Sorry, I do not… but it would look something like this: (Note the code about half way down) <h2>Department Info</h2>
<form name=”registerform” id=”registerform” action=”https://site.911discount.com/wp-login.php?action=register” method=”post”>
<p>
<label>Username
<input type=”text” name=”user_login” id=”user_login” class=”input” value=”” size=”20″ tabindex=”10″ /></label>
</p>
<p>
<label>E-mail
<input type=”text” name=”user_email” id=”user_email” class=”input” value=”” size=”25″ tabindex=”20″ /></label>
</p>
<p id=’user_email2-p’><label id=’user_email2-label’>*Confirm E-mail
<input type=’text’ autocomplete=’off’ name=’user_email2′ id=’user_email2′ class=’input’ value=” size=’25’ tabindex=’21’ /></label></p>
<p id=’first_name-p’><label id=’first_name-label’>*First Name
<input type=’text’ name=’first_name’ id=’first_name’ class=’input’ value=” size=’25’ tabindex=’22’ /></label></p>
<p id=’last_name-p’><label id=’last_name-label’>*Last Name
<input type=’text’ name=’last_name’ id=’last_name’ class=’input’ value=” size=’25’ tabindex=’23’ /></label></p>
<p id=’dob-p’><label id=’dob-label’>*DOB
<input type=’text’ name=’dob’ id=’dob’ class=’datepicker’ value=” size=’25’ tabindex=’24’ /></label></p>
<p id=’address-p’><label id=’address-label’>*Address
<input type=’text’ name=’address’ id=’address’ class=’input’ value=” size=’25’ tabindex=’25’ /></label></p>
<p id=’address_2-p’><label id=’address_2-label’>Address 2
<input type=’text’ name=’address_2′ id=’address_2′ class=’input’ value=” size=’25’ tabindex=’26’ /></label></p>
<p id=’phone-p’><label id=’phone-label’>*Phone
<input type=’text’ name=’phone’ id=’phone’ class=’input’ value=” size=’25’ tabindex=’27’ /></label></p>
<h2>Department Info</h2>
<p id=’job_title-p’><label id=’job_title-label’>*Job Title
<input type=’text’ name=’job_title’ id=’job_title’ class=’input’ value=” size=’25’ tabindex=’28’ /></label></p>
<p id=’what_fire_department_do_you_work_for-p’><label id=’what_fire_department_do_you_work_for-label’>*What Fire Department do you work for?
<input type=’text’ name=’what_fire_department_do_you_work_for’ id=’what_fire_department_do_you_work_for’ class=’input’ value=” size=’25’ tabindex=’29’ /></label></p>
<p id=’name_and_telephone_number_of_your_supervisor-p’><label id=’name_and_telephone_number_of_your_supervisor-label’>*Name and Telephone Number of your Supervisor
<input type=’text’ name=’name_and_telephone_number_of_your_supervisor’ id=’name_and_telephone_number_of_your_supervisor’ class=’input’ value=” size=’25’ tabindex=’30’ /></label></p>
<p id=’department_address-p’><label id=’department_address-label’>*Department Address
<input type=’text’ name=’department_address’ id=’department_address’ class=’input’ value=” size=’25’ tabindex=’31’ /></label></p>
<p id=’department_phone-p’><label id=’department_phone-label’>*Department Phone
<input type=’text’ name=’department_phone’ id=’department_phone’ class=’input’ value=” size=’25’ tabindex=’32’ /></label></p>
<p id=’badge_-p’><label id=’badge_-label’>*Badge #
<input type=’text’ name=’badge_’ id=’badge_’ class=’input’ value=” size=’25’ tabindex=’33’ /></label></p>
<p id=’drivers_license_-p’><label id=’drivers_license_-label’>*Drivers License #
<input type=’text’ name=’drivers_license_’ id=’drivers_license_’ class=’input’ value=” size=’25’ tabindex=’34’ /></label></p>
<p id=’employee_id__or_firefighter_1_certification_number-p’><label id=’employee_id__or_firefighter_1_certification_number-label’>*Employee ID # or Firefighter 1 Certification Number
<input type=’text’ name=’employee_id__or_firefighter_1_certification_number’ id=’employee_id__or_firefighter_1_certification_number’ class=’input’ value=” size=’25’ tabindex=’35’ /></label></p>
<p id=’how_did_you_hear_about_us-p’><label id=’how_did_you_hear_about_us-label’>How did you hear about us?
<input type=’text’ name=’how_did_you_hear_about_us’ id=’how_did_you_hear_about_us’ class=’input’ value=” size=’25’ tabindex=’36’ /></label></p>
<p id=’add_interests-p’><label id=’add_interests-label’>Add Interests
<textarea name=’add_interests’ id=’add_interests’ cols=’25’ rows=’5′ tabindex=’37’></textarea></label></p>
<p id=’pass1-p’><label id=’pass1-label’>*Password
<input type=’password’ autocomplete=’off’ name=’pass1′ id=’pass1′ value=” size=’25’ tabindex=’38’ /></label></p>
<p id=’pass2-p’><label id=’pass2-label’>*Confirm Password
<input type=’password’ autocomplete=’off’ name=’pass2′ id=’pass2′ value=” size=’25’ tabindex=’39’ /></label></p>
<div id=’pass-strength-result’>Strength Indicator</div>
<small id=’pass_strength_msg’>Your password must be at least 6 characters long. To make your password stronger, use upper and lower case letters, numbers, and the following symbols !@#$%^&*()</small> <p id=”reg_passmail”>A password will be e-mailed to you.</p>
<br class=”clear” />
<input type=”hidden” name=”redirect_to” value=”” />
<p class=”submit”><input type=”submit” name=”wp-submit” id=”wp-submit” class=”button-primary” value=”Register” tabindex=”100″ /></p>
</form>
I’m thinking if you create a registration page just as you normally would, add the fields you need and then grab ALL the code that makes that page, create a new static page from that code and hardcode your lines of text in it…. it should work. You then just need to make sure to make the proper adjustments to ALL links to the registration page.