[de_fb_form _builder_version=”4.27.4″ _module_preset=”default” _unique_id=”7cefd357-c7b9-4745-81a7-6e25141208ad” theme_builder_area=”post_content” form_type=”register” hover_enabled=”0″ sticky_enabled=”0″ title=”Registration Form” success_message=”Your account has been successfully created. Please check your email for a verification link to activate your account.” is_user_edit=”on” submit_button_text=”Register” send_copy_to_sender=”on” sender_email_field=”Field_2″ redirect_after_success=”on” redirect_url_after_submission=”https://app.diasporameds.com/login/” use_simple_captcha=”on” simple_captcha_required_text=”Registration Incomplete: Please complete all required fields before proceeding.”][de_fb_form_field _builder_version=”4.27.4″ _module_preset=”default” theme_builder_area=”post_content” form_step=”0″ current_step=”0″ field_title=”Username:” required_mark=”on” field_label_position=”top” hover_enabled=”0″ sticky_enabled=”0″ field_id=”Field_1″ field_mapping_type=”user_default” user_default_field=”user_login”][/de_fb_form_field][de_fb_form_field _builder_version=”4.27.4″ _module_preset=”default” theme_builder_area=”post_content” form_step=”0″ current_step=”0″ field_title=”Email:” field_type=”email” required_mark=”on” field_label_position=”top” hover_enabled=”0″ sticky_enabled=”0″ field_id=”Field_2″ field_mapping_type=”user_default” user_default_field=”user_email”][/de_fb_form_field][de_fb_form_field _builder_version=”4.27.4″ _module_preset=”default” theme_builder_area=”post_content” form_step=”0″ current_step=”0″ field_title=”Password:” field_type=”password” required_mark=”on” field_label_position=”top” hover_enabled=”0″ sticky_enabled=”0″ field_id=”Field_3″ field_mapping_type=”user_default” user_default_field=”user_pass”][/de_fb_form_field][de_fb_form_field _builder_version=”4.27.4″ _module_preset=”default” theme_builder_area=”post_content” form_step=”0″ current_step=”0″ field_title=”Confirm Password:” field_type=”password” required_mark=”on” field_label_position=”top” field_placeholder=”Confirm your Password” hover_enabled=”0″ sticky_enabled=”0″ field_id=”Field_4″ field_mapping_type=”user_default” user_default_field=”pass_repeat”][/de_fb_form_field][/de_fb_form]