<html style="margin:0;padding:0;height:100%"><head><meta content="text/html; charset=UTF-8" http-equiv="Content-Type" /><style type="text/css"> .beta-base .preheader, .beta-base .header, .beta-base .sidebar, .beta-base .body, .beta-base .footer, #mainContent { text-align: left; } .beta-base .preheader, .beta-base .header, .beta-base .body, .beta-base .sidebar, .beta-base .leftSidebar, .beta-base .rightSidebar, .beta-base .footer { margin: 0; padding: 0; border: none; white-space: normal; line-height: normal; } .beta-base .title, .beta-base .subtitle, .beta-base .text, .beta-base img { margin: 0; padding: 0; background: none; border: none; white-space: normal; line-height: normal; } .beta-base .bodyContainer td.preheader{ padding: 10px 0; } .beta-base .bodyContainer td.header { padding: 0; height: 30px; } .beta-base .bodyContainer td.body, .beta-base .bodyContainer td.footer, .beta-base .bodyContainer td.sidebar, .beta-base .bodyContainer td.leftSidebar, .beta-base .bodyContainer td.rightSidebar { padding: 20px; } .beta-base .bodyContainer td.header p, .beta-base .bodyContainer td.preheader p, .beta-base .bodyContainer td.body p, .beta-base .bodyContainer td.footer p, .beta-base .bodyContainer td.sidebar p, .beta-base .bodyContainer td.leftSidebar p, .beta-base .bodyContainer td.rightSidebar p { margin: 0; color: inherit; } .beta-base .bodyContainer td.header div.title, .beta-base .bodyContainer td.preheader div.title, .beta-base .bodyContainer td.body div.title, .beta-base .bodyContainer td.footer div.title, .beta-base .bodyContainer td.sidebar div.title, .beta-base .bodyContainer td.leftSidebar div.title, .beta-base .bodyContainer td.rightSidebar div.title, .beta-base .bodyContainer td.header div.subtitle, .beta-base .bodyContainer td.preheader div.subtitle, .beta-base .bodyContainer td.body div.subtitle, .beta-base .bodyContainer td.footer div.subtitle, .beta-base .bodyContainer td.sidebar div.subtitle, .beta-base .bodyContainer td.leftSidebar div.subtitle, .beta-base .bodyContainer td.rightSidebar div.subtitle, .beta-base .bodyContainer td.header div.text, .beta-base .bodyContainer td.preheader div.text, .beta-base .bodyContainer td.body div.text, .beta-base .bodyContainer td.body div.text div, .beta-base .bodyContainer td.footer div.text, .beta-base .bodyContainer td.sidebar div.text, .beta-base .bodyContainer td.leftSidebar div.text, .beta-base .bodyContainer td.rightSidebar div.text { overflow: auto; } .beta-base .optout { margin-bottom: 10px; margin-top: 10px; } div.infusion-captcha { width: 220px; padding: 10px; } div.infusion-captcha input, div.infusion-captcha select, div.infusion-captcha textarea { width: 95%; display: inline-block; vertical-align: middle; } table.infusion-field-container td.infusion-field-input-container input[type='text'], table.infusion-field-container td.infusion-field-input-container input[type='password'], table.infusion-field-container td.infusion-field-input-container textarea { width: 98%; /* must be 98% to make the snippet-menu line up due to border width */ margin: 0; } table.infusion-field-container td.infusion-field-input-container select { width: 101%; *width: 102%; /* this one for IE */ margin: 0; } table.infusion-field-container td.infusion-field-label-container { padding-right: 5px; } td.header .image-snippet img { vertical-align: bottom; } #webformErrors { color: #990000; font-size: 14px; } html, body { margin: 0; padding: 0; height: 100%; } .infusion-form { margin: 0; height: 100%; } .infusion-option { display: block; text-align: left; } </style><style type="text/css"> .beta-font-b h1, .beta-font-b h2, .beta-font-b h3, .beta-font-b h4, .beta-font-b h5, .beta-font-b h6 { font-family: arial,sans-serif; } .beta-font-b h1 {font-size: 24px;} .beta-font-b h2 {font-size: 20px;} .beta-font-b h3 {font-size: 14px;} .beta-font-b h4 {font-size: 12px;} .beta-font-b h5 {font-size: 10px;} .beta-font-b h6 {font-size: 8px;} .beta-font-b address {font-style: italic;} .beta-font-b pre {font-family: Courier New, monospace;} .beta-font-b .title, .beta-font-b .title p { font-size: 20px; font-weight: bold; font-family: arial,sans-serif; } .beta-font-b .subtitle, .beta-font-b .subtitle p { font-size: 11px; font-weight: normal; font-family: arial,sans-serif; } .beta-font-b .text, .beta-font-b p { font-size: 12px; font-family: arial,sans-serif; } .beta-font-b .preheader .text, .beta-font-b .preheader .text p { font-size: 11px; font-family: arial,sans-serif; } .beta-font-b .footer a { font-size: 11px; font-family: arial,sans-serif; } .beta-font-b .footer .text { font-size: 10px; font-family: verdana,sans-serif; } .beta-font-b .sidebar .title, .beta-font-b .leftSidebar .title, .beta-font-b .rightSidebar .title { font-size: 15px; font-weight: bold; font-family: arial,sans-serif; } .beta-font-b .sidebar .subtitle, .beta-font-b .leftSidebar .subtitle, .beta-font-b .rightSidebar .subtitle { font-size: 12px; font-family: arial, sans-serif; } .beta-font-b .sidebar .text, .beta-font-b .sidebar .text p, .beta-font-b .leftSidebar .text, .beta-font-b .rightSidebar .text { font-size: 11px; font-family: arial, sans-serif; } .infusion-field-label-container { font-size: 14px; font-family: arial,sans-serif; } .infusion-field-input-container { color: #000000; font-size: 12px; } .infusion-option label { color: #000000; font-size: 14px; font-family: arial,sans-serif; } </style><style type="text/css"> .custom-30 .background{ background-color:#ffffff; ; } .custom-30 .title{ color:#1a242e; ; } .custom-30 .subtitle{ color:#ffffff; ; } .custom-30 .text{ color:#000000; ; } .custom-30 a{ color:#ffffff; ; } .custom-30 .background .preheader .text{ color:#FFFFFF; ; } .custom-30 .background .preheader a{ color:#157DB8; ; } .custom-30 .header{ background-color:#ffffff; ; } .custom-30 .header .title{ color:#000000; ; } .custom-30 .header .subtitle{ color:#000000; ; } .custom-30 .header .text{ color:#000000; ; } .custom-30 .header .a{ color:#157DB8; ; } .custom-30 .hero{ background-color:#025C8D; ; } .custom-30 .hero .title{ color:#FFFFFF; ; } .custom-30 .hero .subtitle{ color:#FFFFFF; ; } .custom-30 .hero .text{ color:#FFFFFF; ; } .custom-30 .hero .a{ color:#157DB8; ; } .custom-30 .quote{ background-color:#013B5A; ; } .custom-30 .quote:after{ border-color:#013B5A transparent transparent transparent; ; } .custom-30 .quote .title{ color:#FFFFFF; ; } .custom-30 .quote .subtitle{ color:#FFFFFF; ; } .custom-30 .quote .text{ color:#FFFFFF; ; } .custom-30 .quote .a{ color:#157DB8; ; } .custom-30 .body{ background-color:#fffeff; ; } .custom-30 .main .title{ color:#000000; ; } .custom-30 .main .subtitle{ color:#000000; ; } .custom-30 .main .text{ color:#000000; ; } .custom-30 .main .a{ color:#157DB8; ; } .custom-30 .sidebar{ background-color:#ffffff; ; } .custom-30 .sidebar .title{ color:#000000; ; } .custom-30 .sidebar .subtitle{ color:#000000; ; } .custom-30 .sidebar .text{ color:#000000; ; } .custom-30 .sidebar .a{ color:#157DB8; ; } .custom-30 .leftSidebar{ background-color:#ffffff; ; } .custom-30 .leftSidebar .title{ color:#000000; ; } .custom-30 .leftSidebar .subtitle{ color:#000000; ; } .custom-30 .rightSidebar{ background-color:#ffffff; ; } .custom-30 .rightSidebar .title{ color:#000000; ; } .custom-30 .rightSidebar .subtitle{ color:#000000; ; } .custom-30 .footer{ background-color:#6cbad0; ; } .custom-30 .footer .text{ color:#000000; ; } .custom-30 .footer .title{ color:#000000; ; } .custom-30 .footer a{ color:#ffffff; ; } .custom-30 .footer .subtitle{ color:#000000; ; } .custom-30 .infusion-field-label-container{ font-size:14px; ; } .custom-30 .infusion-field-label-container{ font-family:Arial; ; } .custom-30 .infusion-field-label-container{ color:#000000; ; } .custom-30 .infusion-field-input{ font-size:14px; ; } .custom-30 .infusion-option label{ font-size:14px; ; } .custom-30 .infusion-option label{ font-family:Arial; ; } .custom-30 .infusion-option label{ color:#000000; ; } .custom-30 .webFormBodyContainer{ border-width:7px; ; } .custom-30 .webFormBodyContainer{ border-style:Solid; ; } .custom-30 .webFormBodyContainer{ border-color:#69bbd3; ; } </style><style type="text/css"> .leftSidebar { width:300px; } .infusion-field-label-container { text-align:Left; } .infusion-field-input-container { width:200px; } .bodyContainer { width:939px; } .rightSidebar { width:100px; } .infusion-field-label-container { vertical-align:Top; } .infusion-field-input-container { width:300px; } </style><script src=";b=" type="text/javascript"> </script></head><body leftmargin="0" marginheight="0" marginwidth="0" offset="0" style="margin-bottom: 0px; margin-top: 0px"> <div class="text" id="webformErrors" name="errorContent"></div> <form accept-charset="UTF-8" action="" class="infusion-form" method="POST" name="USA Create Account Standard Medical Alert System" onsubmit="var form = document.forms[0]; var resolution = document.createElement('input'); resolution.setAttribute('id', 'screenResolution'); resolution.setAttribute('type', 'hidden'); resolution.setAttribute('name', 'screenResolution'); var resolutionString = screen.width + 'x' + screen.height; resolution.setAttribute('value', resolutionString); form.appendChild(resolution); var pluginString = ''; if (window.ActiveXObject) { var activeXNames = {'AcroPDF.PDF':'Adobe Reader', 'ShockwaveFlash.ShockwaveFlash':'Flash', 'QuickTime.QuickTime':'Quick Time', 'SWCtl':'Shockwave', 'WMPLayer.OCX':'Windows Media Player', 'AgControl.AgControl':'Silverlight'}; var plugin = null; for (var activeKey in activeXNames) { try { plugin = null; plugin = new ActiveXObject(activeKey); } catch (e) { // do nothing, the plugin is not installed } pluginString += activeXNames[activeKey] + ','; } var realPlayerNames = ['rmockx.RealPlayer G2 Control', 'rmocx.RealPlayer G2 Control.1', 'RealPlayer.RealPlayer(tm) ActiveX Control (32-bit)', 'RealVideo.RealVideo(tm) ActiveX Control (32-bit)', 'RealPlayer']; for (var index = 0; index &lt; realPlayerNames.length; index++) { try { plugin = new ActiveXObject(realPlayerNames[index]); } catch (e) { continue; } if (plugin) { break; } } if (plugin) { pluginString += 'RealPlayer,'; } } else { for (var i = 0; i &lt; navigator.plugins.length; i++) { pluginString += navigator.plugins[i].name + ','; } } pluginString = pluginString.substring(0, pluginString.lastIndexOf(',')); var plugins = document.createElement('input'); plugins.setAttribute('id', 'pluginList'); plugins.setAttribute('type', 'hidden'); plugins.setAttribute('name', 'pluginList'); plugins.setAttribute('value', pluginString); form.appendChild(plugins); var java = navigator.javaEnabled(); var javaEnabled = document.createElement('input'); javaEnabled.setAttribute('id', 'javaEnabled'); javaEnabled.setAttribute('type', 'hidden'); javaEnabled.setAttribute('name', 'javaEnabled'); javaEnabled.setAttribute('value', java); form.appendChild(javaEnabled);"><input name="inf_form_xid" type="hidden" value="2a58fba76d4d4e210d7f879da4a8d3a8" /><input name="inf_form_name" type="hidden" value="USA Create Account Standard Medical Alert System" /><input name="infusionsoft_version" type="hidden" value="" /> <div class="custom-30 beta-base beta-font-b" id="mainContent" style="height:100%"> <table cellpadding="10" cellspacing="0" class="background" style="width: 100%; height: 100%"> <tbody> <tr> <td align="center" valign="top"> <table cellpadding="0" cellspacing="0" class="bodyContainer"> <tbody> <tr> <td class="header" colspan="2" sectionid="header"> <div> <div class="authoring-image image-snippet" contentid="header_img"> <div class="authoring-image image-snippet" contentid="header_img"> <div class="imageSnippet-alignDiv" style="text-align: center;"><img align="bottom" alt="Company Logo" border="0" class="simage" height="148" src="" style="margin-left: 0px; margin-right: 0px;" title="Company Logo" width="899" /></div> </div> </div> </div> </td> </tr> </tbody> </table> <table bgcolor="#FFFFFF" cellpadding="20" cellspacing="0" class="bodyContainer"> <tbody> <tr> <td class="leftSidebar" sectionid="leftSidebar" valign="top"> <div> <div> <div class="title" style="text-align:left"> <div class="title" contentid="title" style="text-align: left;"> <div> <h2><span style="color: #2493ae;">Fill in the fields below to create your account.</span></h2> </div> </div> </div> </div> </div> <div> <div style="height:40px; line-height:40px;"> </div> </div> <div> <table class="infusion-field-container" style="width:200;"> <tbody> <tr> <td class="infusion-field-label-container" style="width:300px;"><label for="inf_field_FirstName">Your First Name *</label></td> </tr> <tr> <td class="infusion-field-input-container" style="width:200px;"><input class="infusion-field-input-container" id="inf_field_FirstName" name="inf_field_FirstName" type="text" /></td> </tr> <tr> <td class="infusion-field-label-container" style="width:300px;"><label for="inf_field_LastName">Your Last Name *</label></td> </tr> <tr> <td class="infusion-field-input-container" style="width:200px;"><input class="infusion-field-input-container" id="inf_field_LastName" name="inf_field_LastName" type="text" /></td> </tr> </tbody> </table> </div> <div> <table class="infusion-field-container" style="width:200;"> <tbody> <tr> <td class="infusion-field-label-container" style="width:300px;"><label for="inf_field_Phone1">Your Phone Number *</label></td> </tr> <tr> <td class="infusion-field-input-container" style="width:200px;"><input class="infusion-field-input-container" id="inf_field_Phone1" name="inf_field_Phone1" type="text" /></td> </tr> </tbody> </table> </div> <div> <table class="infusion-field-container" style="width:200;"> <tbody> <tr> <td class="infusion-field-label-container" style="width:300px;"><label for="inf_field_Email">Your Email *</label></td> </tr> <tr> <td class="infusion-field-input-container" style="width:200px;"><input class="infusion-field-input-container" id="inf_field_Email" name="inf_field_Email" type="text" /></td> </tr> </tbody> </table> </div> <div> <div style="height:15px; line-height:15px;"> </div> </div> <div> <div style="height:50px; line-height:50px;"> </div> </div> <div> <div class="infusion-submit" style="text-align:right;"><button style="width:200px; height:50px; background-color:#F5F5F5; color:#000000; font-size:17px; font-family:Helvetica; border-color:#000000; border-style:Solid; border-width:1px; -moz-border-radius:3px;border-radius:3px;" type="submit" value="Next">Next</button></div> </div> <div> <div style="height:35px; line-height:35px;"> </div> </div> <div> <div> <div class="doctor_trusted" data-seal_align="right_bottom" data-seal_type="medium"></div> <script type="text/javascript"> var dt_seal_id = 1074899; (function (){var dt=document.createElement('script');dt.type='text/javascript';dt.async=true; dt.src=document.location.protocol+'//' + dt_seal_id + '.js'; var s=document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(dt, s);})(); </script> <noscript> <a href="//" shape="rect" target="_blank"><img alt="Doctor Trusted Trusted Seal" height="42" src="" width="150" /></a> </noscript> </div> </div> </td> <td class="body" sectionid="body" valign="top"> <div> <div style="height:15px; line-height:15px;"> </div> </div> <div> <div class="authoring-image image-snippet" contentid="image"> <div class="authoring-image image-snippet" contentid="image"> <div class="imageSnippet-alignDiv" style="text-align: right;"><img align="bottom" alt="Interesting Image" border="0" class="simage" height="470" src="" style="margin-left: 0px; margin-right: 0px;" title="Interesting Image" width="450" /></div> </div> </div> </div> </td> </tr> <tr> <td class="footer" colspan="2" sectionid="footer" valign="top"> <div> <div class="authoring-image image-snippet" contentid="image"> <div class="authoring-image image-snippet" contentid="image"> <div class="imageSnippet-alignDiv" style="text-align: left;"><img align="bottom" alt="Trust Icons" border="0" class="simage" height="151" src="" style="margin-left: 0px; margin-right: 0px;" title="Trust Icons" width="899" /></div> </div> </div> </div> </td> </tr> </tbody> </table> </td> </tr> </tbody> </table> </div> </form> </body></html>