<script type="text/javascript" src="jscripts/ipb_register.js"></script>
<script type="text/javascript">
//<![CDATA[
var coppa_bounce = '{$this->ipsclass->lang['coppa_bounce']}';
coppa_check();
//]]>
</script>
<div class="borderwrap">
	<div class="maintitle"><{CAT_IMG}>&nbsp;{$this->ipsclass->lang['registration_form']}</div>
	<div class="formsubtitle">{$this->ipsclass->lang['coppa_info']}</div>
	<div class="tablepad"  align="center">
		<span class="postcolor">
			<b>{$this->ipsclass->lang['coppa_link']}</b><br /><br /> 
			<form action='{$this->ipsclass->base_url}act=Reg&amp;CODE=coppa_two' method='post'>
			<select name='m'>
			 <option value='0'>{$this->ipsclass->lang['select_month']}</option>
			 <foreach="array(1,2,3,4,5,6,7,8,9,10,11,12) as $month">
			 	<option value='{$month}'>{$this->ipsclass->lang['M_' . $month ]}</option>
			 </foreach>
			</select>
			
			<select name='d'>
			 <option value='0'>{$this->ipsclass->lang['select_day']}</option>
			 <foreach="range(1,31) as $day">
			 	<option value='{$day}'>{$day}</option>
			 </foreach>
			</select>
			
			<select name='y'>
			 <option value='0'>{$this->ipsclass->lang['select_year']}</option>
			 <foreach="array_reverse(range( date('Y') - 130, date('Y') )) as $year">
			 	<option value='{$year}'>{$year}</option>
			 </foreach>
			</select>
			 <input type='submit' value='{$this->ipsclass->lang['coppa_continue_button']}' />
			</form>
		</span>
	</div>
	<div class="formsubtitle">{$this->ipsclass->lang['coppa_form']}</div>
	<div class="tablepad">{$this->ipsclass->lang['coppa_form_text']} <a href="mailto:{$this->ipsclass->vars['email_in']}">{$this->ipsclass->vars['email_in']}</a></div>
</div>