User account | UC Davis Koret Shelter Medicine Program

$form = (

[user_registration_help] => array (

[#value] => []

[#weight] => [-20]

)

[account] => array (

[#type] => [fieldset]

[#title] => [Account information]

[#weight] => [-10]

[name] => array (

[#type] => [textfield]

[#title] => [Username]

[#default_value] => []

[#maxlength] => [60]

[#description] => [Spaces are allowed; punctuation is not allowed except for periods, hyphens, and underscores.]

[#required] => [1]

)

[mail] => array (

[#type] => [textfield]

[#title] => [E-mail address]

[#default_value] => []

[#maxlength] => [64]

[#description] => [A valid e-mail address. All e-mails from the system will be sent to this address. The e-mail address is not made public and will only be used if you wish to receive a new password or wish to receive certain news or notifications by e-mail.]

[#required] => [1]

)

[#uid] => []

[civicrm-profile-register] => array (

[#title] => []

[#value] => [<script type="text/javascript" src="/sites/all/modules/civicrm/packages/jquery/jquery.js"></script> <script type="text/javascript" src="/sites/all/modules/civicrm/packages/jquery/jquery-ui.js"></script> <style type="text/css">@import url("/sites/all/modules/civicrm/packages/jquery/themes/smoothness/jquery-ui.css");</style> <script type="text/javascript" src="/sites/all/modules/civicrm/packages/jquery/plugins/flexigrid.js"></script> <style type="text/css">@import url("/sites/all/modules/civicrm/packages/jquery/css/flexigrid.css");</style> <script type="text/javascript" src="/sites/all/modules/civicrm/packages/jquery/plugins/jquery.autocomplete.js"></script> <style type="text/css">@import url("/sites/all/modules/civicrm/packages/jquery/css/jquery.autocomplete.css");</style> <script type="text/javascript" src="/sites/all/modules/civicrm/packages/jquery/plugins/tree_component.min.js"></script> <script type="text/javascript" src="/sites/all/modules/civicrm/packages/jquery/plugins/css.js"></script> <style type="text/css">@import url("/sites/all/modules/civicrm/packages/jquery/css/tree_component.css");</style> <script type="text/javascript" src="/sites/all/modules/civicrm/packages/jquery/plugins/jquery.menu.pack.js"></script> <script type="text/javascript" src="/sites/all/modules/civicrm/packages/jquery/plugins/jquery.dimensions.js"></script> <style type="text/css">@import url("/sites/all/modules/civicrm/packages/jquery/css/menu.css");</style> <script type="text/javascript" src="/sites/all/modules/civicrm/packages/jquery/plugins/jquery.chainedSelects.js"></script> <script type="text/javascript" src="/sites/all/modules/civicrm/packages/jquery/plugins/jquery.treeview.min.js"></script> <script type="text/javascript" src="/sites/all/modules/civicrm/packages/jquery/plugins/jquery.bgiframe.pack.js"></script> <script type="text/javascript" src="/sites/all/modules/civicrm/packages/jquery/plugins/jquery.contextMenu.js"></script> <script type="text/javascript" src="/sites/all/modules/civicrm/packages/jquery/plugins/jquery.tableHeader.js"></script> <script type="text/javascript" src="/sites/all/modules/civicrm/packages/jquery/plugins/checkboxselect.js"></script> <script type="text/javascript" src="/sites/all/modules/civicrm/packages/tinymce/jscripts/tiny_mce/jquery.tinymce.js"></script> <script type="text/javascript" src="/sites/all/modules/civicrm/packages/tinymce/jscripts/tiny_mce/tiny_mce.js"></script> <script type="text/javascript" src="/sites/all/modules/civicrm/packages/jquery/plugins/jquery.textarearesizer.js"></script> <script type="text/javascript" src="/sites/all/modules/civicrm/packages/jquery/plugins/jquery.progressbar.js"></script> <script type="text/javascript" src="/sites/all/modules/civicrm/packages/jquery/plugins/jquery.form.js"></script> <script type="text/javascript" src="/sites/all/modules/civicrm/packages/jquery/plugins/jquery.tokeninput.js"></script> <style type="text/css">@import url("/sites/all/modules/civicrm/packages/jquery/css/token-input-facebook.css");></style> <script type="text/javascript" src="/sites/all/modules/civicrm/packages/jquery/plugins/jquery.timeentry.pack.js"></script> <script type="text/javascript" src="/sites/all/modules/civicrm/packages/jquery/plugins/jquery.mousewheel.pack.js"></script> <script type="text/javascript" src="/sites/all/modules/civicrm/packages/jquery/plugins/jquery.toolTip.js"></script> <style type="text/css">@import url("/sites/all/modules/civicrm/packages/jquery/css/dataTable.css");></style> <script type="text/javascript" src="/sites/all/modules/civicrm/packages/jquery/plugins/jquery.dataTables.min.js"></script> <script type="text/javascript" src="/sites/all/modules/civicrm/packages/jquery/plugins/jquery.dashboard.js"></script> <style type="text/css">@import url(/sites/all/modules/civicrm/packages/jquery/css/dashboard.css);></style> <script type="text/javascript" src="/sites/all/modules/civicrm/packages/jquery/plugins/jquery.FormNavigate.js"></script> <script type="text/javascript">var cj = jQuery.noConflict(); $ = cj;</script><script type="text/javascript" src="/sites/all/modules/civicrm/js/Common.js"></script> <div id="crm-container" lang="en" xml:lang="en"> <script language="JavaScript" type="text/javascript"> cj(function() { countryID = "#country-1" stateProvinceID = "#state_province-1" callbackURL = "/civicrm/ajax/jqState" cj(countryID).chainSelect(stateProvinceID, callbackURL, null ); }); </script> <div><input name="_qf_default" type="hidden" value="Dynamic:upload" /> <input name="MAX_FILE_SIZE" type="hidden" value="67108864" /> <input name="edit[civicrm_dummy_field]" type="hidden" value="CiviCRM Dummy Field for Drupal" /> </div> <div id="profilewrap9"><fieldset><legend>Contact & Organization Info</legend><table class="form-layout-compressed"><tr id="editrow-first_name"><td class="label"><label for="first_name"> First Name <span class="marker" title="This field is required.">*</span> </label></td><td class="edit-value"><input maxlength="64" size="30" name="first_name" type="text" id="first_name" class="form-text big required" /></td></tr><tr id="editrow-last_name"><td class="label"><label for="last_name"> Last Name <span class="marker" title="This field is required.">*</span> </label></td><td class="edit-value"><input maxlength="64" size="30" name="last_name" type="text" id="last_name" class="form-text big required" /></td></tr><tr id="editrow-country-1"><td class="label"><label for="country-1"> Country (Home) <span class="marker" title="This field is required.">*</span> </label></td><td class="edit-value"><select name="country-1" id="country-1" class="form-select required"> <option value="">- select -</option> <option value="1228" selected="selected">United States</option> <option value="1001">Afghanistan</option> <option value="1241">Åland Islands</option> <option value="1002">Albania</option> <option value="1003">Algeria</option> <option value="1004">American Samoa</option> <option value="1005">Andorra</option> <option value="1006">Angola</option> <option value="1007">Anguilla</option> <option value="1008">Antarctica</option> <option value="1009">Antigua and Barbuda</option> <option value="1010">Argentina</option> <option value="1011">Armenia</option> <option value="1012">Aruba</option> <option value="1013">Australia</option> <option value="1014">Austria</option> <option value="1015">Azerbaijan</option> <option value="1212">Bahamas</option> <option value="1016">Bahrain</option> <option value="1017">Bangladesh</option> <option value="1018">Barbados</option> <option value="1019">Belarus</option> <option value="1020">Belgium</option> <option value="1021">Belize</option> <option value="1022">Benin</option> <option value="1023">Bermuda</option> <option value="1024">Bhutan</option> <option value="1025">Bolivia</option> <option value="1026">Bosnia and Herzegovina</option> <option value="1027">Botswana</option> <option value="1028">Bouvet Island</option> <option value="1029">Brazil</option> <option value="1030">British Indian Ocean Territory</option> <option value="1032">Brunei Darussalam</option> <option value="1033">Bulgaria</option> <option value="1034">Burkina Faso</option> <option value="1036">Burundi</option> <option value="1037">Cambodia</option> <option value="1038">Cameroon</option> <option value="1039">Canada</option> <option value="1040">Cape Verde</option> <option value="1041">Cayman Islands</option> <option value="1042">Central African Republic</option> <option value="1043">Chad</option> <option value="1044">Chile</option> <option value="1045">China</option> <option value="1046">Christmas Island</option> <option value="1047">Cocos (Keeling) Islands</option> <option value="1048">Colombia</option> <option value="1049">Comoros</option> <option value="1051">Congo</option> <option value="1050">Congo, The Democratic Republic of the</option> <option value="1052">Cook Islands</option> <option value="1053">Costa Rica</option> <option value="1054">Côte d'Ivoire</option> <option value="1055">Croatia</option> <option value="1056">Cuba</option> <option value="1057">Cyprus</option> <option value="1058">Czech Republic</option> <option value="1059">Denmark</option> <option value="1060">Djibouti</option> <option value="1061">Dominica</option> <option value="1062">Dominican Republic</option> <option value="1064">Ecuador</option> <option value="1065">Egypt</option> <option value="1066">El Salvador</option> <option value="1067">Equatorial Guinea</option> <option value="1068">Eritrea</option> <option value="1069">Estonia</option> <option value="1070">Ethiopia</option> <option value="1072">Falkland Islands (Malvinas)</option> <option value="1073">Faroe Islands</option> <option value="1074">Fiji</option> <option value="1075">Finland</option> <option value="1076">France</option> <option value="1077">French Guiana</option> <option value="1078">French Polynesia</option> <option value="1079">French Southern Territories</option> <option value="1080">Gabon</option> <option value="1213">Gambia</option> <option value="1081">Georgia</option> <option value="1082">Germany</option> <option value="1083">Ghana</option> <option value="1084">Gibraltar</option> <option value="1085">Greece</option> <option value="1086">Greenland</option> <option value="1087">Grenada</option> <option value="1088">Guadeloupe</option> <option value="1089">Guam</option> <option value="1090">Guatemala</option> <option value="1245">Guernsey</option> <option value="1091">Guinea</option> <option value="1092">Guinea-Bissau</option> <option value="1093">Guyana</option> <option value="1094">Haiti</option> <option value="1095">Heard Island and McDonald Islands</option> <option value="1096">Holy See (Vatican City State)</option> <option value="1097">Honduras</option> <option value="1098">Hong Kong</option> <option value="1099">Hungary</option> <option value="1100">Iceland</option> <option value="1101">India</option> <option value="1102">Indonesia</option> <option value="1103">Iran, Islamic Republic of</option> <option value="1104">Iraq</option> <option value="1105">Ireland</option> <option value="1246">Isle of Man</option> <option value="1106">Israel</option> <option value="1107">Italy</option> <option value="1108">Jamaica</option> <option value="1109">Japan</option> <option value="1244">Jersey</option> <option value="1110">Jordan</option> <option value="1111">Kazakhstan</option> <option value="1112">Kenya</option> <option value="1113">Kiribati</option> <option value="1114">Korea, Democratic People's Republic of</option> <option value="1115">Korea, Republic of</option> <option value="1116">Kuwait</option> <option value="1117">Kyrgyzstan</option> <option value="1118">Lao People's Democratic Republic</option> <option value="1119">Latvia</option> <option value="1120">Lebanon</option> <option value="1121">Lesotho</option> <option value="1122">Liberia</option> <option value="1123">Libyan Arab Jamahiriya</option> <option value="1124">Liechtenstein</option> <option value="1125">Lithuania</option> <option value="1126">Luxembourg</option> <option value="1127">Macao</option> <option value="1128">Macedonia, Republic of</option> <option value="1129">Madagascar</option> <option value="1130">Malawi</option> <option value="1131">Malaysia</option> <option value="1132">Maldives</option> <option value="1133">Mali</option> <option value="1134">Malta</option> <option value="1135">Marshall Islands</option> <option value="1136">Martinique</option> <option value="1137">Mauritania</option> <option value="1138">Mauritius</option> <option value="1139">Mayotte</option> <option value="1140">Mexico</option> <option value="1141">Micronesia, Federated States of</option> <option value="1142">Moldova</option> <option value="1143">Monaco</option> <option value="1144">Mongolia</option> <option value="1243">Montenegro</option> <option value="1145">Montserrat</option> <option value="1146">Morocco</option> <option value="1147">Mozambique</option> <option value="1035">Myanmar</option> <option value="1148">Namibia</option> <option value="1149">Nauru</option> <option value="1150">Nepal</option> <option value="1152">Netherlands</option> <option value="1151">Netherlands Antilles</option> <option value="1153">New Caledonia</option> <option value="1154">New Zealand</option> <option value="1155">Nicaragua</option> <option value="1156">Niger</option> <option value="1157">Nigeria</option> <option value="1158">Niue</option> <option value="1159">Norfolk Island</option> <option value="1160">Northern Mariana Islands</option> <option value="1161">Norway</option> <option value="1162">Oman</option> <option value="1163">Pakistan</option> <option value="1164">Palau</option> <option value="1165">Palestinian Territory, Occupied</option> <option value="1166">Panama</option> <option value="1167">Papua New Guinea</option> <option value="1168">Paraguay</option> <option value="1169">Peru</option> <option value="1170">Philippines</option> <option value="1171">Pitcairn</option> <option value="1172">Poland</option> <option value="1173">Portugal</option> <option value="1174">Puerto Rico</option> <option value="1175">Qatar</option> <option value="1179">Reunion</option> <option value="1176">Romania</option> <option value="1177">Russian Federation</option> <option value="1178">Rwanda</option> <option value="1180">Saint Helena</option> <option value="1181">Saint Kitts and Nevis</option> <option value="1182">Saint Lucia</option> <option value="1183">Saint Pierre and Miquelon</option> <option value="1184">Saint Vincent and the Grenadines</option> <option value="1185">Samoa</option> <option value="1186">San Marino</option> <option value="1207">Sao Tome and Principe</option> <option value="1187">Saudi Arabia</option> <option value="1188">Senegal</option> <option value="1242">Serbia</option> <option value="1238">Serbia and Montenegro</option> <option value="1189">Seychelles</option> <option value="1190">Sierra Leone</option> <option value="1191">Singapore</option> <option value="1192">Slovakia</option> <option value="1193">Slovenia</option> <option value="1194">Solomon Islands</option> <option value="1195">Somalia</option> <option value="1196">South Africa</option> <option value="1197">South Georgia and the South Sandwich Islands</option> <option value="1198">Spain</option> <option value="1199">Sri Lanka</option> <option value="1200">Sudan</option> <option value="1201">Suriname</option> <option value="1202">Svalbard and Jan Mayen</option> <option value="1203">Swaziland</option> <option value="1204">Sweden</option> <option value="1205">Switzerland</option> <option value="1206">Syrian Arab Republic</option> <option value="1208">Taiwan</option> <option value="1209">Tajikistan</option> <option value="1210">Tanzania, United Republic of</option> <option value="1211">Thailand</option> <option value="1063">Timor-Leste</option> <option value="1214">Togo</option> <option value="1215">Tokelau</option> <option value="1216">Tonga</option> <option value="1217">Trinidad and Tobago</option> <option value="1218">Tunisia</option> <option value="1219">Turkey</option> <option value="1220">Turkmenistan</option> <option value="1221">Turks and Caicos Islands</option> <option value="1222">Tuvalu</option> <option value="1223">Uganda</option> <option value="1224">Ukraine</option> <option value="1225">United Arab Emirates</option> <option value="1226">United Kingdom</option> <option value="1227">United States Minor Outlying Islands</option> <option value="1229">Uruguay</option> <option value="1230">Uzbekistan</option> <option value="1231">Vanuatu</option> <option value="1232">Venezuela</option> <option value="1233">Viet Nam</option> <option value="1031">Virgin Islands, British</option> <option value="1234">Virgin Islands, U.S.</option> <option value="1235">Wallis and Futuna</option> <option value="1236">Western Sahara</option> <option value="1237">Yemen</option> <option value="1239">Zambia</option> <option value="1240">Zimbabwe</option> </select></td></tr><tr id="editrow-state_province-1"><td class="label"><label for="state_province-1">State (Home)</label></td><td class="edit-value"><select name="state_province-1" id="state_province-1" class="form-select"> <option value="">- select -</option> <option value="1000">Alabama</option> <option value="1001">Alaska</option> <option value="1052">American Samoa</option> <option value="1002">Arizona</option> <option value="1003">Arkansas</option> <option value="1060">Armed Forces Americas</option> <option value="1059">Armed Forces Europe</option> <option value="1061">Armed Forces Pacific</option> <option value="1004">California</option> <option value="1005">Colorado</option> <option value="1006">Connecticut</option> <option value="1007">Delaware</option> <option value="1050">District of Columbia</option> <option value="1008">Florida</option> <option value="1009">Georgia</option> <option value="1053">Guam</option> <option value="1010">Hawaii</option> <option value="1011">Idaho</option> <option value="1012">Illinois</option> <option value="1013">Indiana</option> <option value="1014">Iowa</option> <option value="1015">Kansas</option> <option value="1016">Kentucky</option> <option value="1017">Louisiana</option> <option value="1018">Maine</option> <option value="1019">Maryland</option> <option value="1020">Massachusetts</option> <option value="1021">Michigan</option> <option value="1022">Minnesota</option> <option value="1023">Mississippi</option> <option value="1024">Missouri</option> <option value="1025">Montana</option> <option value="1026">Nebraska</option> <option value="1027">Nevada</option> <option value="1028">New Hampshire</option> <option value="1029">New Jersey</option> <option value="1030">New Mexico</option> <option value="1031">New York</option> <option value="1032">North Carolina</option> <option value="1033">North Dakota</option> <option value="1055">Northern Mariana Islands</option> <option value="1034">Ohio</option> <option value="1035">Oklahoma</option> <option value="1036">Oregon</option> <option value="1037">Pennsylvania</option> <option value="1056">Puerto Rico</option> <option value="1038">Rhode Island</option> <option value="1039">South Carolina</option> <option value="1040">South Dakota</option> <option value="1041">Tennessee</option> <option value="1042">Texas</option> <option value="1058">United States Minor Outlying Islands</option> <option value="1043">Utah</option> <option value="1044">Vermont</option> <option value="1057">Virgin Islands</option> <option value="1045">Virginia</option> <option value="1046">Washington</option> <option value="1047">West Virginia</option> <option value="1048">Wisconsin</option> <option value="1049">Wyoming</option> </select></td></tr><tr id="editrow-custom_7"><td class="label"><label for="custom_7">Organization Type</label></td><td class="edit-value"><select name="custom_7" id="custom_7" class="form-select"> <option value="">- select -</option> <option value="Rescue organization">Rescue organization</option> <option value="Shelter">Shelter</option> <option value="University">University</option> <option value="Veterinary hospital">Veterinary hospital</option> <option value="Other">Other</option> </select></td></tr><tr id="helprow-custom_7"><td> </td><td class="description">What type of organization do you work with?</td></tr><tr id="editrow-custom_8"><td class="label"><label for="custom_8">Organization (Other)</label></td><td class="edit-value"><input name="custom_8" type="text" id="custom_8" class="form-text" /></td></tr><tr id="helprow-custom_8"><td> </td><td class="description">If you selected "Other", please specify your Organization Type here.</td></tr><tr id="editrow-custom_9"><td class="label"><label for="custom_9">Postion</label></td><td class="edit-value"><select name="custom_9" id="custom_9" class="form-select"> <option value="">- select -</option> <option value="Shelter Director">Shelter Director</option> <option value="Shelter Staff">Shelter Staff</option> <option value="Veterinarian">Veterinarian</option> <option value="Veterinary Student">Veterinary Student</option> <option value="Veterinary Technician">Veterinary Technician</option> <option value="Volunteer">Volunteer</option> <option value="Other">Other</option> </select></td></tr><tr id="helprow-custom_9"><td> </td><td class="description">What is your position?</td></tr><tr id="editrow-custom_10"><td class="label"><label for="custom_10">Position (Other)</label></td><td class="edit-value"><input name="custom_10" type="text" id="custom_10" class="form-text" /></td></tr><tr id="helprow-custom_10"><td> </td><td class="description">If you selected "Other", please specify your position here.</td></tr><tr id="editrow-custom_11"><td class="label"><label for="custom_11">Number of Animals</label></td><td class="edit-value"><input name="custom_11" type="text" id="custom_11" class="form-text" /></td></tr><tr id="helprow-custom_11"><td> </td><td class="description">Please enter the number of animals your organization cares for in one year.</td></tr><tr id="editrow-is_opt_out"><td class="label"><label for="is_opt_out">Newsletter Opt Out</label></td><td class="edit-value"><input id="is_opt_out" name="is_opt_out" type="checkbox" value="1" class="form-checkbox" /></td></tr><tr id="helprow-is_opt_out"><td> </td><td class="description">Check this box if you do not want to receive email newsletters.</td></tr></table></fieldset></div> </div> <script type="text/javascript"> </script> <script type="text/javascript"> cj(document).ready(function(){ cj('#selector tr:even').addClass('odd-row '); cj('#selector tr:odd ').addClass('even-row'); }); </script><script type="text/javascript">jQuery.noConflict(true);</script>]

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[submit] => array (

[#type] => [submit]

[#value] => [Create new account]

[#weight] => [30]

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[#validate] => array (

[0] => [user_register_validate]

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[#parameters] => array (

[0] => [user_register]

[1] => array (

[storage] => []

[submitted] => []

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[#type] => [hidden]

[#value] => [user_register]

[#id] => [edit-user-register]

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[#id] => [user-register]

[#description] => []

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[#tree] => []

[#parents] => array (

)

[#method] => [post]

[#action] => [/user/register]

[#submit] => array (

[0] => [user_register_submit]

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[#after_build] => array (

[0] => [wysiwyg_tinymce_plainlinks_process_form]

[1] => [wysiwyg_process_form]

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[captcha] => array (

[#type] => [captcha]

[#captcha_type] => [image_captcha/Image]

[#description] => [This question is for testing whether you are a human visitor and to prevent automated spam submissions.]

[#weight] => [29.9]

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);

UC Davis Koret Shelter Medicine Program

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UC Davis Koret Shelter Medicine Program

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