<form id="confirmDeleteForm" method="post" action="<?php echo $this->base ?>/users/profilegeneral/delete">
    <p>
        <?php echo $this->translate('Why do you want to delete your Community-ID account?') ?><br />
        <?php echo $this->translate('Please check all that apply:') ?>
    </p>
    <ul>
        <li>
            <input type="checkbox" name="reason_test" style="top:0" /><?php echo $this->translate('This was just a test account') ?>
        </li>
        <li>
            <input type="checkbox" name="reason_foundbetter" style="top:0" /><?php echo $this->translate('I found a better service') ?>
        </li>
        <li>
            <input type="checkbox" name="reason_lackedfeatures" style="top:0" /><?php echo $this->translate('Service lacked some key features I needed') ?>
        </li>
        <li>
            <input type="checkbox" name="reason_none" style="top:0" /><?php echo $this->translate('No particular reason') ?>
        </li>
    </ul>
    <label for="reason_comments"><?php echo $this->translate('Additional comments:') ?></label>
    <textarea id="reason_comments" name="reason_comments"></textarea><br />
    <input type="submit" id="delete" value="<?php echo $this->translate('Delete Account') ?>" />
    <input type="button" id="cancel" value="<?php echo $this->translate('Cancel') ?>" onclick="location.href='<?php echo $this->base ?>/users/profile'" />
    <script type="text/javascript">
        var oButton = new YAHOO.widget.Button("delete");
        var oButton = new YAHOO.widget.Button(
            "cancel",
            {
                type    : "push",
                onclick : {fn: function() {
                                    location.href='<?php echo $this->base ?>/users/profile'
                               }
                          }
            }
        );
    </script> 
</form>
