{global_header_before_title}
{preload_replace:widget_bundle="frontpage"}
{embed="embeds/global_header" page="login_sequences"}

 
 <div id="columns"> 
        <div class="fts-incorrect-name"> 
            <div class="box-wrap">
                  <h1 class="title underline">Modifying your name</h1>
                  <p>You can request minor modifications to your name below that may have been caused by an error in data entry.</p>
                  <p>If your name is completely different to the one listed below, please click <a onclick="javascript:jQuery('#cmd').val('not_me');jQuery('form').submit();">This Is Not Me.</a></p>
                  <p>Once you click request, your name change will be reviewed within 24 hours.</p>
                  <p>For legal reasons, if you are a dental practitioner, your name must be the same as the name you are registered under.</p>
                  <p>However, you can be known by a different first name by using the <a onclick="javascript:jQuery('#cmd').val('preferred_name');jQuery('form').submit();">Preferred Name</a> option</p>
                  
                  <div class="box-wrap-content" >
                       [##if '[##message##]' != '' ##]
                         <p class="alert">[##message##]</p>
                       [##/if##]
                       <p class="alert" id="message"></p>
                       <form name="fts-incorrect-name" method="post" action="{site_url}">
                           <input type="hidden" name="ACT" value="[##AID##]"/>
                           <input type="hidden" name="CID" value="[##CID##]"/>
                           <input type="hidden" name="cmd" id="cmd" value="" />
                           <div class="container">
                                <div class="item main-item">
                                    <label>Your Name<em>*</em></label>
                                    <select id="salutation" name="salutation" class="required">
                                        [##salutation##]
                                    </select>

                                    <span>
                                    <label>First Name<em>*</em></label>
                                    <input type="text" name="firstname" id="firstname" value="[##firstname##]" data="[##firstname##]" maxlength="32" size="21"/>
                                    </span>
                                    
                                    <span>
                                    <label class="initial">Middle Initial</label>
                                    <input type="text" name="initial" id="initial" value="[##initial##]" data="[##initial##]" maxlength="3" size="21"/>
                                    </span>
                                    
                                    <span>
                                    <label>Last Name<em>*</em></label>
                                    <input type="text" name="lastname" id="lastname" value="[##lastname##]" data="[##lastname##]" maxlength="32" size="21"/>
                                    </span>
                            
                                </div>
                                
                                <div class="item clearer">
                                    <a class="f-left" onclick="javascript:jQuery('#cmd').val('not_me');jQuery('form').submit();">This is not me</a>
                                </div>
                               
                                <div class="item actions clearer">
                                    <span class="f-right">
                                        <input type="button" class="btn-cancel" id="cancel" name="cancel" value="">
                                        &nbsp;
                                        <input type="submit" class="btn-request" name="request" id="request" value="">
                                    </span>
                                </div>
                           </div>    
                       </form>
                       <script type="text/javascript">
                       jQuery(document).ready(function($){
                           var alertObj = $('#message');
                           alertObj.hide();
                           $('#cancel').click(function(){
                               $('#cmd').val('cancel');
                               $('form').submit();
                           });
                           $('#request').click(function(){
                              var bChanged = false;
                              if ($('#firstname').length){
                                  var firstname = $('#firstname').val();
                                  if (firstname.length < 2){
                                      alertObj.html('ERROR: Your First Name must be at least 2 characters - Please reenter.');
                                      alertObj.show();
                                      return false;
                                  }else{
                                      if ($('#firstname').attr('data') != firstname){
                                          bChanged = true;
                                      }
                                  }
                              } 
                              if ($('#lastname').length){
                                  var lastname = $('#lastname').val();
                                  if ($('#lastname').val().length < 2){
                                      alertObj.html('ERROR: Your Last Name must be at least 2 characters - Please reenter.');
                                      alertObj.show();
                                      return false;
                                  }else{
                                      if ($('#lastname').attr('data') != lastname){
                                          bChanged = true;
                                      }
                                  }
                              } 
                              if ($('#initial').length){
                                  var initial = $('#initial').val();
                                  if ($('#initial').attr('data') != initial){
                                     bChanged = true;
                                  }
                              }
                              if (!bChanged){
                                  alertObj.html('ERROR: Please make the changes to your name below or click Cancel.');
                                  alertObj.show();
                                  return false;
                              }
                              alertObj.hide();
                              return true;
                           });
                       });
                       </script>
                  </div>
                  
            </div>
 
        </div> <!--/col1--> 
 
{global_footer}