value="OCS">Ship Books to me</option>
</optgroup>
</select>
</div>
</div>
<div class="illiad-mailing-address">
<div class="row">
<div class="span3">
<label for="Address"><span class="req">*</span> <span class="<#ERROR name="ERRORAddress">">Address (No P.O. Boxes)</span></label>
<input id="Address" name="Address" placeholder="Address Line 1" type="text" value="<#PARAM name="Address">" />
</div>
</div>
<div class="row">
<div class="span3">
<input id="Address2" name="Address2" placeholder="Address Line 2" type="text" value="<#PARAM name="Address2">" />
</div>
</div>
<div class="row">
<div class="span1">
<input id="City" name="City" placeholder="City" type="text" value="<#PARAM name="City">" />
</div>
<div class="span1">
<input id="State" name="State" placeholder="State" type="text"value="<#PARAM name="State">" />
</div>
<div class="span1">
<input id="Zip" name="Zip" type="text" placeholder="Zip" value="<#PARAM name="Zip">" />
</div>
</div>
</div>
<input name="SubmitButton" style="margin-top: 1em;" tabindex="8" type="submit" value="Submit Information" />
</form>
<#INCLUDE filename="include_footer.html">