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return false; }" action="/user/register" method="post" id="search-block-form" accept-charset="UTF-8"><div><div class="container-inline"> <h2 class="element-invisible">Search form</h2> <div class="form-item form-type-textfield form-item-search-block-form"> <label class="element-invisible" for="edit-search-block-form--2">Search... </label> <input title="Enter the terms you wish to search for." placeholder="Search..." class="text-input fa fa-search form-text" aria-hidden="" type="text" id="edit-search-block-form--2" name="search_block_form" value="" size="40" maxlength="128" /> </div> <div class="form-actions form-wrapper" id="edit-actions--2"><input type="submit" id="edit-submit--2" name="op" value="" class="form-submit" /></div><input type="hidden" name="form_build_id" value="form-HIosV4iNJuBI-ZkPJNjpNovBdy207IDwUjfYMkskG1Y" /> <input type="hidden" name="form_id" value="search_block_form" /> </div> </div></form> </div> </div> <div id="block-ucsf-b1gfoot-tweaks-header-socialmedia" class="block block-ucsf-b1gfoot-tweaks"> <div class="content"> <div class="nav-social"></div> </div> </div> <div id="block-menu-block-1" class="block block-menu-block"> <div class="content"> </div> </div> </div> </div> </div> <div id="breadcrumb" class="row-full-width"><div class="inside"><h2 class="element-invisible">You are here</h2><div class="breadcrumb"><a href="/">Home</a> > <a href="/user">User account</a> > <span class="breadcrumb-page-title">Create new account</span></div></div></div> <h1 class="title" id="page-title">User account</h1> <div class="content-top"> </div> <div id="main-wrapper"> <div id="main" class="clearfix"> <div id="content" class="column"> <div class="inside"> <a id="main-content"></a> <div class="tabs"><h2 class="element-invisible">Primary tabs</h2><ul class="tabs primary"><li class="active"><a href="/user/register" class="active">Create new account<span class="element-invisible">(active tab)</span></a></li> <li><a href="/user">Log in</a></li> <li><a href="/user/password">Request new password</a></li> </ul></div> <div class="region region-content"> <div id="block-system-main" class="block block-system"> <div class="content"> <form class="user-info-from-cookie" enctype="multipart/form-data" action="/user/register" method="post" id="user-register-form" accept-charset="UTF-8"><div><div id="edit-account" class="form-wrapper"><div class="form-item form-type-textfield form-item-name"> <label for="edit-name">Username <span class="form-required" title="This field is required.">*</span></label> <input class="username form-text required" type="text" id="edit-name" name="name" value="" size="60" maxlength="60" /> <div class="description">Spaces are allowed; punctuation is not allowed except for periods, hyphens, apostrophes, and underscores.</div> </div> <div class="form-item form-type-textfield form-item-mail"> <label for="edit-mail">E-mail address <span class="form-required" title="This field is required.">*</span></label> <input type="text" id="edit-mail" name="mail" value="" size="60" maxlength="254" class="form-text required" /> <div class="description">A valid e-mail address. All e-mails from the system will be sent to this address. The e-mail address is not made public and will only be used if you wish to receive a new password or wish to receive certain news or notifications by e-mail.</div> </div> <input type="hidden" name="timezone" value="America/Los_Angeles" /> </div><input type="hidden" name="form_build_id" value="form-gl6NRI-VBONfa0lhLywtkK5MO2pG3fjQpn5YfSL-7b8" /> <input type="hidden" name="form_id" value="user_register_form" /> <fieldset class="collapsible required-fields group-employer-profile field-group-fieldset form-wrapper"><legend><span class="fieldset-legend">Employer Profile</span></legend><div class="fieldset-wrapper"><div class="field-type-email field-name-field-email-organization-address field-widget-email-textfield form-wrapper" id="edit-field-email-organization-address"><div id="field-email-organization-address-add-more-wrapper"><div class="text-full-wrapper"><div class="form-item form-type-textfield form-item-field-email-organization-address-und-0-email"> <label for="edit-field-email-organization-address-und-0-email">Organization Email Address </label> <input type="text" id="edit-field-email-organization-address-und-0-email" name="field_email_organization_address[und][0][email]" value="" size="60" maxlength="128" class="form-text" /> </div> </div></div></div><div class="field-type-text field-name-field-text-organization-name field-widget-text-textfield form-wrapper" id="edit-field-text-organization-name"><div id="field-text-organization-name-add-more-wrapper"><div class="form-item form-type-textfield form-item-field-text-organization-name-und-0-value"> <label for="edit-field-text-organization-name-und-0-value">Organization Name <span class="form-required" title="This field is required.">*</span></label> <input class="text-full form-text required" type="text" id="edit-field-text-organization-name-und-0-value" name="field_text_organization_name[und][0][value]" value="" size="60" maxlength="255" /> </div> </div></div><div class="field-type-image field-name-field-image-organization field-widget-image-image form-wrapper" id="edit-field-image-organization"><div id="edit-field-image-organization-und-0-ajax-wrapper"><div class="form-item form-type-managed-file form-item-field-image-organization-und-0"> <label for="edit-field-image-organization-und-0-upload">Organization Logo </label> <div class="image-widget form-managed-file clearfix"><div class="image-widget-data"><input type="file" id="edit-field-image-organization-und-0-upload" name="files[field_image_organization_und_0]" size="22" class="form-file" /><input type="submit" id="edit-field-image-organization-und-0-upload-button" name="field_image_organization_und_0_upload_button" value="Upload" class="form-submit" /><input type="hidden" name="field_image_organization[und][0][fid]" value="0" /> <input type="hidden" name="field_image_organization[und][0][display]" value="1" /> </div></div> <div class="description">Files must be less than <strong>256 MB</strong>.<br />Allowed file types: <strong>png gif jpg jpeg</strong>.</div> </div> </div></div><div class="field-type-link-field field-name-field-link-organization field-widget-link-field form-wrapper" id="edit-field-link-organization"><div id="field-link-organization-add-more-wrapper"><div class="form-item form-type-link-field form-item-field-link-organization-und-0"> <label for="edit-field-link-organization-und-0">Organization Website </label> <div class="link-field-subrow clearfix"><div class="link-field-url"><div class="form-item form-type-textfield form-item-field-link-organization-und-0-url"> <label class="element-invisible" for="edit-field-link-organization-und-0-url">URL </label> <input type="text" id="edit-field-link-organization-und-0-url" name="field_link_organization[und][0][url]" value="" size="60" maxlength="2048" class="form-text" /> </div> </div></div> </div> </div></div><div class="field-type-text-long field-name-field-textarea-organization-info field-widget-text-textarea form-wrapper" id="edit-field-textarea-organization-info"><div id="field-textarea-organization-info-add-more-wrapper"><div class="form-item form-type-textarea form-item-field-textarea-organization-info-und-0-value"> <label for="edit-field-textarea-organization-info-und-0-value">Organization Info <span class="form-required" title="This field is required.">*</span></label> <div class="form-textarea-wrapper resizable"><textarea class="text-full form-textarea required" id="edit-field-textarea-organization-info-und-0-value" name="field_textarea_organization_info[und][0][value]" cols="60" rows="4"></textarea></div> </div> </div></div><div class="field-type-addressfield field-name-field-address-location field-widget-addressfield-standard form-wrapper" id="edit-field-address-location"><div id="field-address-location-add-more-wrapper"><div id="addressfield-wrapper"><fieldset id="edit-field-address-location-und-0" class="form-wrapper"><legend><span class="fieldset-legend">Location</span></legend><div class="fieldset-wrapper"><div class="form-item form-type-select form-item-field-address-location-und-0-country"> <label for="edit-field-address-location-und-0-country">Country </label> <select class="country form-select" autocomplete="country" id="edit-field-address-location-und-0-country" name="field_address_location[und][0][country]"><option value="">- None -</option><option value="US" selected="selected">United States</option></select> </div> <div class="street-block"><div class="form-item form-type-textfield form-item-field-address-location-und-0-thoroughfare"> <label for="edit-field-address-location-und-0-thoroughfare">Address 1 </label> <input class="thoroughfare form-text" autocomplete="address-line1" type="text" id="edit-field-address-location-und-0-thoroughfare" name="field_address_location[und][0][thoroughfare]" value="" size="30" maxlength="255" /> </div> <div class="form-item form-type-textfield form-item-field-address-location-und-0-premise"> <label for="edit-field-address-location-und-0-premise">Address 2 </label> <input class="premise form-text" autocomplete="address-line2" type="text" id="edit-field-address-location-und-0-premise" name="field_address_location[und][0][premise]" value="" size="30" maxlength="255" /> </div></div> <div class="addressfield-container-inline locality-block country-US"><div class="form-item form-type-textfield form-item-field-address-location-und-0-locality"> <label for="edit-field-address-location-und-0-locality">City </label> <input class="locality form-text" autocomplete="address-level2" type="text" id="edit-field-address-location-und-0-locality" name="field_address_location[und][0][locality]" value="" size="30" maxlength="255" /> </div> <div class="form-item form-type-select form-item-field-address-location-und-0-administrative-area"> <label for="edit-field-address-location-und-0-administrative-area">State </label> <select class="state form-select" autocomplete="address-level1" id="edit-field-address-location-und-0-administrative-area" name="field_address_location[und][0][administrative_area]"><option value="" selected="selected">- None -</option><option value="AL">Alabama</option><option value="AK">Alaska</option><option value="AZ">Arizona</option><option value="AR">Arkansas</option><option value="CA">California</option><option value="CO">Colorado</option><option value="CT">Connecticut</option><option value="DE">Delaware</option><option value="DC">District of Columbia</option><option value="FL">Florida</option><option value="GA">Georgia</option><option value="HI">Hawaii</option><option value="ID">Idaho</option><option value="IL">Illinois</option><option value="IN">Indiana</option><option value="IA">Iowa</option><option value="KS">Kansas</option><option value="KY">Kentucky</option><option value="LA">Louisiana</option><option value="ME">Maine</option><option value="MD">Maryland</option><option value="MA">Massachusetts</option><option value="MI">Michigan</option><option value="MN">Minnesota</option><option value="MS">Mississippi</option><option value="MO">Missouri</option><option value="MT">Montana</option><option value="NE">Nebraska</option><option value="NV">Nevada</option><option value="NH">New Hampshire</option><option value="NJ">New Jersey</option><option value="NM">New Mexico</option><option value="NY">New York</option><option value="NC">North Carolina</option><option value="ND">North Dakota</option><option value="OH">Ohio</option><option value="OK">Oklahoma</option><option value="OR">Oregon</option><option value="PA">Pennsylvania</option><option value="RI">Rhode Island</option><option value="SC">South Carolina</option><option value="SD">South Dakota</option><option value="TN">Tennessee</option><option value="TX">Texas</option><option value="UT">Utah</option><option value="VT">Vermont</option><option value="VA">Virginia</option><option value="WA">Washington</option><option value="WV">West Virginia</option><option value="WI">Wisconsin</option><option value="WY">Wyoming</option><option value=" ">--</option><option value="AA">Armed Forces (Americas)</option><option value="AE">Armed Forces (Europe, Canada, Middle East, Africa)</option><option value="AP">Armed Forces (Pacific)</option><option value="AS">American Samoa</option><option value="FM">Federated States of Micronesia</option><option value="GU">Guam</option><option value="MH">Marshall Islands</option><option value="MP">Northern Mariana Islands</option><option value="PW">Palau</option><option value="PR">Puerto Rico</option><option value="VI">Virgin Islands</option></select> </div> <div class="form-item form-type-textfield form-item-field-address-location-und-0-postal-code"> <label for="edit-field-address-location-und-0-postal-code">ZIP code </label> <input class="postal-code form-text" autocomplete="postal-code" type="text" id="edit-field-address-location-und-0-postal-code" name="field_address_location[und][0][postal_code]" value="" size="10" maxlength="255" /> </div></div> </div></fieldset> </div></div></div></div></fieldset> <fieldset class="captcha form-wrapper"><legend><span class="fieldset-legend">CAPTCHA</span></legend><div class="fieldset-wrapper"><div class="fieldset-description">This question is for testing if you are a human visitor, and to prevent automated spam submissions.</div><input type="hidden" name="captcha_sid" value="1150061" /> <input type="hidden" name="captcha_token" value="2003fcc8179708d58b2beb50583448d2" /> <img typeof="foaf:Image" src="/image_captcha?sid=1150061&ts=1732956738" width="216" height="72" alt="Image CAPTCHA" title="Image CAPTCHA" /><div class="form-item form-type-textfield form-item-captcha-response"> <label for="edit-captcha-response">What code is in the image? <span class="form-required" title="This field is required.">*</span></label> <input type="text" id="edit-captcha-response" name="captcha_response" value="" size="15" maxlength="128" class="form-text required" /> <div class="description">Enter the characters shown in the image.</div> </div> </div></fieldset> <div class="form-actions form-wrapper" id="edit-actions"><input type="submit" id="edit-submit" name="op" value="Create new account" class="form-submit" /></div></div></form> </div> </div> </div> </div> </div> <div id="sidebar" class="column"> </div> </div></div> <div id="footer"> <div class="section"> <div class="footer-bottom"> <nav aria-label="Footer Navigation" class="footer--navigation"> <ul> <li><a href="https://www.ucsf.edu/accessibility-resources">Accessibility</a></li> <li><a href="https://www.ucsf.edu/website-privacy-policy">Privacy Policy</a></li> <li><a href="https://websites.ucsf.edu/website-terms-use">Terms of Use </a></li> <li><a href="https://websites.ucsf.edu/azlist">A-Z Website List</a></li> </ul> </nav> <div class="footer--copyright"> <p>© 2024 The Regents of the University of California</p> </div> </div> </div> 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