
<patTemplate:tmpl name="pageoutput" unusedvars="strip">
	<h2 class="page-header">{_JOMRES_EDIT_COUNTRY_TITLE}</h2>

	<form action="{JOMRES_SITEPAGE_URL_ADMIN}" method="post" name="adminForm" class="form-horizontal">
		{JOMRESTOOLBAR}
		<fieldset>
			<div class="control-group">
				<label class="control-label" for="country_code">{_JOMRES_EDIT_COUNTRY_COUNTRYCODE}</label>

				<div class="controls">
					<input class="input-large" type="text" name="country_code" value="{COUNTRYCODE}"/>
				</div>
			</div>

			<div class="control-group">
				<label class="control-label" for="country_name">{_JOMRES_EDIT_COUNTRY_COUNTRYNAME}</label>

				<div class="controls">
					<input class="input-large" type="text" name="country_name" value="{COUNTRYNAME}"/>
				</div>
			</div>

			<input type="hidden" name="id" value="{ID}"/>
			<input type="hidden" name="option" value="com_jomres"/>
			<input type="hidden" name="task" value="save_country"/>
			<input type="hidden" name="no_html" value="1"/>
			{CSRF_TOKEN}
		</fieldset>
	</form>
</patTemplate:tmpl>