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class="panel-title"> <div class="text-center">First Time User? Register Here*</div> </div> <form id="RegistrationForm" class="registration" action="/" method="post"> <div> <div class="form-group center-block"> <input class="form-control" required="required" placeholder="First Name*" type="text" id="FirstName" name="FirstName" value="" /> <span class="text-danger field-validation-valid" data-valmsg-for="FirstName" data-valmsg-replace="true"></span> </div> <div class="form-group center-block"> <input class="form-control" required="required" placeholder="Last Name*" type="text" id="LastName" name="LastName" value="" /> <span class="text-danger field-validation-valid" data-valmsg-for="LastName" data-valmsg-replace="true"></span> </div> <div class="form-group center-block"> <input class="form-control" required="required" placeholder="Email Address*" type="text" id="Email" name="Email" value="" /> <span class="text-danger field-validation-valid" data-valmsg-for="Email" data-valmsg-replace="true"></span> </div> <div class="form-group center-block"> <input class="form-control" placeholder="Business Phone Number" type="text" id="PhoneNumber" name="PhoneNumber" value="" /> <span class="text-danger field-validation-valid" data-valmsg-for="PhoneNumber" data-valmsg-replace="true"></span> </div> <div class="text-center"> <input id="btnSubmit" type="submit" value="Register" class="btn btn-default submitbtn" /> </div> </div> <input name="__RequestVerificationToken" type="hidden" value="CfDJ8D5AtO_aNqpGkgSxW3Pf20NzCgKfIKmDi4_DXSJB3khn7Y7-6gYAIfvH1JYzXrNRbb9vgPkg4NcC7qw5JkTKXcXmaBu4KlesX_FqZDtk9ymEg2dAEr-RKQbl79nBZhaLLgn7M8doMscXex59RthCmeY" /></form> <script type="text/javascript"> var phrma_api = ''; //window.phrma_api2 = ''; $(document).ready(function () { $("#btnSubmit").click(function () { var formValid = $('#RegistrationForm').valid(); $("#btnSubmit").attr("disabled", formValid); $('#RegistrationForm').submit(); return true; }); }); </script> <script src="/js/register.js?v=RMun-iWN8OVLYrEi_S2nwkjnlL9hxMEN9zhOTugojXw" type="text/javascript"></script> </div> </div> <footer> <p>*PhRMA Connect is a resource for PhRMA member company employees. 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