<div style="padding:1em;">

<postform>
<postsuccess>
<h3>Consultant Added</h3>
<p>
<a href="http://#this_domain#/#so_slash_string#?&sts=All Consultants"><b>Back to Consultant List &gt;</b></a>
</p>
</postsuccess>
<postneutral>

<h2>New Consultant</h2>

<div class="unit">
<div class="unit_left">
CCS Username:
</div>
<div class="unit_right">
<input type="text" name="1_name">
<div style="padding:3px; color:##999;"><small>
Required - you need this to properly identify a given user
as a CCS consultant.
</small></div>
</div>
</div>

<div class="unit">
<div class="unit_left">
Consultant Name:
</div>
<div class="unit_right">
<input type="text" name="1_title">
</div>
</div>

<div class="unit">
<div class="unit_left">
CCS Referral Number:
</div>
<div class="unit_right">
<input type="text" name="1_referral_number">
</div>
</div>

<div class="unit">
<div class="unit_left">
&nbsp;
</div>
<div class="unit_right">
<input type="submit" value="Add Consultant" style="cursor:pointer;">
</div>
</div>

<input type="hidden" name="1_posttype" value="INSERT" style="display:none;">
<input type="hidden" name="1_orb" value="ccsconsultant" style="display:none;">
<input type="hidden" name="1_user_key_id" value="5" style="display:none;">

</postneutral>
</postform>

</div>