	                  </select>
					</div>
				</div>
			</div>
			
			
			
		</div>
		
		<div class="form-fields-wrapper">
			<div class="form-steps-bottom"></div>
			
			<input class="button btn-full push-top btn-primary" name="commit" type="submit" value="Register" id = "btn-submit" id = "btn-submit">