<br /><br /><STRONG>*IMPORTANT - This information is necessary to personalize your package</STRONG><br /><br><br /><div id="productInformation"><br /><%%KEEPWHITESPACE%%> <div id="productInformation"><br /><%%KEEPWHITESPACE%%> <table class="accountTable tabular grid"><br /><%%KEEPWHITESPACE%%> <tbody><tr><br /><%%KEEPWHITESPACE%%> <th colspan="2" class="leftAlign">Your Personal Membership Information</th><br /><%%KEEPWHITESPACE%%> </tr><br /><%%KEEPWHITESPACE%%> <tr><br /><%%KEEPWHITESPACE%%> <td class="rightAlignTop"><label class="checkoutLabel">* Birthdate </label></td><br /><%%KEEPWHITESPACE%%> <td>&nbsp;<input class="regula-validation checkoutTop" id="Contact0Birthday" name="Contact0Birthday" size="10" placeholder="" type="date"><br /><%%KEEPWHITESPACE%%> </td><br /><br /><%%KEEPWHITESPACE%%> </tr><br /><%%KEEPWHITESPACE%%> <tr><br /><%%KEEPWHITESPACE%%> <td class="rightAlign"><br /><%%KEEPWHITESPACE%%> <label class="checkoutLabel"><br /><br /><%%KEEPWHITESPACE%%> * Create Password<br /><br /><%%KEEPWHITESPACE%%> </label><br /><%%KEEPWHITESPACE%%> </td><br /><%%KEEPWHITESPACE%%> <td>&nbsp;<input class="regula-validation checkout" id="Contact0Password" name="Contact0Password" size="16" type="password"><br /><br /><%%KEEPWHITESPACE%%> </td><br /><%%KEEPWHITESPACE%%> </tr><br /><%%KEEPWHITESPACE%%> <tr><br /><%%KEEPWHITESPACE%%> <td>&nbsp;</td><br /><%%KEEPWHITESPACE%%> </tr><br /><br /><%%KEEPWHITESPACE%%> </tbody></table><br /></div><br /></div><br /><br />