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| <form action="email" id="TfacsSubmission" email no_submit_on_return mwreturn="Flex-Form Thank You!">
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| <_email template="SubmissionEmailTemplate"></_email>
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| <_create mwwrite="Admin:{{CURRENTTIMESTAMP}} [firstname] [lastname]" mwtemplate="Submission" />
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| {| class="smwtable-clean th-top-right border"
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| |-
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| ! <label for="firstname">Name {{r|*}}</label>
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| | <input style="width: 50%;" type="text" name="firstname" placeholder="first name" required="required" />
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| <input style="width: 50%;" type="text" name="lastname" placeholder="last name" required="required" />
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| ! <label for="birthdate">Date of birth {{r|*}}</label>
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| | <input type="date" name="birthdate" value="{{CURRENTYEAR}}-{{CURRENTMONTH}}-{{CURRENTDAY}}" min="1900-01-01" max="2999-12-31" required="required" />
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| ! <label for="birthcountry">Country of birth {{r|*}}</label>
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| | <select name="birthcountry" selected="" placeholder="select" options="{{ListOfCountries}}" />
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| ! <label for="street">Address {{r|*}}</label>
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| | <input style="width: 100%;" type="text" name="street" placeholder="street address" required="required" /><br>
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| <input style="width: 100%;" type="text" name="street2" placeholder="address line 2" /><br>
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| <input style="width: 50%;" type="text" name="city" placeholder="city" required="required" /><input style="width: 50%;" type="text" name="stateprov" placeholder="state / province" /><br>
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| <input style="width: 50%;" type="text" name="postalcode" placeholder="zip/postal code" required="required" /><select style="width: 50%;" name="country" selected="" options="{{ListOfCountries}}" required="required" />
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| ! <label for="email">Contact {{r|*}}</label>
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| | <input style="width: 100%;" type="email" name="email" placeholder="email" required="required" />
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| <input style="width: 100%;" type="tel" id="phone" name="telephone" placeholder="phone number" required="required" /><br>
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| Include [https://en.wikipedia.org/wiki/List_of_country_calling_codes#Ordered_by_code an international code] if applicable.
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| |}
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| <input type="submit" value="submit" />
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| </form>{{#widget:FlexForm.css}}
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| Account creation can be done automatically upon submit with API js gadget, by using first and last name fields for username, password can be randomized, email can be pulled from form also.
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