%@ Page Language="vb" AutoEventWireup="false" MasterPageFile="~/mp1.Master" Codebehind="signup.aspx.vb" Inherits="HSI_WEBSITE.signup" Title="HSI - Subscribe" %> <%@ Register Assembly="RadCalendar.Net2" Namespace="Telerik.WebControls" TagPrefix="radCln" %> <%@ Register Assembly="RadInput.Net2" Namespace="Telerik.WebControls" TagPrefix="radI" %> <%@ Register Assembly="RadAjax.Net2" Namespace="Telerik.WebControls" TagPrefix="radA" %> <%@ Register TagPrefix="recaptcha" Namespace="Recaptcha" Assembly="Recaptcha" %> HSI HEALTHCARE SAFETY INTERNATIONAL HSI PORTAL Intelligent Service Process Automation and Integration SignIn Here to Complete Pending Transaction User Name: * Password: * Forget User Name/Password Forget User Name / Password Email: * HSI PORTAL NEW SUBSCRIPTION Company Name: * Company Initials: * Last Name: * First Name: * User Name: * Password: * Re-type Password: * Email: * Phone No: * Fax No: * Country: * State: * City: * Zip Code: * Address 1: * Address 2: * Time zone: * Payments Select Subscription <%If rdoModule.Items.Count > 1 Then%> Number of PeopleReceiving Services <%If Val(hdPatientRate.Value) > 0 Then%> * <%Else%> Not applicable <%End If%> () () <%End If%> Subscription Period: From: To: Basic Storage Space: Extra Storage Space: 0 1 2 3 4 5 6 7 8 9 10 DISCOUNT COUPON: Total Amount: Master Services Agreement " method="post">