Simple registration

* E-mail
* Password:
* Confirm password:
* First Name
* Last Name
* Telephone

* Address Line 1
Address Line 2
* City
Postcode
* Country	--- Please Select --- New Zealand
Zone	--- Please Select --- AucklandBay of PlentyCanterburyCoromandelFiordlandGisborneHawke's BayManawatu-WanganuiMarlboroughMt Cook-MackenzieNelsonNorthlandOtagoSouthlandTaranakiWaikatoWairprarapaWellingtonWest Coast