[MM_Form_Data name=’shippingAddress’] [MM_Form_Data name=’shippingCity’], [MM_Form_Data name=’shippingState’] [MM_Form_Data name=’shippingZipCode’]
[MM_Member_Data name=’customField_3′]
Name: [MM_Form_Data name=’firstName’] [MM_Form_Data name=’lastName’]
Email Address: [MM_Form_Data name=’email’]
Phone: [MM_Form_Data name=’phone’]
Username: [MM_Form_Data name=’username’] Password: [MM_Form_Data name=’password’] Member Since: [MM_Form_Data name=’registrationDate’] [MM_Member_Decision status=’pending_cancel’] Account will cancel on [MM_Member_Data name=’cancellationDate’ dateFormat=’M j, Y’][/MM_Member_Decision] Membership Level: [MM_Form_Data name=’membershipLevelName’] [MM_Member_Decision status=’!pending_cancel’] cancel [/MM_Member_Decision]
Address: [MM_Form_Data name=’billingAddress’]
City: [MM_Form_Data name=’billingCity’]
State: [MM_Form_Data name=’billingState’]
Zip Code: [MM_Form_Data name=’billingZipCode’]
Country: [MM_Form_Data name=’billingCountry’]