{{ DIALOG_DISPLAY }}

{{ FORM_TITLE }}

{{ CSRF_FORM }}

{{ Login information }}

{{ Account status }} {{ select_status }}
{{ Account status }} {{ STATUS }} {{ HINT_STATUS }}
{{ Parent account }} {{ select_parents }} {{ HINT_PARENT }}
{{ Username }} {{ c_username }}
{{ Password }}
{{ Re-type password }}
{{ Name }}
{{ Email }}
{{ Mobile }}

{{ Personal information }}

{{ Address }}
{{ City }}
{{ State or Province }}
{{ Country }}
{{ Zipcode }}

{{ BUTTON_DELETE }}

{{ BUTTON_BACK }}