2 <table class="wrapper" width="300">
4 <td colspan="2" class="title"><?=_Assure Someone?></td>
7 <td class="DataTD" width="125"><?=_Email?>: </td>
8 <td class="DataTD" width="125"><input type="text" name="email"></td>
11 <td class="DataTD" width="125"><?=_Date of Birth?><br>
12 (<?=_dd/mm/yyyy?>)</td>
13 <td class="DataTD" width="125"><?=$DoB?></td>
16 <td class="DataTD" colspan="2"><input type="submit" name="process" value="<?=_Next?>"></td>