<center><table summary="Input fields table">
<tr> <td align="right"><?php $form->AddInputPart("condition"); ?></td> <td><b><?php $form->AddLabelPart(array("FOR"=>"condition")); ?></b></td> <td><?php echo (IsSet($verify["condition"]) ? "[Verify]" : ""); ?></td> </tr>
<tr> <th align="right"><?php $form->AddLabelPart(array("FOR"=>"dependent")); ?>:</th> <td><?php $form->AddInputPart("dependent"); ?></td> <td><?php echo (IsSet($verify["dependent"]) ? "[Verify]" : ""); ?></td> </tr>
<tr> <td colspan="3" align="center"><hr /></td> </tr>
<tr> <td colspan="3" align="center"><?php $form->AddInputPart("doit"); ?></td> </tr>
</table></center>
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