[de_fb_form title=”Diasporameds Account Register” form_type=”register” default_user_role=”customer” submit_button_text=”Register” disable_submit_for_required=”on” use_preload_animation=”on” success_message=”Thank you for registering, your account with Diaspora meds has been created” button_alignment=”left” _builder_version=”4.25.1″ _module_preset=”default” _unique_id=”7f5bfd4c-6d1f-462c-a0c7-0e2ce9aae897″ form_title_font=”Poppins|500|||||||” form_title_text_color=”#0C71C3″ label_text_font=”|700|||||||” label_text_text_color=”#0C71C3″ success_notice_text_text_color=”#1a991e” form_field_font=”||||||||” custom_button=”on” button_text_size=”14px” button_text_color=”#ffffff” button_bg_color=”#0C71C3″ button_border_color=”#0C71C3″ button_border_radius=”5px” hover_enabled=”0″ global_colors_info=”{}” sticky_enabled=”0″][de_fb_form_field field_title=”First Name” field_id=”Field_5″ required_mark=”on” field_grid_column=”et_pb_column_1_2″ field_label_position=”top” field_placeholder=”Enter your first name” use_icon=”on” font_icon=”||divi||400″ _builder_version=”4.25.1″ _module_preset=”default” hover_enabled=”0″ global_colors_info=”{}” form_step=”0″ current_step=”0″ field_mapping_type=”user_default” user_default_field=”first_name” sticky_enabled=”0″][/de_fb_form_field][de_fb_form_field field_title=”Last Name” field_id=”Field_6″ required_mark=”on” field_grid_column=”et_pb_column_1_2″ field_label_position=”top” field_placeholder=”Enter your last name” use_icon=”on” font_icon=”||divi||400″ _builder_version=”4.25.1″ _module_preset=”default” hover_enabled=”0″ global_colors_info=”{}” form_step=”0″ current_step=”0″ field_mapping_type=”user_default” user_default_field=”last_name” sticky_enabled=”0″][/de_fb_form_field][de_fb_form_field field_title=”Username” field_id=”Field_1″ required_mark=”on” field_mapping_type=”user_default” user_default_field=”user_login” field_grid_column=”et_pb_column_1_2″ field_label_position=”top” field_placeholder=”Enter username ” description_text=”on” description_text_text=”You’ll use this name to login and it is how your name will be displayed in the account section.” use_icon=”on” font_icon=”||fa||900″ enable_autocomplete=”off” _builder_version=”4.25.1″ _module_preset=”default” form_field_text_color=”#0C71C3″ field_description_font=”|700|||||||” field_description_text_color=”#E02B20″ field_description_font_size=”10px” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=”Email ” field_id=”Field_2″ required_mark=”on” field_mapping_type=”user_default” user_default_field=”user_email” field_grid_column=”et_pb_column_1_2″ field_label_position=”top” field_placeholder=”Enter your email” use_icon=”on” font_icon=”||fa||900″ _builder_version=”4.25.1″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=”Password” field_id=”Field_3″ field_type=”password” required_mark=”on” field_mapping_type=”user_default” user_default_field=”user_pass” field_grid_column=”et_pb_column_1_2″ field_label_position=”top” field_placeholder=”Enter your password” use_icon=”on” font_icon=”||fa||900″ password_font_icon=”||fa||900″ _builder_version=”4.25.1″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=”Password” field_id=”Field_3_2″ field_type=”password” required_mark=”on” field_mapping_type=”user_default” user_default_field=”pass_repeat” field_grid_column=”et_pb_column_1_2″ field_label_position=”top” field_placeholder=”Confirm password” use_icon=”on” font_icon=”||fa||900″ _builder_version=”4.25.1″ _module_preset=”default” hover_enabled=”0″ global_colors_info=”{}” form_step=”0″ current_step=”0″ password_font_icon=”||fa||900″ sticky_enabled=”0″][/de_fb_form_field][/de_fb_form]