
<page name="password request">
	<title>Password Request</title>
	<content>
		<xhtml>
			<form name="CustomerMembershipApplication" method="post" action="PasswordRequest.aspx" id="CustomerMembershipApplication">
<input type="hidden" name="__VIEWSTATE" value="dDwxNDE0ODU4OTYzOztsPFByb2R1Y3RDb21taXR0ZWU7Q29uZmVyZW5jZVNwZWFrZXI7VmVuZG9yQWR2aXNvcnk7Vm9sdW50ZWVyT3RoZXI7U3VibWl0Oz4+n++mgB7ZFE0pY0u6kypAUwbG7E0=" />

				<table class="form">
					<table id="Form" cellpadding="0" cellspacing="0" border="0" width="100%"><tr><td>
	
						<tr>
							<td colspan="2">
								&nbsp;</td>
						</tr>
						<tr>
							<td colspan="2">
								&nbsp;</td>
						</tr>
						<tr>
							<td class="bodycontent" width="48%">
								<span id="SalutationLabel">Salutation:</span></td>
							<td>
								<table id="Salutation" class="bodycontent" border="0">
		<tr>
			<td><input id="Salutation_0" type="radio" name="Salutation" value="Mr." /><label for="Salutation_0">Mr.</label></td><td><input id="Salutation_1" type="radio" name="Salutation" value="Mrs." /><label for="Salutation_1">Mrs.</label></td><td><input id="Salutation_2" type="radio" name="Salutation" value="Miss." /><label for="Salutation_2">Miss.</label></td><td><input id="Salutation_3" type="radio" name="Salutation" value="Ms." /><label for="Salutation_3">Ms.</label></td><td><input id="Salutation_4" type="radio" name="Salutation" value="Dr." /><label for="Salutation_4">Dr.</label></td>
		</tr>
	</table></td>
						</tr>
						<tr>
							<td class="bodycontent">
								<span id="FirstNameLabel">First Name:</span></td>
							<td class="bodycontent">
								<input name="FirstName" type="text" maxlength="70" id="FirstName" size="40" /></td>
						</tr>
						<tr>
							<td class="bodycontent">
								<span id="LastNameLabel">Last Name:</span></td>
							<td class="bodycontent">
								<input name="LastName" type="text" maxlength="70" id="LastName" size="40" /></td>
						</tr>
						<tr>
							<td class="bodycontent">
								<span id="TitleLabel">Business Title:</span></td>
							<td class="bodycontent">
								<input name="Title" type="text" maxlength="70" id="Title" size="40" /></td>
						</tr>
						<tr>
							<td class="bodycontent">
								<span id="Address1Label">Address:</span></td>
							<td class="bodycontent">
								<input name="Address1" type="text" maxlength="70" id="Address1" size="40" /></td>
						</tr>
						<tr>
							<td class="bodycontent">
								<span id="Label5">Suite / Floor:</span></td>
							<td class="bodycontent">
								<input name="Address2" type="text" maxlength="70" id="Address2" size="40" /></td>
						</tr>
						<tr>
							<td class="bodycontent">
								<span id="CityLabel">City:</span></td>
							<td class="bodycontent">
								<input name="City" type="text" maxlength="70" id="City" size="40" /></td>
						</tr>
						<tr>
							<td class="bodycontent">
								<span id="Province_StateLabel">State or Province:</span>
								<span id="Label7" class="note"><font size="1"><br />* North American residents: Please use the two-character abbreviation (e.g. CA) for the name of your state / province.</font></span></td>
							<td class="bodycontent">
								<input name="Province_State" type="text" maxlength="75" id="Province_State" size="40" /></td>
						</tr>
						<tr>
							<td class="bodycontent">
								<span id="Postal_ZipCodeLabel">Zip or postal code:</span></td>
							<td class="bodycontent">
								<input name="Postal_ZipCode" type="text" maxlength="70" id="Postal_ZipCode" size="40" /></td>
						</tr>
						<tr>
							<td class="bodycontent">
								<span id="CountryLabel">Country:</span></td>
							<td class="bodycontent">
								<input name="Country" type="text" maxlength="70" id="Country" size="40" /></td>
						</tr>
						<tr>
							<td class="bodycontent">
								<span id="EmailLabel">E-mail Address:</span></td>
							<td class="bodycontent">
								<input name="Email" type="text" maxlength="70" id="Email" size="40" /></td>
						</tr>
						<tr>
							<td class="bodycontent">
								<span id="PhoneLabel">Phone Number:</span></td>
							<td class="bodycontent">
								<input name="Phone" type="text" maxlength="70" id="Phone" size="40" /></td>
						</tr>
						<tr>
							<td class="bodycontent">
								<span id="Label13">Ext.</span></td>
							<td class="bodycontent">
								<input name="PhoneExtension" type="text" maxlength="10" id="PhoneExtension" size="10" /></td>
						</tr>
						<tr>
							<td class="bodycontent">
								<span id="Label11">Fax:</span></td>
							<td class="bodycontent">
								<input name="Fax" type="text" maxlength="70" id="Fax" size="40" /></td>
						</tr>
						<tr>
							<td class="bodycontent">
								<span id="CompanyLabel">Company Name:</span></td>
							<td class="bodycontent">
								<input name="Company" type="text" maxlength="100" id="Company" size="40" /></td>
						</tr>
						<tr>
							<td class="bodycontent">
								<span id="CompanyContactLabel">Company Main Contact:</span>
								<span id="Label1" class="note"><font size="1"><br />Individual who receives Mosaic notices/renewal and exercises Voting Rights for your company</font></span>
							</td>
							<td class="bodycontent">
								<input name="CompanyContact" type="text" maxlength="70" id="CompanyContact" size="40" /></td>
						</tr>
						<tr>
							<td class="bodycontent">
								<span id="CompanyTypeLabel">Please indicate if your company is an Infor Licensee or Partner:</span></td>
							<td class="bodycontent">
								<table id="CompanyType" class="bodycontent" border="0">
		<tr>
			<td><input id="CompanyType_0" type="radio" name="CompanyType" value="Customer" /><label for="CompanyType_0">Licensee</label></td><td><input id="CompanyType_1" type="radio" name="CompanyType" value="Partner" /><label for="CompanyType_1">Partner</label></td>
		</tr>
	</table></td>
						</tr>
						<tr>
							<td class="bodycontent">
								<span id="UsernameLabel">Your preferred username:</span></td>
							<td class="bodycontent">
								<input name="Username" type="text" maxlength="20" id="Username" size="40" /></td>
						</tr>
						<tr>
							<td class="bodycontent">
								<span id="PasswordLabel">Your preferred password:</span></td>
							<td class="bodycontent">
								<input name="Password" type="text" maxlength="20" id="Password" class="password" /></td>
						</tr>
						<tr>
							<td class="bodycontent">
								<span id="Password2Label">Re-enter your password:</span></td>
							<td class="bodycontent">
								<input name="Password2" type="text" maxlength="20" id="Password2" class="password" /></td>
						</tr>
						<tr>
							<td class="bodycontent">
								<span id="Label18">If you are interested in becoming a Mosaic volunteer, please indicate your areas of interest:</span>
							</td>
							<td class="bodycontent">
								<input id="ProductCommittee" type="checkbox" name="ProductCommittee" /><label for="ProductCommittee">Product Committee</label><br/>
								<input id="ConferenceSpeaker" type="checkbox" name="ConferenceSpeaker" /><label for="ConferenceSpeaker">Conference Speaker</label><br/>
								<input id="VendorAdvisory" type="checkbox" name="VendorAdvisory" /><label for="VendorAdvisory">Vendor Advisory Committee</label><br/>
								<input id="VolunteerOther" type="checkbox" name="VolunteerOther" /><label for="VolunteerOther">Inform me of other volunteer opportunities</label>
							</td>
						</tr>
						<tr>
							<td class="bodycontent" align="middle" colspan="2">
								<input type="image" name="Submit" onclick="if (typeof(Page_ClientValidate) == 'function') Page_ClientValidate(); " language="javascript" id="Submit" src="../images/buttons/but_submit.gif" alt="" border="0" />
								<br />
								<br />
								<span id="fineprintlabel"><font size="1">Submission of this form authorizes consent for the above named individual to receive user group correspondence.</font></span>
							</td>
						</tr>
					
</td></tr></table>
					<tr>
						<td class="bodycontent" colspan="2">
							</td>
					</tr>
				</table>
			</form>
		</xhtml>
	</content>
</page>
