From d8c27a18fa56b72f5e9e3f82e6c9e3ac1f7cf10c Mon Sep 17 00:00:00 2001
From: David Adams <dcadams@stanford.edu>
Date: Wed, 30 Oct 2013 14:48:05 -0700
Subject: [PATCH] Changes to CME registration form

These changes bring the form to Nov 12 specs.
---
 ...how_stanford_affiliated__del_field_cmeu.py | 301 +++++++++++++
 common/djangoapps/cme_registration/models.py  | 226 +++++-----
 .../tests/registration_tests.py               | 395 +++++++++---------
 common/djangoapps/cme_registration/views.py   | 342 +++++++++++----
 lms/templates/cme_register.html               | 351 ++++++++++------
 5 files changed, 1120 insertions(+), 495 deletions(-)
 create mode 100644 common/djangoapps/cme_registration/migrations/0002_auto__del_field_cmeuserprofile_how_stanford_affiliated__del_field_cmeu.py

diff --git a/common/djangoapps/cme_registration/migrations/0002_auto__del_field_cmeuserprofile_how_stanford_affiliated__del_field_cmeu.py b/common/djangoapps/cme_registration/migrations/0002_auto__del_field_cmeuserprofile_how_stanford_affiliated__del_field_cmeu.py
new file mode 100644
index 000000000000..e79ea96ae963
--- /dev/null
+++ b/common/djangoapps/cme_registration/migrations/0002_auto__del_field_cmeuserprofile_how_stanford_affiliated__del_field_cmeu.py
@@ -0,0 +1,301 @@
+# -*- coding: utf-8 -*-
+import datetime
+from south.db import db
+from south.v2 import SchemaMigration
+from django.db import models
+
+
+class Migration(SchemaMigration):
+
+    def forwards(self, orm):
+        # Deleting field 'CmeUserProfile.how_stanford_affiliated'
+        db.delete_column('cme_registration', 'how_stanford_affiliated')
+
+        # Deleting field 'CmeUserProfile.profession'
+        db.delete_column('cme_registration', 'profession')
+
+        # Deleting field 'CmeUserProfile.stanford_affiliated'
+        db.delete_column('cme_registration', 'stanford_affiliated')
+
+        # Deleting field 'CmeUserProfile.phone_number'
+        db.delete_column('cme_registration', 'phone_number')
+
+        # Deleting field 'CmeUserProfile.fax'
+        db.delete_column('cme_registration', 'fax')
+
+        # Deleting field 'CmeUserProfile.hear_about_us'
+        db.delete_column('cme_registration', 'hear_about_us')
+
+        # Deleting field 'CmeUserProfile.mailing_list'
+        db.delete_column('cme_registration', 'mailing_list')
+
+        # Deleting field 'CmeUserProfile.state_province'
+        db.delete_column('cme_registration', 'state_province')
+
+        # Deleting field 'CmeUserProfile.extension'
+        db.delete_column('cme_registration', 'extension')
+
+        # Deleting field 'CmeUserProfile.organization'
+        db.delete_column('cme_registration', 'organization')
+
+        # Adding field 'CmeUserProfile.first_name'
+        db.add_column('cme_registration', 'first_name',
+                      self.gf('django.db.models.fields.CharField')(max_length=50, null=True, blank=True),
+                      keep_default=False)
+
+        # Adding field 'CmeUserProfile.last_name'
+        db.add_column('cme_registration', 'last_name',
+                      self.gf('django.db.models.fields.CharField')(max_length=50, null=True, blank=True),
+                      keep_default=False)
+
+        # Adding field 'CmeUserProfile.middle_initial'
+        db.add_column('cme_registration', 'middle_initial',
+                      self.gf('django.db.models.fields.CharField')(max_length=1, null=True, blank=True),
+                      keep_default=False)
+
+        # Adding field 'CmeUserProfile.birth_date'
+        db.add_column('cme_registration', 'birth_date',
+                      self.gf('django.db.models.fields.CharField')(max_length=5, null=True, blank=True),
+                      keep_default=False)
+
+        # Adding field 'CmeUserProfile.license_country'
+        db.add_column('cme_registration', 'license_country',
+                      self.gf('django.db.models.fields.CharField')(max_length=50, null=True, blank=True),
+                      keep_default=False)
+
+        # Adding field 'CmeUserProfile.license_state'
+        db.add_column('cme_registration', 'license_state',
+                      self.gf('django.db.models.fields.CharField')(max_length=50, null=True, blank=True),
+                      keep_default=False)
+
+        # Adding field 'CmeUserProfile.physician_status'
+        db.add_column('cme_registration', 'physician_status',
+                      self.gf('django.db.models.fields.CharField')(max_length=8, null=True, blank=True),
+                      keep_default=False)
+
+        # Adding field 'CmeUserProfile.affiliation'
+        db.add_column('cme_registration', 'affiliation',
+                      self.gf('django.db.models.fields.CharField')(max_length=46, null=True, blank=True),
+                      keep_default=False)
+
+        # Adding field 'CmeUserProfile.other_affiliation'
+        db.add_column('cme_registration', 'other_affiliation',
+                      self.gf('django.db.models.fields.CharField')(max_length=46, null=True, blank=True),
+                      keep_default=False)
+
+        # Adding field 'CmeUserProfile.sub_affiliation'
+        db.add_column('cme_registration', 'sub_affiliation',
+                      self.gf('django.db.models.fields.CharField')(max_length=46, null=True, blank=True),
+                      keep_default=False)
+
+        # Adding field 'CmeUserProfile.stanford_department'
+        db.add_column('cme_registration', 'stanford_department',
+                      self.gf('django.db.models.fields.CharField')(max_length=46, null=True, blank=True),
+                      keep_default=False)
+
+        # Adding field 'CmeUserProfile.sunet_id'
+        db.add_column('cme_registration', 'sunet_id',
+                      self.gf('django.db.models.fields.CharField')(max_length=33, null=True, blank=True),
+                      keep_default=False)
+
+        # Adding field 'CmeUserProfile.state'
+        db.add_column('cme_registration', 'state',
+                      self.gf('django.db.models.fields.CharField')(max_length=50, null=True, blank=True),
+                      keep_default=False)
+
+        # Adding field 'CmeUserProfile.county_province'
+        db.add_column('cme_registration', 'county_province',
+                      self.gf('django.db.models.fields.CharField')(max_length=50, null=True, blank=True),
+                      keep_default=False)
+
+
+        # Changing field 'CmeUserProfile.license_number'
+        db.alter_column('cme_registration', 'license_number', self.gf('django.db.models.fields.CharField')(max_length=20, null=True))
+
+        # Changing field 'CmeUserProfile.professional_designation'
+        db.alter_column('cme_registration', 'professional_designation', self.gf('django.db.models.fields.CharField')(max_length=25, null=True))
+
+    def backwards(self, orm):
+        # Adding field 'CmeUserProfile.how_stanford_affiliated'
+        db.add_column('cme_registration', 'how_stanford_affiliated',
+                      self.gf('django.db.models.fields.CharField')(max_length=255, null=True, blank=True),
+                      keep_default=False)
+
+        # Adding field 'CmeUserProfile.profession'
+        db.add_column('cme_registration', 'profession',
+                      self.gf('django.db.models.fields.CharField')(max_length=30, null=True, blank=True),
+                      keep_default=False)
+
+        # Adding field 'CmeUserProfile.stanford_affiliated'
+        db.add_column('cme_registration', 'stanford_affiliated',
+                      self.gf('django.db.models.fields.BooleanField')(default=False),
+                      keep_default=False)
+
+        # Adding field 'CmeUserProfile.phone_number'
+        db.add_column('cme_registration', 'phone_number',
+                      self.gf('django.db.models.fields.CharField')(max_length=30, null=True, blank=True),
+                      keep_default=False)
+
+        # Adding field 'CmeUserProfile.fax'
+        db.add_column('cme_registration', 'fax',
+                      self.gf('django.db.models.fields.CharField')(max_length=30, null=True, blank=True),
+                      keep_default=False)
+
+        # Adding field 'CmeUserProfile.hear_about_us'
+        db.add_column('cme_registration', 'hear_about_us',
+                      self.gf('django.db.models.fields.CharField')(max_length=255, null=True, blank=True),
+                      keep_default=False)
+
+        # Adding field 'CmeUserProfile.mailing_list'
+        db.add_column('cme_registration', 'mailing_list',
+                      self.gf('django.db.models.fields.BooleanField')(default=False),
+                      keep_default=False)
+
+        # Adding field 'CmeUserProfile.state_province'
+        db.add_column('cme_registration', 'state_province',
+                      self.gf('django.db.models.fields.CharField')(max_length=50, null=True, blank=True),
+                      keep_default=False)
+
+        # Adding field 'CmeUserProfile.extension'
+        db.add_column('cme_registration', 'extension',
+                      self.gf('django.db.models.fields.CharField')(max_length=10, null=True, blank=True),
+                      keep_default=False)
+
+        # Adding field 'CmeUserProfile.organization'
+        db.add_column('cme_registration', 'organization',
+                      self.gf('django.db.models.fields.CharField')(max_length=255, null=True, blank=True),
+                      keep_default=False)
+
+        # Deleting field 'CmeUserProfile.first_name'
+        db.delete_column('cme_registration', 'first_name')
+
+        # Deleting field 'CmeUserProfile.last_name'
+        db.delete_column('cme_registration', 'last_name')
+
+        # Deleting field 'CmeUserProfile.middle_initial'
+        db.delete_column('cme_registration', 'middle_initial')
+
+        # Deleting field 'CmeUserProfile.birth_date'
+        db.delete_column('cme_registration', 'birth_date')
+
+        # Deleting field 'CmeUserProfile.license_country'
+        db.delete_column('cme_registration', 'license_country')
+
+        # Deleting field 'CmeUserProfile.license_state'
+        db.delete_column('cme_registration', 'license_state')
+
+        # Deleting field 'CmeUserProfile.physician_status'
+        db.delete_column('cme_registration', 'physician_status')
+
+        # Deleting field 'CmeUserProfile.affiliation'
+        db.delete_column('cme_registration', 'affiliation')
+
+        # Deleting field 'CmeUserProfile.other_affiliation'
+        db.delete_column('cme_registration', 'other_affiliation')
+
+        # Deleting field 'CmeUserProfile.sub_affiliation'
+        db.delete_column('cme_registration', 'sub_affiliation')
+
+        # Deleting field 'CmeUserProfile.stanford_department'
+        db.delete_column('cme_registration', 'stanford_department')
+
+        # Deleting field 'CmeUserProfile.sunet_id'
+        db.delete_column('cme_registration', 'sunet_id')
+
+        # Deleting field 'CmeUserProfile.state'
+        db.delete_column('cme_registration', 'state')
+
+        # Deleting field 'CmeUserProfile.county_province'
+        db.delete_column('cme_registration', 'county_province')
+
+
+        # Changing field 'CmeUserProfile.license_number'
+        db.alter_column('cme_registration', 'license_number', self.gf('django.db.models.fields.CharField')(max_length=255, null=True))
+
+        # Changing field 'CmeUserProfile.professional_designation'
+        db.alter_column('cme_registration', 'professional_designation', self.gf('django.db.models.fields.CharField')(max_length=3, null=True))
+
+    models = {
+        'auth.group': {
+            'Meta': {'object_name': 'Group'},
+            'id': ('django.db.models.fields.AutoField', [], {'primary_key': 'True'}),
+            'name': ('django.db.models.fields.CharField', [], {'unique': 'True', 'max_length': '80'}),
+            'permissions': ('django.db.models.fields.related.ManyToManyField', [], {'to': "orm['auth.Permission']", 'symmetrical': 'False', 'blank': 'True'})
+        },
+        'auth.permission': {
+            'Meta': {'ordering': "('content_type__app_label', 'content_type__model', 'codename')", 'unique_together': "(('content_type', 'codename'),)", 'object_name': 'Permission'},
+            'codename': ('django.db.models.fields.CharField', [], {'max_length': '100'}),
+            'content_type': ('django.db.models.fields.related.ForeignKey', [], {'to': "orm['contenttypes.ContentType']"}),
+            'id': ('django.db.models.fields.AutoField', [], {'primary_key': 'True'}),
+            'name': ('django.db.models.fields.CharField', [], {'max_length': '50'})
+        },
+        'auth.user': {
+            'Meta': {'object_name': 'User'},
+            'date_joined': ('django.db.models.fields.DateTimeField', [], {'default': 'datetime.datetime.now'}),
+            'email': ('django.db.models.fields.EmailField', [], {'max_length': '75', 'blank': 'True'}),
+            'first_name': ('django.db.models.fields.CharField', [], {'max_length': '30', 'blank': 'True'}),
+            'groups': ('django.db.models.fields.related.ManyToManyField', [], {'to': "orm['auth.Group']", 'symmetrical': 'False', 'blank': 'True'}),
+            'id': ('django.db.models.fields.AutoField', [], {'primary_key': 'True'}),
+            'is_active': ('django.db.models.fields.BooleanField', [], {'default': 'True'}),
+            'is_staff': ('django.db.models.fields.BooleanField', [], {'default': 'False'}),
+            'is_superuser': ('django.db.models.fields.BooleanField', [], {'default': 'False'}),
+            'last_login': ('django.db.models.fields.DateTimeField', [], {'default': 'datetime.datetime.now'}),
+            'last_name': ('django.db.models.fields.CharField', [], {'max_length': '30', 'blank': 'True'}),
+            'password': ('django.db.models.fields.CharField', [], {'max_length': '128'}),
+            'user_permissions': ('django.db.models.fields.related.ManyToManyField', [], {'to': "orm['auth.Permission']", 'symmetrical': 'False', 'blank': 'True'}),
+            'username': ('django.db.models.fields.CharField', [], {'unique': 'True', 'max_length': '30'})
+        },
+        'cme_registration.cmeuserprofile': {
+            'Meta': {'object_name': 'CmeUserProfile', 'db_table': "'cme_registration'", '_ormbases': ['student.UserProfile']},
+            'address_1': ('django.db.models.fields.TextField', [], {'null': 'True', 'blank': 'True'}),
+            'address_2': ('django.db.models.fields.TextField', [], {'null': 'True', 'blank': 'True'}),
+            'affiliation': ('django.db.models.fields.CharField', [], {'max_length': '46', 'null': 'True', 'blank': 'True'}),
+            'birth_date': ('django.db.models.fields.CharField', [], {'max_length': '5', 'null': 'True', 'blank': 'True'}),
+            'city': ('django.db.models.fields.TextField', [], {'null': 'True', 'blank': 'True'}),
+            'country': ('django.db.models.fields.CharField', [], {'max_length': '50', 'null': 'True', 'blank': 'True'}),
+            'county_province': ('django.db.models.fields.CharField', [], {'max_length': '50', 'null': 'True', 'blank': 'True'}),
+            'first_name': ('django.db.models.fields.CharField', [], {'max_length': '50', 'null': 'True', 'blank': 'True'}),
+            'last_name': ('django.db.models.fields.CharField', [], {'max_length': '50', 'null': 'True', 'blank': 'True'}),
+            'license_country': ('django.db.models.fields.CharField', [], {'max_length': '50', 'null': 'True', 'blank': 'True'}),
+            'license_number': ('django.db.models.fields.CharField', [], {'max_length': '20', 'null': 'True', 'blank': 'True'}),
+            'license_state': ('django.db.models.fields.CharField', [], {'max_length': '50', 'null': 'True', 'blank': 'True'}),
+            'middle_initial': ('django.db.models.fields.CharField', [], {'max_length': '1', 'null': 'True', 'blank': 'True'}),
+            'other_affiliation': ('django.db.models.fields.CharField', [], {'max_length': '46', 'null': 'True', 'blank': 'True'}),
+            'patient_population': ('django.db.models.fields.CharField', [], {'max_length': '25', 'null': 'True', 'blank': 'True'}),
+            'physician_status': ('django.db.models.fields.CharField', [], {'max_length': '8', 'null': 'True', 'blank': 'True'}),
+            'postal_code': ('django.db.models.fields.CharField', [], {'max_length': '20', 'null': 'True', 'blank': 'True'}),
+            'professional_designation': ('django.db.models.fields.CharField', [], {'max_length': '25', 'null': 'True', 'blank': 'True'}),
+            'specialty': ('django.db.models.fields.CharField', [], {'max_length': '255', 'null': 'True', 'blank': 'True'}),
+            'stanford_department': ('django.db.models.fields.CharField', [], {'max_length': '46', 'null': 'True', 'blank': 'True'}),
+            'state': ('django.db.models.fields.CharField', [], {'max_length': '50', 'null': 'True', 'blank': 'True'}),
+            'sub_affiliation': ('django.db.models.fields.CharField', [], {'max_length': '46', 'null': 'True', 'blank': 'True'}),
+            'sub_specialty': ('django.db.models.fields.CharField', [], {'max_length': '255', 'null': 'True', 'blank': 'True'}),
+            'sunet_id': ('django.db.models.fields.CharField', [], {'max_length': '33', 'null': 'True', 'blank': 'True'}),
+            'userprofile_ptr': ('django.db.models.fields.related.OneToOneField', [], {'to': "orm['student.UserProfile']", 'unique': 'True', 'primary_key': 'True'})
+        },
+        'contenttypes.contenttype': {
+            'Meta': {'ordering': "('name',)", 'unique_together': "(('app_label', 'model'),)", 'object_name': 'ContentType', 'db_table': "'django_content_type'"},
+            'app_label': ('django.db.models.fields.CharField', [], {'max_length': '100'}),
+            'id': ('django.db.models.fields.AutoField', [], {'primary_key': 'True'}),
+            'model': ('django.db.models.fields.CharField', [], {'max_length': '100'}),
+            'name': ('django.db.models.fields.CharField', [], {'max_length': '100'})
+        },
+        'student.userprofile': {
+            'Meta': {'object_name': 'UserProfile', 'db_table': "'auth_userprofile'"},
+            'allow_certificate': ('django.db.models.fields.BooleanField', [], {'default': 'True'}),
+            'courseware': ('django.db.models.fields.CharField', [], {'default': "'course.xml'", 'max_length': '255', 'blank': 'True'}),
+            'gender': ('django.db.models.fields.CharField', [], {'db_index': 'True', 'max_length': '6', 'null': 'True', 'blank': 'True'}),
+            'goals': ('django.db.models.fields.TextField', [], {'null': 'True', 'blank': 'True'}),
+            'id': ('django.db.models.fields.AutoField', [], {'primary_key': 'True'}),
+            'language': ('django.db.models.fields.CharField', [], {'db_index': 'True', 'max_length': '255', 'blank': 'True'}),
+            'level_of_education': ('django.db.models.fields.CharField', [], {'db_index': 'True', 'max_length': '6', 'null': 'True', 'blank': 'True'}),
+            'location': ('django.db.models.fields.CharField', [], {'db_index': 'True', 'max_length': '255', 'blank': 'True'}),
+            'mailing_address': ('django.db.models.fields.TextField', [], {'null': 'True', 'blank': 'True'}),
+            'meta': ('django.db.models.fields.TextField', [], {'blank': 'True'}),
+            'name': ('django.db.models.fields.CharField', [], {'db_index': 'True', 'max_length': '255', 'blank': 'True'}),
+            'user': ('django.db.models.fields.related.OneToOneField', [], {'related_name': "'profile'", 'unique': 'True', 'to': "orm['auth.User']"}),
+            'year_of_birth': ('django.db.models.fields.IntegerField', [], {'db_index': 'True', 'null': 'True', 'blank': 'True'})
+        }
+    }
+
+    complete_apps = ['cme_registration']
\ No newline at end of file
diff --git a/common/djangoapps/cme_registration/models.py b/common/djangoapps/cme_registration/models.py
index 14ea65721b8c..5cec88056f38 100644
--- a/common/djangoapps/cme_registration/models.py
+++ b/common/djangoapps/cme_registration/models.py
@@ -18,103 +18,149 @@ class CmeUserProfile(UserProfile):
     class Meta:
         db_table = "cme_registration"
 
-    PROFESSION_CHOICES = (('Allied Health Professional', 'Allied Health Professional'),
-                          ('Fellow', 'Fellow'),
-                          ('Nurse', 'Nurse'),
-                          ('Nurse Practioner', 'Nurse Practioner'),
-                          ('Physician', 'Physician'),
-                          ('Physician Assistant', 'Physician Assistant'),
-                          ('Resident', 'Resident'),
-                          ('Student', 'Student'))
-    profession = models.CharField(blank=True, null=True, max_length=30, choices=PROFESSION_CHOICES)
+    first_name = models.CharField(max_length=50, blank=True, null=True)
+    last_name = models.CharField(max_length=50, blank=True, null=True)
+    middle_initial = models.CharField(max_length=1, blank=True, null=True)
+    birth_date = models.CharField(max_length=5, blank=True, null=True)
 
-    PROFESSIONAL_DESIGNATION_CHOICES = (('MD', 'MD'),
-                                        ('DO', 'DO'),
-                                        ('PA', 'PA'),
+    PROFESSIONAL_DESIGNATION_CHOICES = (('DO', 'DO'),
+                                        ('MD', 'MD'),
+                                        ('MD, PhD', 'MD, PhD'),
+                                        ('MBBS', 'MBBS'),
                                         ('NP', 'NP'),
-                                        ('RN', 'RN'))
-    professional_designation = models.CharField(blank=True, null=True, max_length=3, choices=PROFESSIONAL_DESIGNATION_CHOICES)
-    license_number = models.CharField(blank=True, null=True, max_length=255)
-    organization = models.CharField(blank=True, null=True, max_length=255)
-    stanford_affiliated = models.BooleanField(default=0)
+                                        ('PA', 'PA'),
+                                        ('RN', 'RN'),
+                                        ('Other', 'Other'),
+                                        ('None', 'None'))
+    professional_designation = models.CharField(blank=True, null=True, max_length=25, choices=PROFESSIONAL_DESIGNATION_CHOICES)
+    license_number = models.CharField(max_length=20, blank=True, null=True, )
+    license_country = models.CharField(max_length=50, blank=True, null=True)
+    license_state = models.CharField(max_length=50, blank=True, null=True)
 
-    HOW_STANFORD_AFFILIATED_CHOICES = (('Lucile Packard Children\'s Hospital at Stanford', 'Lucile Packard Children\'s Hospital at Stanford'),
-                                       ('Packard Children\'s Health Alliance (PCHA)', 'Packard Children\'s Health Alliance (PCHA)'),
-                                       ('Stanford Hospital & Clinics', 'Stanford Hospital & Clinics'),
-                                       ('Stanford University', 'Stanford University'),
-                                       ('University Healthcare Alliance (UHA)', 'University Healthcare Alliance (UHA)'),
-                                       ('Other', 'Other, please enter:'))
-    how_stanford_affiliated = models.CharField(blank=True, null=True, max_length=255, choices=HOW_STANFORD_AFFILIATED_CHOICES)
+    PHYSICIAN_STATUS_CHOICES = (('Active', 'Active'),
+                                ('Resident', 'Resident'),
+                                ('Fellow', 'Fellow'),
+                                ('Retired', 'Retired'))
+    physician_status = models.CharField(blank=True, null=True, max_length=8)
 
     PATIENT_POPULATION_CHOICES = (('Adult', 'Adult'),
                                   ('Pediatric', 'Pediatric'),
-                                  ('Both (Adult/Pediatric)', 'Both (Adult/Pediatric)'))
+                                  ('Both', 'Both'),
+                                  ('None', 'None'))
     patient_population = models.CharField(blank=True, null=True, max_length=25, choices=PATIENT_POPULATION_CHOICES)
     specialty = models.CharField(blank=True, null=True, max_length=255)
     sub_specialty = models.CharField(blank=True, null=True, max_length=255)
+
+    AFFILIATION_CHOICES = (('Lucile Packard Children\'s Hospital', 'Lucile Packard Children\'s Hospital'),
+                           ('Packard Children\'s Health Alliance', 'Packard Children\'s Health Alliance'),
+                           ('Stanford Hospital and Clinics', 'Stanford Hospital and Clinics'),
+                           ('Stanford University', 'Stanford University'),
+                           ('University Healthcare Alliance', 'University Healthcare Alliance'),
+                           ('Other', 'Other'))
+    affiliation = models.CharField(blank=True, null=True, max_length=46, choices=AFFILIATION_CHOICES)
+    other_affiliation = models.CharField(blank=True, null=True, max_length=46)
+    sub_affiliation = models.CharField(blank=True, null=True, max_length=46)
+
+    DEPARTMENT_CHOICES = (('Anesthesiology,Perioperative,Pain Medicine', 'Anesthesiology,Perioperative,Pain Medicine'),
+                          ('Biochemistry', 'Biochemistry'),
+                          ('Cardiothoracic Surgery', 'Cardiothoracic Surgery'),
+                          ('Centers - School of Medicine', 'Centers - School of Medicine'),
+                          ('Chemical and Systems Biology', 'Chemical and Systems Biology'),
+                          ('Comparative Medicine', 'Comparative Medicine'),
+                          ('Dermatology', 'Dermatology'),
+                          ('Developmental Biology', 'Developmental Biology'),
+                          ('Genetics Operations', 'Genetics Operations'),
+                          ('Health Research and Policy', 'Health Research and Policy'),
+                          ('Medicine', 'Medicine'),
+                          ('Microbiology and Immunology', 'Microbiology and Immunology'),
+                          ('Molecular and Cellular Physiology', 'Molecular and Cellular Physiology'),
+                          ('Neurobiology', 'Neurobiology'),
+                          ('Neurology', 'Neurology'),
+                          ('Neurosurgery', 'Neurosurgery'),
+                          ('Obstetrics & Gynecology', 'Obstetrics & Gynecology'),
+                          ('Ophthalmology', 'Ophthalmology'),
+                          ('Orthopaedic Surgery', 'Orthopaedic Surgery'),
+                          ('Otolaryngology/Head & Neck Surgery', 'Otolaryngology/Head & Neck Surgery'),
+                          ('Pathology', 'Pathology'),
+                          ('Pediatrics', 'Pediatrics'),
+                          ('Psychiatry and Behavioral Sciences', 'Psychiatry and Behavioral Sciences'),
+                          ('Radiation Oncology', 'Radiation Oncology'),
+                          ('Radiology', 'Radiology'),
+                          ('School of Medicine', 'School of Medicine'),
+                          ('SoM - Basic Science Pool', 'SoM - Basic Science Pool'),
+                          ('SoM - Bio-X/Clark', 'SoM - Bio-X/Clark'),
+                          ('SoM - Bioengineering', 'SoM - Bioengineering'),
+                          ('SoM - Clinical Science Pool', 'SoM - Clinical Science Pool'),
+                          ('SoM - Other Departments', 'SoM - Other Departments'),
+                          ('SoM Dean\'s Office Administrative Units', 'SoM Dean\'s Office Administrative Units'),
+                          ('SoM Non Cap Projects', 'SoM Non Cap Projects'),
+                          ('Stanford Cancer/Stem Cell Biology', 'Stanford Cancer/Stem Cell Biology'),
+                          ('Stanford Institutes of Medicine', 'Stanford Institutes of Medicine'),
+                          ('Structural Biology Department', 'Structural Biology Department'),
+                          ('Surgery', 'Surgery'),
+                          ('Urology', 'Urology'),
+                          ('Urology - Administration', 'Urology - Administration'),
+                          ('Urology - Divisions', 'Urology - Divisions'))
+    stanford_department = models.CharField(blank=True, null=True, max_length=46, choices=DEPARTMENT_CHOICES)
+    sunet_id = models.CharField(blank=True, null=True, max_length=33)
+
     address_1 = models.TextField(blank=True, null=True)
     address_2 = models.TextField(blank=True, null=True)
     city = models.TextField(blank=True, null=True)
-    STATE_CHOICES = (('Alabama', 'Alabama'),
-                     ('Alaska', 'Alaska'),
-                     ('Arizona', 'Arizona'),
-                     ('Arkansas', 'Arkansas'),
-                     ('California', 'California'),
-                     ('Colorado', 'Colorado'),
-                     ('Connecticut', 'Connecticut'),
-                     ('Delaware', 'Deleware'),
-                     ('District of Columbia', 'District of Columbia'),
-                     ('Florida', 'Florida'),
-                     ('Georgia', 'Georgia'),
-                     ('Hawaii', 'Hawaii'),
-                     ('Idaho', 'Idaho'),
-                     ('Illinois', 'Indiana'),
-                     ('Iowa', 'Iowa'),
-                     ('Kansas', 'Kansas'),
-                     ('Kentucky', 'Kentucky'),
-                     ('Louisiana', 'Louisiana'),
-                     ('Maine', 'Maine'),
-                     ('Maryland', 'Maryland'),
-                     ('Massachusetts', 'Massachusetts'),
-                     ('Michigan', 'Michigan'),
-                     ('Minnesota', 'Minnesota'),
-                     ('Mississippi', 'Mississippi'),
-                     ('Missouri', 'Missouri'),
-                     ('Montana', 'Montana'),
-                     ('Nebraska', 'Nebraska'),
-                     ('Nevada', 'Nevada'),
-                     ('Vermont', 'Vermont'),
-                     ('Virginia', 'Virginia'),
-                     ('Washington', 'Washington'),
-                     ('West Virginia', 'West Virginia'),
-                     ('Wisconsin', 'Wisconsin'),
-                     ('Wyoming', 'Wyoming'),
-                     ('American Samoa', 'American Samoa'),
-                     ('Armed Forces America', 'Armed Forces America'),
-                     ('Armed Forces Europe', 'Armed Forces Europe'),
-                     ('Armed Forces Pacific', 'Armed Forces Pacific'),
-                     ('Guam', 'Guam'),
-                     ('Northern Mariana Islands', 'Northern, Mariana Islands'),
-                     ('Palau', 'Palau'),
-                     ('Puerto Rico', 'Puerto Rico'),
-                     ('Utah', 'Utah'),
-                     ('Virgin Island', 'Virgin Island'),
-                     ('Alberta', 'Alberta'),
-                     ('British Columbia', 'British Columbia'),
-                     ('Manitoba', 'Manitoba'),
-                     ('Nanavut', 'Nanavut'),
-                     ('New Brunswick', 'New Brunswick'),
-                     ('Newfoundland and Labrador', 'Newfoundland and Labrador'),
-                     ('Northwest Territories', 'Northwest Territories'),
-                     ('Nova Scotia', 'Nova Scotia'),
-                     ('Ontario', 'Ontario'),
-                     ('Prince Edward Island', 'Prince Edward Island'),
-                     ('Quebec', 'Quebec'),
-                     ('Saskatchewan', 'Saskatchewan'),
-                     ('Yukon Territory', 'Yukon Territory'),
-                     ('Other', 'Other'))
+    STATE_CHOICES = (('AL', 'Alabama'),
+                     ('AK', 'Alaska'),
+                     ('AZ', 'Arizona'),
+                     ('AR', 'Arkansas'),
+                     ('CA', 'California'),
+                     ('CO', 'Colorado'),
+                     ('CT', 'Connecticut'),
+                     ('DE', 'Deleware'),
+                     ('DC', 'District of Columbia'),
+                     ('FL', 'Florida'),
+                     ('GA', 'Georgia'),
+                     ('HI', 'Hawaii'),
+                     ('ID', 'Idaho'),
+                     ('IL', 'Illinois'),
+                     ('IN', 'Indiana'),
+                     ('IA', 'Iowa'),
+                     ('KS', 'Kansas'),
+                     ('KY', 'Kentucky'),
+                     ('LA', 'Louisiana'),
+                     ('ME', 'Maine'),
+                     ('MD', 'Maryland'),
+                     ('MA', 'Massachusetts'),
+                     ('MI', 'Michigan'),
+                     ('MN', 'Minnesota'),
+                     ('MS', 'Mississippi'),
+                     ('MO', 'Missouri'),
+                     ('MT', 'Montana'),
+                     ('NE', 'Nebraska'),
+                     ('NV', 'Nevada'),
+                     ('NH', 'New Hampshire'),
+                     ('NJ', 'New Jersey'),
+                     ('NM', 'New Mexico'),
+                     ('NY', 'New York'),
+                     ('NC', 'North Carolina'),
+                     ('ND', 'North Dakota'),
+                     ('OH', 'Ohio'),
+                     ('OK', 'Oklahoma'),
+                     ('OR', 'Oregon'),
+                     ('PA', 'Pennsylvania'),
+                     ('RI', 'Rhode Island'),
+                     ('SC', 'South Carolina'),
+                     ('SD', 'South Dakota'),
+                     ('TN', 'Tennessee'),
+                     ('TX', 'Texas'),
+                     ('UT', 'Utah'),
+                     ('VT', 'Vermont'),
+                     ('VA', 'Virginia'),
+                     ('WA', 'Washington'),
+                     ('WV', 'West Virginia'),
+                     ('WI', 'Wisconsin'),
+                     ('WY', 'Wyoming'))
 
-    state_province = models.CharField(blank=True, null=True, max_length=50, choices=STATE_CHOICES)
+    state = models.CharField(blank=True, null=True, max_length=50, choices=STATE_CHOICES)
+    county_province = models.CharField(blank=True, null=True, max_length=50)
     postal_code = models.CharField(blank=True, null=True, max_length=20)
     COUNTRY_CHOICES = (('United States', 'United States'),
                        ('Afghanistan', 'Afghanistan'),
@@ -364,13 +410,5 @@ class Meta:
                        ('Other', 'Other'))
 
     country = models.CharField(blank=True, null=True, max_length=50, choices=COUNTRY_CHOICES)
-    phone_number = models.CharField(blank=True, null=True, max_length=30)
-    extension = models.CharField(blank=True, null=True, max_length=10)
-    fax = models.CharField(blank=True, null=True, max_length=30)
-    HEAR_ABOUT_US_CHOICES = (('Direct Mail Brochure', 'Direct Mail Brochure'),
-                             ('Email Announcement', 'Email Announcement'),
-                             ('SCCME Web site', 'SCCME Web site'),
-                             ('Friend/Colleague', 'Friend/Colleague'),
-                             ('Other', 'Other, please enter:'))
-    hear_about_us = models.CharField(blank=True, null=True, max_length=255)
-    mailing_list = models.BooleanField(default=0)
+    GENDER_CHOICES = (('M', 'Male'),
+                      ('F', 'Female'))
diff --git a/common/djangoapps/cme_registration/tests/registration_tests.py b/common/djangoapps/cme_registration/tests/registration_tests.py
index a2f0edd0c7aa..d15bea2e045b 100644
--- a/common/djangoapps/cme_registration/tests/registration_tests.py
+++ b/common/djangoapps/cme_registration/tests/registration_tests.py
@@ -18,7 +18,7 @@
 from student.models import Registration, UserProfile
 from cme_registration.models import CmeUserProfile
 from student.tests.factories import UserFactory
-from cme_registration.views import DENIED_COUNTRIES, validate_export_controls
+from cme_registration.views import DENIED_COUNTRIES, validate_export_controls, setup_sub_affiliation_field
 TEST_MITX_FEATURES = settings.MITX_FEATURES.copy()
 TEST_MITX_FEATURES['USE_CME_REGISTRATION'] = True
 
@@ -35,35 +35,37 @@ def setUp(self):
                           'email': 'test@email.com',
                           'password': '1234',
                           'name': 'Chester Tester',
-                          'stanford_affiliated': '1',
-                          'how_stanford_affiliated': 'j\'st affiliat\'d',
+                          'first_name': 'Chester',
+                          'last_name': 'Tester',
+                          'middle_initial': 'A',
+                          'birth_date': '09/24',
                           'honor_code': 'true',
                           'terms_of_service': 'true',
-                          'profession': 'profession',
                           'professional_designation': 'professional_designation',
                           'license_number': 'license_number',
-                          'organization': 'organization',
+                          'license_country': 'license_country',
+                          'license_state': 'license_state',
+                          'physician_status': 'physician_status',
                           'patient_population': 'patient_population',
                           'specialty': 'specialty',
                           'sub_specialty': 'sub_specialty',
+                          'affiliation': 'affiliation',
+                          'other_affiliation': 'other_affiliation',
+                          'sub_affiliation': 'sub_affiliation',
+                          'sunet_id': 'sunet_id',
+                          'stanford_department': 'stanford_department',
                           'address_1': 'address_1',
                           'address_2': 'address_2',
                           'city': 'city',
-                          'state_province': 'state_province',
+                          'state': 'state',
                           'postal_code': 'postal_code',
                           'country': 'country',
-                          'phone_number': 'phone_number',
-                          'extension': 'extension',
-                          'fax': 'fax',
-                          'hear_about_us': 'hear_about_us',
-                          'mailing_list': 'false'}
+                          'county_province': 'county_province',
+                          }
 
     @unittest.skipIf(settings.MITX_FEATURES.get('DISABLE_CME_REGISTRATION_TESTS', False),
                      dedent("""Skipping Test because the url is not in CMS"""))
     def test_badly_formed_message(self):
-        """
-        Post itself is badly formed
-        """
 
         url = reverse('create_account')
         response = self.client.post(url, {})
@@ -71,274 +73,298 @@ def test_badly_formed_message(self):
 
     @unittest.skipIf(settings.MITX_FEATURES.get('DISABLE_CME_REGISTRATION_TESTS', False),
                      dedent("""Skipping Test because the url is not in CMS"""))
-    def test_profession_required(self):
-        """
-        Profession required field
-        """
+    def test_last_name_required(self):
 
-        self.post_vars['profession'] = ''
+        self.post_vars['last_name'] = ''
         url = reverse('create_account')
         response = self.client.post(url, self.post_vars)
 
-        self.assertContains(response, '{"field": "profession", "value": "Choose your profession.", "success": false}')
+        self.assertContains(response, '{"field": "last_name", "value": "Enter your last name", "success": false}')
+
+    @unittest.skipIf(settings.MITX_FEATURES.get('DISABLE_CME_REGISTRATION_TESTS', False),
+                     dedent("""Skipping Test because the url is not in CMS"""))
+    def test_first_name_required(self):
+
+        self.post_vars['first_name'] = ''
+        url = reverse('create_account')
+        response = self.client.post(url, self.post_vars)
+
+        self.assertContains(response, '{"field": "first_name", "value": "Enter your first name", "success": false}')
+
+    @unittest.skipIf(settings.MITX_FEATURES.get('DISABLE_CME_REGISTRATION_TESTS', False),
+                     dedent("""Skipping Test because the url is not in CMS"""))
+    def test_middle_initial_length(self):
+
+        self.post_vars['middle_initial'] = 'ABC'
+        url = reverse('create_account')
+        response = self.client.post(url, self.post_vars)
+
+        self.assertContains(response, '{"field": "middle_initial", "value": "Enter your middle initial as a single character", "success": false}')
+
+    @unittest.skipIf(settings.MITX_FEATURES.get('DISABLE_CME_REGISTRATION_TESTS', False),
+                     dedent("""Skipping Test because the url is not in CMS"""))
+    def test_birth_date_required(self):
+
+        self.post_vars['birth_date'] = ''
+        url = reverse('create_account')
+        response = self.client.post(url, self.post_vars)
+
+        self.assertContains(response, '{"field": "birth_date", "value": "Enter your birth date", "success": false}')
+
+    @unittest.skipIf(settings.MITX_FEATURES.get('DISABLE_CME_REGISTRATION_TESTS', False),
+                     dedent("""Skipping Test because the url is not in CMS"""))
+    def test_birth_date_format1(self):
+
+        self.post_vars['birth_date'] = '0102'
+        url = reverse('create_account')
+        response = self.client.post(url, self.post_vars)
+
+        self.assertContains(response, '{"field": "birth_date", "value": "Enter your birth date as MM/DD", "success": false}')
+
+    @unittest.skipIf(settings.MITX_FEATURES.get('DISABLE_CME_REGISTRATION_TESTS', False),
+                     dedent("""Skipping Test because the url is not in CMS"""))
+    def test_birth_date_format2(self):
+
+        self.post_vars['birth_date'] = '14/02'
+        url = reverse('create_account')
+        response = self.client.post(url, self.post_vars)
+
+        self.assertContains(response, '{"field": "birth_date", "value": "month must be in 1..12", "success": false}')
+
+    @unittest.skipIf(settings.MITX_FEATURES.get('DISABLE_CME_REGISTRATION_TESTS', False),
+                     dedent("""Skipping Test because the url is not in CMS"""))
+    def test_professional_designation_required(self):
+
+        self.post_vars['professional_designation'] = ''
+        url = reverse('create_account')
+        response = self.client.post(url, self.post_vars)
+
+        self.assertContains(response, '{"field": "professional_designation", "value": "Choose your professional designation", "success": false}')
 
     @unittest.skipIf(settings.MITX_FEATURES.get('DISABLE_CME_REGISTRATION_TESTS', False),
                      dedent("""Skipping Test because the url is not in CMS"""))
     def test_license_number_required(self):
-        """
-        License number required field
-        """
 
+        self.post_vars['professional_designation'] = 'DO'
         self.post_vars['license_number'] = ''
         url = reverse('create_account')
         response = self.client.post(url, self.post_vars)
 
-        self.assertContains(response, '{"field": "license_number", "value": "Enter your license number.", "success": false}')
+        self.assertContains(response, '{"field": "license_number", "value": "Enter your license number", "success": false}')
 
     @unittest.skipIf(settings.MITX_FEATURES.get('DISABLE_CME_REGISTRATION_TESTS', False),
                      dedent("""Skipping Test because the url is not in CMS"""))
-    def test_patient_population_required(self):
-        """
-        Patient population required field
-        """
+    def test_license_country_required(self):
 
-        self.post_vars['patient_population'] = ''
+        self.post_vars['professional_designation'] = 'DO'
+        self.post_vars['license_country'] = ''
         url = reverse('create_account')
         response = self.client.post(url, self.post_vars)
 
-        self.assertContains(response, '{"field": "patient_population", "value": "Choose your patient population", "success": false}')
+        self.assertContains(response, '{"field": "license_country", "value": "Choose your license country", "success": false}')
 
     @unittest.skipIf(settings.MITX_FEATURES.get('DISABLE_CME_REGISTRATION_TESTS', False),
                      dedent("""Skipping Test because the url is not in CMS"""))
-    def test_specialty_required(self):
-        """
-        Specialty required field
-        """
+    def test_license_state_required(self):
 
-        self.post_vars['specialty'] = ''
+        self.post_vars['license_country'] = 'United States'
+        self.post_vars['license_state'] = ''
         url = reverse('create_account')
         response = self.client.post(url, self.post_vars)
 
-        self.assertContains(response, '{"field": "specialty", "value": "Choose your specialty", "success": false}')
+        self.assertContains(response, '{"field": "license_state", "value": "Choose your license state", "success": false}')
 
     @unittest.skipIf(settings.MITX_FEATURES.get('DISABLE_CME_REGISTRATION_TESTS', False),
                      dedent("""Skipping Test because the url is not in CMS"""))
-    def test_sub_specialty_not_required(self):
-        """
-        Sub specialty not required
-        """
+    def test_physician_status_required(self):
 
-        self.post_vars['sub_specialty'] = ''
+        self.post_vars['professional_designation'] = 'DO'
+        self.post_vars['physician_status'] = ''
         url = reverse('create_account')
         response = self.client.post(url, self.post_vars)
 
-        self.assertContains(response, '"success": true')
+        self.assertContains(response, '{"field": "physician_status", "value": "Enter your physician status", "success": false}')
 
     @unittest.skipIf(settings.MITX_FEATURES.get('DISABLE_CME_REGISTRATION_TESTS', False),
                      dedent("""Skipping Test because the url is not in CMS"""))
-    def test_address_1_required(self):
-        """
-        Address 1 required field
-        """
+    def test_patient_population_required(self):
 
-        self.post_vars['address_1'] = ''
+        self.post_vars['professional_designation'] = 'DO'
+        self.post_vars['patient_population'] = ''
         url = reverse('create_account')
         response = self.client.post(url, self.post_vars)
 
-        self.assertContains(response, '{"field": "address_1", "value": "Enter your Address 01", "success": false}')
+        self.assertContains(response, '{"field": "patient_population", "value": "Choose your patient population", "success": false}')
 
     @unittest.skipIf(settings.MITX_FEATURES.get('DISABLE_CME_REGISTRATION_TESTS', False),
                      dedent("""Skipping Test because the url is not in CMS"""))
-    def test_city_required(self):
-        """
-        City required field
-        """
+    def test_specialty_required(self):
 
-        self.post_vars['city'] = ''
+        self.post_vars['professional_designation'] = 'DO'
+        self.post_vars['specialty'] = ''
         url = reverse('create_account')
         response = self.client.post(url, self.post_vars)
 
-        self.assertContains(response, '{"field": "city", "value": "Enter your city", "success": false}')
+        self.assertContains(response, '{"field": "specialty", "value": "Choose your specialty", "success": false}')
 
     @unittest.skipIf(settings.MITX_FEATURES.get('DISABLE_CME_REGISTRATION_TESTS', False),
                      dedent("""Skipping Test because the url is not in CMS"""))
-    def test_state_province_required(self):
-        """
-        State Province required field
-        """
+    def test_sub_specialty_not_required(self):
 
-        self.post_vars['state_province'] = ''
+        self.post_vars['sub_specialty'] = ''
         url = reverse('create_account')
         response = self.client.post(url, self.post_vars)
 
-        self.assertContains(response, '{"field": "state_province", "value": "Choose your state/Province", "success": false}')
+        self.assertContains(response, '"success": true')
 
     @unittest.skipIf(settings.MITX_FEATURES.get('DISABLE_CME_REGISTRATION_TESTS', False),
                      dedent("""Skipping Test because the url is not in CMS"""))
-    def test_postal_code_required(self):
-        """
-        Postal Code required field
-        """
+    def test_sub_affiliation_field(self):
 
-        self.post_vars['postal_code'] = ''
+        self.post_vars['affiliation'] = 'Packard Children\'s Health Alliance'
+        self.post_vars['PCHA_affiliation'] = 'Dummy_Value1'
+
+        return_vars = setup_sub_affiliation_field(self.post_vars)
+        self.assertEquals(return_vars['sub_affiliation'], 'Dummy_Value1')
+
+        self.post_vars['affiliation'] = 'University Healthcare Alliance'
+        self.post_vars['UHA_affiliation'] = 'Dummy_Value2'
+
+        return_vars = setup_sub_affiliation_field(self.post_vars)
+        self.assertEquals(return_vars['sub_affiliation'], 'Dummy_Value2')
+
+        self.post_vars['affiliation'] = 'Lucile Packard Children\'s Hospital'
+        self.post_vars['PCHA_affiliation'] = 'Dummy_Value1'
+        self.post_vars['UHA_affiliation'] = 'Dummy_Value2'
+
+        return_vars = setup_sub_affiliation_field(self.post_vars)
+        self.assertEquals(return_vars['sub_affiliation'], '')
+
+        self.post_vars['affiliation'] = 'Packard Children\'s Health Alliance'
+        self.post_vars['PCHA_affiliation'] = ''
         url = reverse('create_account')
         response = self.client.post(url, self.post_vars)
 
-        self.assertContains(response, '{"field": "postal_code", "value": "Enter your postal code", "success": false}')
+        self.assertContains(response, '{"field": "sub_affiliation", "value": "Enter your Packard Children\'s Health Alliance affiliation", "success": false}')
 
     @unittest.skipIf(settings.MITX_FEATURES.get('DISABLE_CME_REGISTRATION_TESTS', False),
                      dedent("""Skipping Test because the url is not in CMS"""))
-    def test_country_required(self):
-        """
-        Country required field
-        """
+    def test_sunet_id_required(self):
 
-        self.post_vars['country'] = ''
+        self.post_vars['affiliation'] = 'Stanford University'
+        self.post_vars['sunet_id'] = ''
         url = reverse('create_account')
         response = self.client.post(url, self.post_vars)
 
-        self.assertContains(response, '{"field": "country", "value": "Choose your country", "success": false}')
+        self.assertContains(response, '{"field": "sunet_id", "value": "Enter your SUNet ID", "success": false}')
 
     @unittest.skipIf(settings.MITX_FEATURES.get('DISABLE_CME_REGISTRATION_TESTS', False),
                      dedent("""Skipping Test because the url is not in CMS"""))
-    def test_phone_number_required(self):
-        """
-        Phone number required field
-        """
+    def test_stanford_department_required(self):
 
-        self.post_vars['phone_number'] = ''
+        self.post_vars['affiliation'] = 'Stanford University'
+        self.post_vars['stanford_department'] = ''
         url = reverse('create_account')
         response = self.client.post(url, self.post_vars)
 
-        self.assertContains(response, '{"field": "phone_number", "value": "Enter your phone number", "success": false}')
+        self.assertContains(response, '{"field": "stanford_department", "value": "Choose your Stanford department", "success": false}')
 
     @unittest.skipIf(settings.MITX_FEATURES.get('DISABLE_CME_REGISTRATION_TESTS', False),
                      dedent("""Skipping Test because the url is not in CMS"""))
-    def test_hear_about_us_required(self):
-        """
-        Hear about us required field
-        """
+    def test_address_1_required(self):
 
-        self.post_vars['hear_about_us'] = ''
+        self.post_vars['address_1'] = ''
         url = reverse('create_account')
         response = self.client.post(url, self.post_vars)
 
-        self.assertContains(response, '{"field": "hear_about_us", "value": "Choose how you heard about us", "success": false}')
+        self.assertContains(response, '{"field": "address_1", "value": "Enter your Address 1", "success": false}')
 
     @unittest.skipIf(settings.MITX_FEATURES.get('DISABLE_CME_REGISTRATION_TESTS', False),
                      dedent("""Skipping Test because the url is not in CMS"""))
-    def test_specialty_other(self):
-        """
-        Specialty "other" required field
-        """
+    def test_city_required(self):
 
-        self.post_vars['specialty'] = 'Other'
-        self.post_vars['specialty_free'] = ''
+        self.post_vars['city'] = ''
         url = reverse('create_account')
         response = self.client.post(url, self.post_vars)
 
-        self.assertContains(response, '{"field": "specialty", "value": "Enter your specialty.", "success": false}')
+        self.assertContains(response, '{"field": "city", "value": "Enter your city", "success": false}')
 
     @unittest.skipIf(settings.MITX_FEATURES.get('DISABLE_CME_REGISTRATION_TESTS', False),
                      dedent("""Skipping Test because the url is not in CMS"""))
-    def test_sub_specialty_other(self):
-        """
-        Sub specialty "other" required field
-        """
+    def test_country_required(self):
 
-        self.post_vars['sub_specialty'] = 'Other'
-        self.post_vars['sub_specialty_free'] = ''
+        self.post_vars['country'] = ''
         url = reverse('create_account')
         response = self.client.post(url, self.post_vars)
 
-        self.assertContains(response, '{"field": "sub_specialty", "value": "Enter your sub-specialty.", "success": false}')
+        self.assertContains(response, '{"field": "country", "value": "Choose your country", "success": false}')
 
     @unittest.skipIf(settings.MITX_FEATURES.get('DISABLE_CME_REGISTRATION_TESTS', False),
                      dedent("""Skipping Test because the url is not in CMS"""))
-    def test_hear_about_us_other(self):
-        """
-        Hear about us "other" required field
-        """
+    def test_state_required(self):
 
-        self.post_vars['hear_about_us'] = 'Other'
-        self.post_vars['hear_about_us_free'] = ''
+        self.post_vars['country'] = 'United States'
+        self.post_vars['state'] = ''
         url = reverse('create_account')
         response = self.client.post(url, self.post_vars)
 
-        self.assertContains(response, '{"field": "hear_about_us", "value": "Enter how you heard about us.", "success": false}')
+        self.assertContains(response, '{"field": "state", "value": "Choose your state", "success": false}')
 
     @unittest.skipIf(settings.MITX_FEATURES.get('DISABLE_CME_REGISTRATION_TESTS', False),
                      dedent("""Skipping Test because the url is not in CMS"""))
-    def test_stanford_affiliated_required(self):
-        """
-        Stanford affiliated required field
-        """
+    def test_postal_code_required(self):
 
-        del self.post_vars['stanford_affiliated']
+        self.post_vars['postal_code'] = ''
         url = reverse('create_account')
         response = self.client.post(url, self.post_vars)
 
-        self.assertContains(response, '{"field": "stanford_affiliated", "value": "Select whether, or not, you are affiliated with Stanford.", "success": false}')
+        self.assertContains(response, '{"field": "postal_code", "value": "Enter your postal code", "success": false}')
 
     @unittest.skipIf(settings.MITX_FEATURES.get('DISABLE_CME_REGISTRATION_TESTS', False),
                      dedent("""Skipping Test because the url is not in CMS"""))
-    def test_honor_code_required(self):
-        """
-        Honor code required field
-        """
+    def test_specialty_other(self):
 
-        del self.post_vars['honor_code']
+        self.post_vars['specialty'] = 'Other'
+        self.post_vars['specialty_free'] = ''
         url = reverse('create_account')
         response = self.client.post(url, self.post_vars)
 
-        self.assertContains(response, '{"field": "honor_code", "value": "To enroll, you must follow the honor code.", "success": false}')
+        self.assertContains(response, '{"field": "specialty", "value": "Enter your specialty.", "success": false}')
 
     @unittest.skipIf(settings.MITX_FEATURES.get('DISABLE_CME_REGISTRATION_TESTS', False),
                      dedent("""Skipping Test because the url is not in CMS"""))
-    def test_tos_required(self):
-        """
-        TOS required field
-        """
+    def test_sub_specialty_other(self):
 
-        del self.post_vars['terms_of_service']
+        self.post_vars['sub_specialty'] = 'Other'
+        self.post_vars['sub_specialty_free'] = ''
         url = reverse('create_account')
         response = self.client.post(url, self.post_vars)
 
-        self.assertContains(response, '{"field": "terms_of_service", "value": "You must accept the terms of service.", "success": false}')
+        self.assertContains(response, '{"field": "sub_specialty", "value": "Enter your sub-specialty.", "success": false}')
 
     @unittest.skipIf(settings.MITX_FEATURES.get('DISABLE_CME_REGISTRATION_TESTS', False),
                      dedent("""Skipping Test because the url is not in CMS"""))
-    def test_stanford_affiliated_choose(self):
-        """
-        How Stanford affiliated required if stanford affiliated
-        """
+    def test_honor_code_required(self):
 
-        self.post_vars['how_stanford_affiliated'] = ''
+        del self.post_vars['honor_code']
         url = reverse('create_account')
         response = self.client.post(url, self.post_vars)
 
-        self.assertContains(response, '{"field": "stanford_affiliated", "value": "Choose how you are affiliated with Stanford.", "success": false}')
+        self.assertContains(response, '{"field": "honor_code", "value": "To enroll, you must follow the honor code.", "success": false}')
 
     @unittest.skipIf(settings.MITX_FEATURES.get('DISABLE_CME_REGISTRATION_TESTS', False),
                      dedent("""Skipping Test because the url is not in CMS"""))
-    def test_stanford_affiliated_other(self):
-        """
-        Stanford affiliated "other" required field
-        """
+    def test_tos_required(self):
 
-        self.post_vars['how_stanford_affiliated'] = 'Other'
-        self.post_vars['how_stanford_affiliated_free'] = ''
+        del self.post_vars['terms_of_service']
         url = reverse('create_account')
         response = self.client.post(url, self.post_vars)
 
-        self.assertContains(response, '{"field": "how_stanford_affiliated", "value": "Enter how you are affiliated with Stanford.", "success": false}')
+        self.assertContains(response, '{"field": "terms_of_service", "value": "You must accept the terms of service.", "success": false}')
 
     @unittest.skipIf(settings.MITX_FEATURES.get('DISABLE_CME_REGISTRATION_TESTS', False),
                      dedent("""Skipping Test because the url is not in CMS"""))
     def test_db_records_created(self):
-        """
-        Everything gets created correctly when all input data good
-        """
 
         url = reverse('create_account')
         response = self.client.post(url, self.post_vars)
@@ -357,26 +383,31 @@ def test_db_records_created(self):
         #Check cme_user_profile was created
         cme_user_profile = CmeUserProfile.objects.filter(user=user[0],
                                                          name='Chester Tester',
-                                                         stanford_affiliated=True,
-                                                         how_stanford_affiliated='j\'st affiliat\'d',
-                                                         profession='profession',
+                                                         first_name='Chester',
+                                                         last_name='Tester',
+                                                         middle_initial='A',
+                                                         birth_date='09/24',
                                                          professional_designation='professional_designation',
                                                          license_number='license_number',
-                                                         organization='organization',
+                                                         license_country='license_country',
+                                                         license_state='license_state',
+                                                         physician_status='physician_status',
                                                          patient_population='patient_population',
                                                          specialty='specialty',
                                                          sub_specialty='sub_specialty',
+                                                         affiliation='affiliation',
+                                                         sub_affiliation='',
+                                                         sunet_id='sunet_id',
+                                                         stanford_department='stanford_department',
                                                          address_1='address_1',
                                                          address_2='address_2',
                                                          city='city',
-                                                         state_province='state_province',
+                                                         state='state',
                                                          postal_code='postal_code',
                                                          country='country',
-                                                         phone_number='phone_number',
-                                                         extension='extension',
-                                                         fax='fax',
-                                                         hear_about_us='hear_about_us',
-                                                         mailing_list=False)
+                                                         county_province='county_province'
+                                                         )
+
         self.assertEqual(1, len(cme_user_profile))
 
         #Check user_profile was created
@@ -386,18 +417,15 @@ def test_db_records_created(self):
     @unittest.skipIf(settings.MITX_FEATURES.get('DISABLE_CME_REGISTRATION_TESTS', False),
                      dedent("""Skipping Test because the url is not in CMS"""))
     def test_db_records_with_others_created(self):
-        """
-        Everything gets created correctly when all input data good with "others"
-        """
 
-        self.post_vars['how_stanford_affiliated'] = 'Other'
-        self.post_vars['how_stanford_affiliated_free'] = 'Wife of the provost'
         self.post_vars['specialty'] = 'Other'
         self.post_vars['specialty_free'] = 'Patient care'
         self.post_vars['sub_specialty'] = 'Other'
         self.post_vars['sub_specialty_free'] = 'Legs and feet'
-        self.post_vars['hear_about_us'] = 'Other'
-        self.post_vars['hear_about_us_free'] = 'Through the grapevine'
+        self.post_vars['affiliation'] = 'Other'
+        self.post_vars['other_affiliation'] = 'other_affiliation'
+        self.post_vars['sub_affiliation'] = ''
+
         url = reverse('create_account')
         response = self.client.post(url, self.post_vars)
 
@@ -415,20 +443,31 @@ def test_db_records_with_others_created(self):
         #Check cme_user_profile was created
         cme_user_profile = CmeUserProfile.objects.filter(user=user[0],
                                                          name='Chester Tester',
-                                                         stanford_affiliated=True,
-                                                         how_stanford_affiliated='Wife of the provost',
-                                                         profession='profession',
+                                                         first_name='Chester',
+                                                         last_name='Tester',
+                                                         middle_initial='A',
+                                                         birth_date='09/24',
+                                                         professional_designation='professional_designation',
                                                          license_number='license_number',
+                                                         license_country='license_country',
+                                                         license_state='license_state',
+                                                         physician_status='physician_status',
                                                          patient_population='patient_population',
-                                                         specialty='Patient care',
-                                                         sub_specialty='Legs and feet',
+                                                         affiliation='Other',
+                                                         other_affiliation='other_affiliation',
+                                                         sub_affiliation='',
+                                                         sunet_id='sunet_id',
+                                                         stanford_department='stanford_department',
                                                          address_1='address_1',
+                                                         address_2='address_2',
                                                          city='city',
-                                                         state_province='state_province',
+                                                         state='state',
                                                          postal_code='postal_code',
                                                          country='country',
-                                                         phone_number='phone_number',
-                                                         hear_about_us='Through the grapevine')
+                                                         county_province='county_province',
+                                                         specialty='Patient care',
+                                                         sub_specialty='Legs and feet',
+                                                         )
         self.assertEqual(1, len(cme_user_profile))
 
         #Check user_profile was created
@@ -438,9 +477,6 @@ def test_db_records_with_others_created(self):
     @unittest.skipIf(settings.MITX_FEATURES.get('DISABLE_CME_REGISTRATION_TESTS', False),
                      dedent("""Skipping Test because the url is not in CMS"""))
     def test_valid_email(self):
-        """
-        Email address conforms
-        """
 
         self.post_vars['email'] = 'garbage_email_string'
         url = reverse('create_account')
@@ -451,9 +487,6 @@ def test_valid_email(self):
     @unittest.skipIf(settings.MITX_FEATURES.get('DISABLE_CME_REGISTRATION_TESTS', False),
                      dedent("""Skipping Test because the url is not in CMS"""))
     def test_valid_username(self):
-        """
-        Username conforms
-        """
 
         self.post_vars['username'] = ' $%$%$# '
         url = reverse('create_account')
@@ -464,9 +497,6 @@ def test_valid_username(self):
     @unittest.skipIf(settings.MITX_FEATURES.get('DISABLE_CME_REGISTRATION_TESTS', False),
                      dedent("""Skipping Test because the url is not in CMS"""))
     def test_dupe_username(self):
-        """
-        Username not already existing
-        """
 
         UserFactory.create(username="student001", email="student001@test.com")
 
@@ -479,9 +509,6 @@ def test_dupe_username(self):
     @unittest.skipIf(settings.MITX_FEATURES.get('DISABLE_CME_REGISTRATION_TESTS', False),
                      dedent("""Skipping Test because the url is not in CMS"""))
     def test_register_when_logged_in(self):
-        """
-        Must be logged out to register
-        """
 
         user = UserFactory.create(username="student002", email="student002@test.com")
         self.client.login(username=user.username, password='test')
@@ -493,9 +520,6 @@ def test_register_when_logged_in(self):
     @unittest.skipIf(settings.MITX_FEATURES.get('DISABLE_CME_REGISTRATION_TESTS', False),
                      dedent("""Skipping Test because the url is not in CMS"""))
     def test_register_page_loads(self):
-        """
-        CME Register page itself renders
-        """
 
         url = reverse('register_user')
         response = self.client.post(url, {})
@@ -504,9 +528,6 @@ def test_register_page_loads(self):
     @unittest.skipIf(settings.MITX_FEATURES.get('DISABLE_CME_REGISTRATION_TESTS', False),
                      dedent("""Skipping Test because the url is not in CMS"""))
     def test_reroute_activation_email(self):
-        """
-        Registration successful with reroute activation email true
-        """
 
         settings.MITX_FEATURES['REROUTE_ACTIVATION_EMAIL'] = 'a@b.edu'
 
@@ -520,9 +541,6 @@ def test_reroute_activation_email(self):
     @unittest.skipIf(settings.MITX_FEATURES.get('DISABLE_CME_REGISTRATION_TESTS', False),
                      dedent("""Skipping Test because the url is not in CMS"""))
     def test_save_profile_exception(self):
-        """
-        Profile doesn't get created on exception
-        """
 
         url = reverse('create_account')
         self.client.post(url, self.post_vars)
@@ -534,9 +552,6 @@ def test_save_profile_exception(self):
     @unittest.skipIf(settings.MITX_FEATURES.get('DISABLE_CME_REGISTRATION_TESTS', False),
                      dedent("""Skipping Test because the url is not in CMS"""))
     def test_activation_email_exception(self):
-        """
-        Exception if activation email not sent
-        """
 
         url = reverse('create_account')
         response = self.client.post(url, self.post_vars)
@@ -545,9 +560,7 @@ def test_activation_email_exception(self):
         self.assertContains(response, 'Could not send activation e-mail.')
 
     def test_export_controls(self):
-        """
-        Test export controls verification
-        """
+
         for country in DENIED_COUNTRIES:
             retv = validate_export_controls({'country': country})
             self.assertFalse(retv['success'])
diff --git a/common/djangoapps/cme_registration/views.py b/common/djangoapps/cme_registration/views.py
index d9e54e5a679a..e118df90bd99 100644
--- a/common/djangoapps/cme_registration/views.py
+++ b/common/djangoapps/cme_registration/views.py
@@ -5,6 +5,7 @@
 import json
 import logging
 from dogapi import dog_stats_api
+import datetime
 
 from django_future.csrf import ensure_csrf_cookie
 from django.conf import settings
@@ -22,7 +23,6 @@
 from cme_registration.models import CmeUserProfile
 from mitxmako.shortcuts import render_to_response, render_to_string
 
-
 log = logging.getLogger("mitx.student")
 
 
@@ -40,7 +40,8 @@ def cme_register_user(request, extra_context=None):
         'enrollment_action': request.GET.get('enrollment_action'),
         'patient_population_choices': PATIENT_POPULATION_CHOICES,
         'specialty_choices': SPECIALTY_CHOICES,
-        'sub_specialty_choices': SUB_SPECIALTY_CHOICES
+        'sub_specialty_choices': SUB_SPECIALTY_CHOICES,
+        'sub_affiliation_choices': SUB_AFFILIATION_CHOICES,
     }
     if extra_context is not None:
         context.update(extra_context)
@@ -56,7 +57,7 @@ def cme_create_account(request, post_override=None):
     '''
     json_string = {'success': False}
 
-    post_vars = post_override if post_override else request.POST
+    post_vars = post_override if post_override else request.POST.copy()
 
     # Confirm we have a properly formed request
     for var in ['username', 'email', 'password', 'name']:
@@ -65,27 +66,56 @@ def cme_create_account(request, post_override=None):
             json_string['field'] = var
             return HttpResponse(json.dumps(json_string))
 
-    #Validate required felds
-    error = validate_required_fields(post_vars)
+    # Validate required fields set1
+    error = validate_required_fields_set1(post_vars)
     if error is not None:
         return HttpResponse(json.dumps(error))
 
-    #Validate required check boxes
-    error = validate_required_boxes(post_vars)
+    # Validate length of middle initial
+    error = validate_middle_initial_length(post_vars)
+    if error is not None:
+        return HttpResponse(json.dumps(error))
+
+    # Validate birth date
+    error = validate_birth_date_format(post_vars)
+    if error is not None:
+        return HttpResponse(json.dumps(error))
+
+    # Validate fields dependent on Professional Designation
+    error = validate_professional_fields(post_vars)
     if error is not None:
         return HttpResponse(json.dumps(error))
 
-    #Validate required radio buttons
-    error = validate_required_radios(post_vars)
+    # Setup post_vars for correct sub_affiliation field
+    post_vars = setup_sub_affiliation_field(post_vars)
+
+    # Validate affiliation fields
+    error = validate_affiliation_fields(post_vars)
     if error is not None:
         return HttpResponse(json.dumps(error))
 
-    #Validate required secondary fields
+    # Validate required fields set2
+    error = validate_required_fields_set2(post_vars)
+    if error is not None:
+        return HttpResponse(json.dumps(error))
+
+    # Validate required check boxes
+    error = validate_required_boxes(post_vars)
+    if error is not None:
+        return HttpResponse(json.dumps(error))
+
+    # Validate required radio buttons
+    # Commented out while no radios exist
+#     error = validate_required_radios(post_vars)
+#     if error is not None:
+#         return HttpResponse(json.dumps(error))
+
+    # Validate required secondary fields
     error = validate_required_secondaries(post_vars)
     if error is not None:
         return HttpResponse(json.dumps(error))
 
-    #Validate email address
+    # Validate email address
     try:
         validate_email(post_vars['email'])
     except ValidationError:
@@ -93,7 +123,7 @@ def cme_create_account(request, post_override=None):
         json_string['field'] = 'email'
         return HttpResponse(json.dumps(json_string))
 
-    #Validate username conforms
+    # Validate username conforms
     try:
         validate_slug(post_vars['username'])
     except ValidationError:
@@ -101,7 +131,7 @@ def cme_create_account(request, post_override=None):
         json_string['field'] = 'username'
         return HttpResponse(json.dumps(json_string))
 
-    #Validate Export controls
+    # Validate Export controls
     error = validate_export_controls(post_vars)
     if error is not None:
         return HttpResponse(json.dumps(error))
@@ -163,6 +193,7 @@ def _do_cme_create_account(post_vars):
     Since CmeUserProfile is implemented using multi-table inheritence of UserProfile, the CmeUserProfile object
     will also contain all the UserProfile fields.
     """
+
     user = User(username=post_vars['username'],
                 email=post_vars['email'],
                 is_active=False)
@@ -191,19 +222,18 @@ def _do_cme_create_account(post_vars):
 
     #UserProfile fields
     cme_user_profile.name = post_vars['name']
+    cme_user_profile.gender = post_vars.get('gender')
 
     #CmeUserProfile fields
-    cme_user_profile.profession = post_vars.get('profession')
+    cme_user_profile.last_name = post_vars['last_name']
+    cme_user_profile.first_name = post_vars['first_name']
+    cme_user_profile.middle_initial = post_vars.get('middle_initial')
+    cme_user_profile.birth_date = post_vars['birth_date']
     cme_user_profile.professional_designation = post_vars.get('professional_designation')
     cme_user_profile.license_number = post_vars.get('license_number')
-    cme_user_profile.organization = post_vars.get('organization')
-    cme_user_profile.stanford_affiliated = True if post_vars.get('stanford_affiliated') == '1' else False
-
-    if post_vars.get('how_stanford_affiliated') == 'Other':
-        cme_user_profile.how_stanford_affiliated = post_vars.get('how_stanford_affiliated_free')
-    else:
-        cme_user_profile.how_stanford_affiliated = post_vars.get('how_stanford_affiliated')
-
+    cme_user_profile.license_country = post_vars.get('license_country')
+    cme_user_profile.license_state = post_vars.get('license_state')
+    cme_user_profile.physician_status = post_vars.get('physician_status')
     cme_user_profile.patient_population = post_vars.get('patient_population')
 
     if post_vars.get('specialty') == 'Other':
@@ -216,32 +246,34 @@ def _do_cme_create_account(post_vars):
     else:
         cme_user_profile.sub_specialty = post_vars.get('sub_specialty')
 
+    cme_user_profile.affiliation = post_vars.get('affiliation')
+
+    if post_vars.get('affiliation') == 'Other':
+        cme_user_profile.other_affiliation = post_vars.get('other_affiliation')
+    else:
+        cme_user_profile.other_affiliation = None
+
+    cme_user_profile.sub_affiliation = post_vars.get('sub_affiliation')
+    cme_user_profile.sunet_id = post_vars.get('sunet_id')
+    cme_user_profile.stanford_department = post_vars.get('stanford_department')
     cme_user_profile.address_1 = post_vars.get('address_1')
     cme_user_profile.address_2 = post_vars.get('address_2')
     cme_user_profile.city = post_vars.get('city')
-    cme_user_profile.state_province = post_vars.get('state_province')
+    cme_user_profile.state = post_vars.get('state')
+    cme_user_profile.county_province = post_vars.get('county_province')
     cme_user_profile.postal_code = post_vars.get('postal_code')
     cme_user_profile.country = post_vars.get('country')
-    cme_user_profile.phone_number = post_vars.get('phone_number')
-    cme_user_profile.extension = post_vars.get('extension')
-    cme_user_profile.fax = post_vars.get('fax')
-
-    if post_vars.get('hear_about_us') == 'Other':
-        cme_user_profile.hear_about_us = post_vars.get('hear_about_us_free')
-    else:
-        cme_user_profile.hear_about_us = post_vars.get('hear_about_us')
-
-    cme_user_profile.mailing_list = 1 if post_vars.get('mailing_list') == 'true' else 0
 
     try:
         cme_user_profile.save()
 
     except Exception:
+        print "Could not create cme_user_profile"
         log.exception("UserProfile creation failed for user {0}.".format(user.email))
     return (user, cme_user_profile, registration)
 
 
-def validate_required_fields(post_vars):
+def validate_required_fields_set1(post_vars):
     """
     Checks that required free text fields contain at least 2 chars
     `post_vars` is dict of post parameters (a `dict`)
@@ -252,29 +284,174 @@ def validate_required_fields(post_vars):
     required_fields_list = [{'email': 'A properly formatted e-mail is required.'},
                             {'password': 'A valid password is required.'},
                             {'username': 'Username must be minimum of two characters long.'},
-                            {'name': 'Your legal name must be a minimum of two characters long.'},
-                            {'profession': 'Choose your profession.'},
-                            {'license_number': 'Enter your license number.'},
+                            {'name': 'Your full name must be a minimum of two characters long.'},
+                            {'last_name': 'Enter your last name'},
+                            {'first_name': 'Enter your first name'},
+                            {'birth_date': 'Enter your birth date'},
+                            {'professional_designation': 'Choose your professional designation'},
+                            ]
+
+    error = {}
+    for required_field in required_fields_list:
+        for key, val in required_field.iteritems():
+            if len(post_vars.get(key)) < 2:
+                error['success'] = False
+                error['value'] = val
+                error['field'] = key
+                return error
+
+
+def validate_middle_initial_length(post_vars):
+    """
+    Checks length of middle initial
+    """
+
+    if len(post_vars.get('middle_initial')) > 1:
+        error = {}
+        error['success'] = False
+        error['value'] = 'Enter your middle initial as a single character'
+        error['field'] = 'middle_initial'
+        return error
+
+
+def validate_birth_date_format(post_vars):
+    """
+    Checks date is in format 'MM/DD'
+    """
+
+    birth_date = post_vars.get('birth_date')
+    date_parts = birth_date.split('/')
+
+    error = {}
+    if len(date_parts) < 2:
+        error['success'] = False
+        error['value'] = 'Enter your birth date as MM/DD'
+        error['field'] = 'birth_date'
+        return error
+
+    dummy_year = 2013
+    try:
+        dateobj = datetime.date(dummy_year, int(date_parts[0]), int(date_parts[1]))
+    except ValueError, e:
+        error['success'] = False
+        error['value'] = str(e)
+        error['field'] = 'birth_date'
+        return error
+
+
+def validate_professional_fields(post_vars):
+    """
+    Checks that professional fields are filled out correctly
+    `post_vars` is dict of post parameters (a `dict`)
+    Returns a dict indicating failure, field and message on empty field else None
+    """
+
+    required_fields_list = [{'license_number': 'Enter your license number'},
+                            {'license_country': 'Choose your license country'},
+                            {'physician_status': 'Enter your physician status'},
                             {'patient_population': 'Choose your patient population'},
                             {'specialty': 'Choose your specialty'},
-                            {'address_1': 'Enter your Address 01'},
+                            ]
+
+    error = {}
+    if post_vars.get('professional_designation') in ['DO', 'MD', 'MD, PhD', 'MBBS']:
+        for required_field in required_fields_list:
+            for key, val in required_field.iteritems():
+                if len(post_vars.get(key)) < 2:
+                    error['success'] = False
+                    error['value'] = val
+                    error['field'] = key
+                    return error
+
+    # license_state is required if license_country = United States
+    if post_vars.get('license_country') == 'United States':
+        if len(post_vars.get('license_state')) < 2:
+            error['success'] = False
+            error['value'] = 'Choose your license state'
+            error['field'] = 'license_state'
+            return error
+
+
+def setup_sub_affiliation_field(post_vars):
+    """
+    Sets post_vars['sub_affiliation'] to correct value dependent upon affiliation dropdown
+    """
+
+    affiliation_values = [{'Packard Children\'s Health Alliance': 'PCHA_affiliation'},
+                          {'University Healthcare Alliance': 'UHA_affiliation'},
+                          ]
+
+    post_vars['sub_affiliation'] = ''
+    for affiliation_value in affiliation_values:
+        for key, val in affiliation_value.iteritems():
+            if post_vars.get('affiliation') == key:
+                post_vars['sub_affiliation'] = post_vars.get(val)
+
+    return post_vars
+
+
+def validate_affiliation_fields(post_vars):
+    """
+    Checks affiliation fields
+    """
+
+    error = {}
+    affiliation_fields_list = [{'Packard Children\'s Health Alliance': 'Enter your Packard Children\'s Health Alliance affiliation'},
+                               {'University Healthcare Alliance': 'Enter your University Healthcare Alliance affiliation'},
+                               ]
+
+    for affiliation_field in affiliation_fields_list:
+        for key, val in affiliation_field.iteritems():
+            if post_vars.get('affiliation') == key and len(post_vars.get('sub_affiliation')) < 2:
+                error['success'] = False
+                error['value'] = val
+                error['field'] = 'sub_affiliation'
+                return error
+
+    required_fields_list = [{'sunet_id': 'Enter your SUNet ID'},
+                            {'stanford_department': 'Choose your Stanford department'},
+                            ]
+
+    if post_vars.get('affiliation') == 'Stanford University':
+        for required_field in required_fields_list:
+            for key, val in required_field.iteritems():
+                if len(post_vars.get(key)) < 2:
+                    error['success'] = False
+                    error['value'] = val
+                    error['field'] = key
+                    return error
+
+
+def validate_required_fields_set2(post_vars):
+    """
+    Checks that required free text fields contain at least 2 chars
+    `post_vars` is dict of post parameters (a `dict`)
+    Returns a dict indicating failure, field and message on empty field else None
+    """
+
+    #Add additional required fields here
+    required_fields_list = [{'address_1': 'Enter your Address 1'},
                             {'city': 'Enter your city'},
-                            {'state_province': 'Choose your state/Province'},
-                            {'postal_code': 'Enter your postal code'},
                             {'country': 'Choose your country'},
-                            {'phone_number': 'Enter your phone number'},
-                            {'hear_about_us': 'Choose how you heard about us'}
-                           ]
+                            {'postal_code': 'Enter your postal code'},
+                            ]
 
     error = {}
     for required_field in required_fields_list:
-        for key, val in required_field.iteritems():   
+        for key, val in required_field.iteritems():
             if len(post_vars.get(key)) < 2:
                 error['success'] = False
                 error['value'] = val
                 error['field'] = key
                 return error
 
+    if post_vars.get('country') == 'United States':
+        if len(post_vars.get('state')) < 2:
+            error['success'] = False
+            error['value'] = 'Choose your state'
+            error['field'] = 'state'
+            return error
+
 
 def validate_required_boxes(post_vars):
     """
@@ -307,11 +484,8 @@ def validate_required_secondaries(post_vars):
     """
 
     #Add additional required secondaries here
-    required_secondaries_dict = {'stanford_affiliated': ('1', 'how_stanford_affiliated', 'Choose how you are affiliated with Stanford.'),
-                                 'how_stanford_affiliated': ('Other', 'how_stanford_affiliated_free', 'Enter how you are affiliated with Stanford.'),
-                                 'specialty': ('Other', 'specialty_free', 'Enter your specialty.'),
+    required_secondaries_dict = {'specialty': ('Other', 'specialty_free', 'Enter your specialty.'),
                                  'sub_specialty': ('Other', 'sub_specialty_free', 'Enter your sub-specialty.'),
-                                 'hear_about_us': ('Other', 'hear_about_us_free', 'Enter how you heard about us.')
                                  }
 
     error = {}
@@ -322,25 +496,25 @@ def validate_required_secondaries(post_vars):
             error['field'] = k
             return error
 
-
-def validate_required_radios(post_vars):
-    """
-    Checks that required radio buttons have been checked
-    `post_vars is dict of post parameters (a `dict)
-    Returns a dict indicating failure, field and message on empty field else None
-    """
-
-    #Add additional required radios here
-    required_radios_dict = {'stanford_affiliated': 'Select whether, or not, you are affiliated with Stanford.'
-                            }
-
-    error = {}
-    for k, val in required_radios_dict.items():
-        if k not in post_vars:
-            error['success'] = False
-            error['value'] = val
-            error['field'] = k
-            return error
+# Commented out while no radios exist
+# def validate_required_radios(post_vars):
+#     """
+#     Checks that required radio buttons have been checked
+#     `post_vars is dict of post parameters (a `dict)
+#     Returns a dict indicating failure, field and message on empty field else None
+#     """
+#
+#     #Add additional required radios here
+#     required_radios_dict = {
+#                             }
+#
+#     error = {}
+#     for k, val in required_radios_dict.items():
+#         if k not in post_vars:
+#             error['success'] = False
+#             error['value'] = val
+#             error['field'] = k
+#             return error
 
 
 def validate_export_controls(post_vars):
@@ -357,21 +531,22 @@ def validate_export_controls(post_vars):
         }
 
 
-DENIED_COUNTRIES = [
-    'Sudan',
-    'Korea, Democratic People\'s Republic Of',
-    'Iran, Islamic Republic Of',
-    'Cuba',
-    'Syrian Arab Republic',
-    ]
+DENIED_COUNTRIES = ['Sudan',
+                    'Korea, Democratic People\'s Republic Of',
+                    'Iran, Islamic Republic Of',
+                    'Cuba',
+                    'Syrian Arab Republic',
+                    ]
 
-#Construct dicts for specialty and sub-specialty dropdowns
+#Construct dicts for specialty, sub-specialty, sub-affiliation dropdowns
 SPECIALTY_CHOICES = {}
 SUB_SPECIALTY_CHOICES = {}
+SUB_AFFILIATION_CHOICES = {}
 
 PATIENT_POPULATION_CHOICES = (('Adult', 'Adult'),
                               ('Pediatric', 'Pediatric'),
-                              ('Both', 'Both (Adult/Pediatric)'))
+                              ('Both', 'Both'),
+                              ('None', 'None'))
 SPECIALTY_CHOICES['Adult'] = (('Addiction_Medicine', 'Addiction Medicine'),
                               ('Allergy', 'Allergy'),
                               ('Anesthesiology', 'Anesthesiology'),
@@ -604,3 +779,18 @@ def validate_export_controls(post_vars):
 SUB_SPECIALTY_CHOICES['Transplant'] = (('Solid_Organ', 'Solid Organ'),
                                        ('Blood_and_Bone_Marrow', 'Blood and Bone Marrow'),
                                        ('Other', 'Other, please enter:'))
+
+SUB_AFFILIATION_CHOICES['Packard_Childrens_Health_Alliance'] = (('Bayside_Medical_Group', 'Bayside Medical Group'),
+                                                                ('Diablo_Valley_Child_Neurology', 'Diablo Valley Child Neurology'),
+                                                                ('Jagdip_Powar_Associates', 'Jagdip Powar, MD and Associates'),
+                                                                ('Judy_Fuentebella_Associates', 'Judy Fuentebella, MD  and Associates'),
+                                                                ('Livermore_Pleasanton_San_Ramon_Pediatrics_Group', 'Livermore Pleasanton San Ramon Pediatrics Group'),
+                                                                ('Pediatric_Cardiology_Medical_Group', 'Pediatric Cardiology Medical Group'),
+                                                                ('Pediatric_Cardiology_Associates', 'Pediatric Cardiology Associates'),
+                                                                ('Peninsula_Pediatrics', 'Peninsula Pediatrics'),
+                                                                ('Sabina_Ali_Associates', 'Sabina Ali, MD  and Associates'))
+
+SUB_AFFILIATION_CHOICES['University_Healthcare_Alliance'] = (('Affinity_Medical_Partners_Medical_Group', 'Affinity Medical Partners Medical Group (AMP)'),
+                                                             ('Bay_Valley_Medical_Group', 'Bay Valley Medical Group (BVMG)'),
+                                                             ('Cardiovascular_Consultants_Medical_Group', 'Cardiovascular Consultants Medical Group (CCMG)'),
+                                                             ('Menlo_Medical_Clinic', 'Menlo Medical Clinic (MMC)'))
diff --git a/lms/templates/cme_register.html b/lms/templates/cme_register.html
index ac58f4e1960b..cd1038ee2982 100644
--- a/lms/templates/cme_register.html
+++ b/lms/templates/cme_register.html
@@ -24,12 +24,13 @@
       $('body').addClass('js').addClass(view_name);
 
       // new window/tab opening
-      $('a[rel="external"], a[class="new-vp"]')
-      .click( function() {
-      window.open( $(this).attr('href') );
-      return false;
+      $('a[rel="external"], a[class="new-vp"]').click( function() {
+        window.open( $(this).attr('href') );
+        return false;
       });
-
+      
+//---------------------------------------- Client side registration behavior ----------------------------------------//
+      
       // form field label styling on focus
       $("form :input").focus(function() {
         $("label[for='" + this.id + "']").parent().addClass("is-focused");
@@ -38,14 +39,21 @@
       });
      
       // display dependent form sections
-      $('input.controller-show').click(function() {
-        $(this).parent().siblings('.controlled').slideDown('fast');
-      });
      
-      $('input.controller-hide').click(function() {
-        $(this).parent().siblings('.controlled').slideUp('fast');
+      $('select.affiliation-controller').change(function() {
+        $(this).siblings('.affiliation-controlled').slideUp('fast');
+        
+        if ($(this).children("option:selected").val() === 'Stanford University') {
+          $(this).siblings('.affiliation-controlled#sunet_id_container, .affiliation-controlled#stanford_department_container').slideDown('fast');
+        } else if ($(this).children("option:selected").val() === "Packard Children's Health Alliance") {
+          $(this).siblings('.affiliation-controlled#PCHA_affiliation_container').slideDown('fast');
+        } else if ($(this).children("option:selected").val() === 'University Healthcare Alliance') {
+          $(this).siblings('.affiliation-controlled#UHA_affiliation_container').slideDown('fast');
+        } else if ($(this).children("option:selected").val() === 'Other') {
+          $(this).siblings('.affiliation-controlled#other_affiliation_container').slideDown('fast');
+        }
       });
-     
+      
       $('select.controller').change(function() {
         if ($(this).children("option:selected").val() === 'Other') {
           $(this).siblings('.controlled').slideDown('fast');
@@ -70,7 +78,44 @@
           $(controlledField).html($(controlledFieldContents).html()).parent().show();
         }
       });
-
+      
+      // Dependent required fields
+      $('select#professional_designation').change(function() {
+        var dependentRequiredFields = 'li#license-number_container, li#license-country_container, li#physician_status_container, li#patient_population_container, li#specialty-container';
+        
+        if ($(this).children("option:selected").val() === 'MD' || $(this).children("option:selected").val() === 'MD, PhD' || $(this).children("option:selected").val() === 'DO' || $(this).children("option:selected").val() === 'MBBS') {
+          $(this).parent().siblings(dependentRequiredFields).addClass('required');
+        } else {
+          $(this).parent().siblings(dependentRequiredFields).removeClass('required');
+        }
+      });
+      $('select#stanford_affiliation').change(function() {
+        if ($(this).children("option:selected").val() === 'Other' || $(this).children("option:selected").val() === '') {
+          $(this).parent().siblings('li.field').removeClass('required');
+        } else {
+          $(this).parent().siblings('li.field').addClass('required');
+        }
+      });
+      $('select#license_country').change(function() {
+        var dependentRequiredFields = 'li#license-state_container';
+        
+        if ($(this).children("option:selected").val() === 'United States') {
+          $(this).parent().siblings(dependentRequiredFields).addClass('required');
+        } else {
+          $(this).parent().siblings(dependentRequiredFields).removeClass('required');
+        }
+      });
+      $('select#country').change(function() {
+        var dependentRequiredFields = 'li#state_container';
+        
+        if ($(this).children("option:selected").val() === 'United States') {
+          $(this).parent().siblings(dependentRequiredFields).addClass('required');
+        } else {
+          $(this).parent().siblings(dependentRequiredFields).removeClass('required');
+        }
+      });
+      
+//--------------------------------------- /Client side registration behavior ----------------------------------------//
     });
 
     (function() {
@@ -172,6 +217,37 @@ <h3><strong>Required Information</strong></h3>
             <input id="name" type="text" name="name" value="" placeholder="example: Jane C Doe" required aria-required="true" />
             <span class="tip tip-input">Needed for any certificates you may earn <strong>(cannot be changed later)</strong></span>
           </li>
+          
+          <li class="field required text" id="field-name">
+            <label for="name">Last Name</label>
+            <input id="last_name" type="text" name="last_name" value="" required aria-required="true" />
+          </li>
+          
+          <li class="field required text" id="field-name">
+            <label for="name">First Name</label>
+            <input id="first_name" type="text" name="first_name" value="" required aria-required="true" />
+          </li>
+          
+          <li class="field select" id="field-name">
+            <label for="name">Middle Initial</label>
+            <input id="middle_initial" type="text" name="middle_initial" value="" required aria-required="true" />
+          </li>
+          
+          <li class="field required text" id="field-name">
+            <label for="name">Month and Day of Birth</label>
+            <input id="birth_date" type="text" name="birth_date" value="" required aria-required="true" placeholder="MM/DD" maxlength="5" />
+          </li>
+          
+          <li class="field select" id="gender_container">
+           <label for="gender">Gender</label>
+           <select id="gender" name="gender">
+             <option value="">--</option>
+             %for code, gender in CmeUserProfile.GENDER_CHOICES:
+               <option value="${code}">${gender}</option>
+             %endfor
+           </select>
+          </li>
+          
         </ol>
 
         % else:
@@ -213,22 +289,13 @@ <h3 class="message-title">Welcome ${extauth_id}</h3>
         % endif
       </fieldset>
 
-      <fieldset class="group group-form group-form-secondary group-form-personalinformation">
+      <fieldset class="group group-form group-form-secondary group-form-professionalinformation form-page">
        <hr />
        <h3><strong>Professional Information</strong></h3>
    
        <ol class="list-input">
-          <li class="field required text" id="field-profession">
-            <label for="profession">Profession</label>
-            <select id="profession" name="profession">
-              <option value="">--</option>
-              %for code, profession in CmeUserProfile.PROFESSION_CHOICES:
-                <option value="${code}">${profession}</option>
-              %endfor
-            </select>
-          </li>
          
-          <li class="field select" id="field-professional-designation">
+          <li class="field required text" id="field-professional-designation_container">
             <label for="professional_designation">Professional Designation</label>
             <select id="professional_designation" name="professional_designation">
               <option value="">--</option>
@@ -238,60 +305,42 @@ <h3><strong>Professional Information</strong></h3>
             </select>
           </li>
          
-          <li class="field required text" id="license-number">
+          <li class="field select" id="license-number_container">
             <label for="license_number">License Number</label>
             <input id="license_number" type="text" name="license_number" />
           </li>
-         
-      </ol>
-      </fieldset>
-     
-      <fieldset class="group group-form group-form-secondary group-form-organizationinformation">
-       <hr />
-       <h3><strong>Organization Information</strong></h3>
-      
-       <ol class="list-input">
-         <li class="field select" id="organization">
-            <label for="organization">Organization</label>
-            <input id="organization" type="text" name="organization" />
-         </li>
-      
-         <li class="field required" id="stanford_affiliated">
-           <label for="stanford_affiliated">Are you affiliated with Stanford?</label>
-           <div class="field select radio " id="is_stanford_affiliated">
-              <span><input id="stanford_affiliated_yes" class="controller-show" type="radio" value="1" name="stanford_affiliated" aria-label="Yes" /> Yes</span>
-              <span><input id="stanford_affiliated_no" class="controller-hide" type="radio" value="0" name="stanford_affiliated" aria-label="No" style="margin-left: 50px;" /> No</span>
-             
-              <div class="field select controlled" id="how_stanford_affiliated" style="display: none;">
-                <br />
-                <label for="how_stanford_affiliated">How are you affiliated with Stanford?</label>
-                <select class="controller" id="how_stanford_affiliated" name="how_stanford_affiliated">
-                  <option value="">--</option>
-                  % for code, how_stanford_affiliated in CmeUserProfile.HOW_STANFORD_AFFILIATED_CHOICES:
-                    % if code == "Other, please enter:":
-                      <option value="${code}" class="controller-show">${how_stanford_affiliated}</option>
-                    % else:
-                      <option value="${code}" class="controller-hide">${how_stanford_affiliated}</option>
-                    % endif
-                  % endfor
-                </select>
-                <div class="field controlled" id="how_stanford_affililiated_free_container" style="display: none;">
-                  <br />
-                  <input id="how_stanford_affililiated_free" type="text" name="how_stanford_affiliated_free" title="Please enter how you are affiliated with Stanford here." />
-                </div>
-              </div>
-           </div>
-         </li>
 
-       </ol>
-      </fieldset>
+          <li class="field select" id="license-country_container">
+            <label for="license_country">License Country</label>
+           <select id="license_country" name="license_country">
+             <option value="">--</option>
+             %for code, country in CmeUserProfile.COUNTRY_CHOICES:
+               <option value="${code}">${country}</option>
+             %endfor
+           </select>
+          </li>
 
-      <fieldset class="group group-form group-form-secondary group-form-patientinformation">
-       <hr />
-       <h3><strong>Your Patient Information</strong></h3>
-      
-       <ol class="list-input">
-        <li class="field required" id="patient_population">
+          <li class="field select" id="license-state_container">
+            <label for="license_state">License State</label>
+           <select id="license_state" name="license_state">
+             <option value="">--</option>
+             %for code, state in CmeUserProfile.STATE_CHOICES:
+               <option value="${code}">${state}</option>
+             %endfor
+           </select>
+          </li>
+
+          <li class="field select" id="physician_status_container">
+            <label for="physician_status">Physician Status</label>
+           <select id="physician_status" name="physician_status">
+             <option value="">--</option>
+             %for code, status in CmeUserProfile.PHYSICIAN_STATUS_CHOICES:
+               <option value="${code}">${status}</option>
+             %endfor
+           </select>
+          </li>
+
+        <li class="field select" id="patient_population_container">
           <label for="patient_population">Patient population</label>
           <select id="patient_population" name="patient_population" class="select-controller">
             <option value="">--</option>
@@ -299,13 +348,15 @@ <h3><strong>Your Patient Information</strong></h3>
               <option value="${code}" class="specialty-${code} sub_specialty">${patient_population}</option>
             %endfor
           </select>
-        </li>
-       
+        </li>          
+         
+         
+         
           #####################################################
           ## Specialty Select Field
           #####################################################
          
-          <li class="field required" style="display: none;">
+          <li class="field select" style="display: none;" id="specialty-container">
             <label for="specialty">Specialty</label>
             <select id="specialty" name="specialty" class="controller select-controller">
               <option value="">--</option>
@@ -313,7 +364,7 @@ <h3><strong>Your Patient Information</strong></h3>
            
             <div class="field controlled" id="specialty_free_container" style="display: none;">
               <br />
-              <input id="specialty_free" type="text" name="specialty_free" title="Please enter your Specialty here." />
+              <input id="specialty_free" type="text" name="specialty_free" title="Please enter your Specialty here." placeholder="Please enter your Specialty here." />
            </div>
           </li>
          
@@ -343,7 +394,7 @@ <h3><strong>Your Patient Information</strong></h3>
           ## Sub Specialty Select Field
           #####################################################
        
-        <li class="field" style="display: none;">
+        <li class="field" style="display: none;" id="sub-specialty-container">
           <label for="sub_specialty">Sub-Specialty</label>
           <select id="sub_specialty" name="sub_specialty" class="controller">
             <option value="">--</option>
@@ -351,7 +402,7 @@ <h3><strong>Your Patient Information</strong></h3>
          
           <div class="field controlled" id="sub_specialty_free_container" style="display: none;">
            <br />
-           <input id="sub_specialty_free" type="text" name="sub_specialty_free" title="Please enter your Sub-Specialty here." />
+           <input id="sub_specialty_free" type="text" name="sub_specialty_free" title="Please enter your Sub-Specialty here." placeholder="Please enter your Sub-Specialty here." />
           </div>
         </li>
        
@@ -417,10 +468,72 @@ <h3><strong>Your Patient Information</strong></h3>
             <option value="${code}">${sub_specialty}</option>
           %endfor
         </div>
-       
+        
+        
        </ol>
       </fieldset>
-       
+      
+      <fieldset class="group group-form group-form-secondary group-form-affiliationinformation form-page">
+        <hr />
+        <h3><strong>Affiliation Information</strong></h3>
+      
+        <ol class="list-input">
+          
+          <li class="field select" id="affiliation">
+            <label for="affiliation">Affiliation</label>
+            <select id="affiliation" name="affiliation" class="affiliation-controller">
+              <option value="">--</option>
+              %for code, affiliation in CmeUserProfile.AFFILIATION_CHOICES:
+                <option value="${code}">${affiliation}</option>
+              %endfor
+            </select>
+           
+            <div class="field affiliation-controlled select required" id="sunet_id_container" style="display: none;">
+              <br />
+              <label for="sunet_id">SUNet ID</label>
+              <input id="sunet_id" type="text" name="sunet_id" />
+            </div>
+            
+            <div class="field affiliation-controlled select required" id="stanford_department_container" style="display: none;">
+              <label for="stanford_department">Stanford Department</label>
+              <select id="stanford_department" name="stanford_department">
+                <option value="">--</option>
+                %for code, stanford_department in CmeUserProfile.DEPARTMENT_CHOICES:
+                  <option value="${code}">${stanford_department}</option>
+                %endfor
+              </select>
+            </div>
+            
+            <div class="field affiliation-controlled select required" id="PCHA_affiliation_container" style="display: none;">
+              <br />
+              <label for="PCHA_affiliation">Packard Children's Health Alliance Affiliation</label>
+              <select id="PCHA_affiliation" name="PCHA_affiliation">
+                <option value="">--</option>
+                %for code, PCHA_affiliation in sub_affiliation_choices['Packard_Childrens_Health_Alliance']:
+                  <option value="${code}">${PCHA_affiliation}</option>
+                %endfor
+              </select>
+            </div>
+            
+            <div class="field affiliation-controlled select required" id="UHA_affiliation_container" style="display: none;">
+              <br />
+              <label for="UHA_affiliation">University Healthcare Alliance Affiliation</label>
+              <select id="UHA_affiliation" name="UHA_affiliation">
+                <option value="">--</option>
+                %for code, UHA_affiliation in sub_affiliation_choices['University_Healthcare_Alliance']:
+                  <option value="${code}">${UHA_affiliation}</option>
+                %endfor
+              </select>
+            </div>
+           
+            <div class="field affiliation-controlled" id="other_affiliation_container" style="display: none;">
+              <br />
+              <input id="other_affiliation" type="text" name="other_affiliation" title="Please enter your affiliation here." placeholder="Please enter your affiliation here." />
+            </div>
+          </li>
+          
+        </ol>
+      </fieldset>
 
       <fieldset class="group group-form group-form-secondary group-form-personalinformation">
         <hr />
@@ -429,37 +542,22 @@ <h3><strong>Professional Contact Information</strong></h3>
 
         <ol class="list-input">
         
-         <li class="field required" id="address_1">
+         <li class="field required" id="address_1_container">
            <label for="address_1">Address 1</label>
            <input id="address_1" type="text" name="address_1" />
          </li>
        
-         <li class="field select" id="address_2">
+         <li class="field select" id="address_2_container">
            <label for="address_2">Address 2</label>
            <input id="address_2" type="text" name="address_2" />
          </li>
        
-         <li class="field required" id="city">
+         <li class="field required" id="city_container">
            <label for="city">City</label>
            <input id="city" type="text" name="city" />
          </li>
-       
-         <li class="field required" id="state_province">
-           <label for="state_province">State/Province</label>
-           <select id="state_province" name="state_province">
-             <option value="">--</option>
-             %for code, state in CmeUserProfile.STATE_CHOICES:
-               <option value="${code}">${state}</option>
-             %endfor
-           </select>
-         </li>
-       
-         <li class="field required" id="postal_code">
-           <label for="postal_code">Postal Code</label>
-           <input id="postal_code" type="text" name="postal_code" />
-         </li>
-       
-         <li class="field required" id="country">
+
+         <li class="field required" id="country_container">
            <label for="country">Country</label>
            <select id="country" name="country">
              <option value="">--</option>
@@ -468,46 +566,31 @@ <h3><strong>Professional Contact Information</strong></h3>
              %endfor
            </select>
          </li>
-        
-         <li class="field required" id="phone_number">
-           <label for="phone_number">Phone Number</label>
-           <input id="phone_number" type="text" name="phone_number" />
-         </li>
-       
-         <li class="field select" id="extension">
-           <label for="extension">Extension</label>
-           <input id="extension" type="text" name="extension" />
-         </li>
-       
-         <li class="field select" id="fax">
-           <label for="fax">Fax</label>
-           <input id="fax" type="text" name="fax" />
-         </li>
-       
-         <li class="field required" id="hear_about_us">
-           <label for="hear_about_us">How did you hear about us?</label>
-           <select class="controller" id="hear_about_us" name="hear_about_us">
+
+         <li class="field" id="state_container">
+           <label for="state">State</label>
+           <select id="state" name="state">
              <option value="">--</option>
-             %for code, about_us in CmeUserProfile.HEAR_ABOUT_US_CHOICES:
-                % if code == "Other, please enter:":
-                  <option value="${code}" class="controller-show">${about_us}</option>
-                % else:
-                  <option value="${code}" class="controller-hide">${about_us}</option>
-                % endif
-              %endfor
+             %for code, state in CmeUserProfile.STATE_CHOICES:
+               <option value="${code}">${state}</option>
+             %endfor
            </select>
-           <div class="field controlled" id="hear_about_us_free" style="display: none;">
-              <br />
-              <input id="hear_about_us_free" type="text" name="hear_about_us_free" title="Please enter how you heard about us here." />
-           </div>
          </li>
-       
-            <input id="mailing_list" type="hidden" name="mailing_list" value="true" />
+         
+         <li class="field" id="county_province_container">
+           <label for="county_province">International Province or Territory</label>
+           <input id="county_province" type="text" name="county_province" />
+         </li>
 
+         <li class="field required" id="postal_code_container">
+           <label for="postal_code">Postal/Zip Code</label>
+           <input id="postal_code" type="text" name="postal_code" />
+         </li>
+       
         </ol>
       </fieldset>
 
-      <fieldset class="group group-form group-form-accountacknowledgements">
+      <fieldset class="group group-form group-form-accountacknowledgements" id="form-checkboxes">
         <hr />
         <legend class="sr">Account Acknowledgements</legend>
 
@@ -543,7 +626,7 @@ <h3><strong>Professional Contact Information</strong></h3>
       <input type="hidden" name="course_id" value="${course_id | h}" />
 % endif
 
-      <div class="form-actions">
+      <div class="form-actions" id="form-submit">
         <button name="submit" type="submit" id="submit" class="action action-primary action-update">Register <span class="orn-plus">+</span> Create My Account</button>
       </div>
     </form>