<head>
<title>Akshar Tutorials Registration</title>
</head><body>
<center>
<form action="" method="post" enctype="multipart/form-data" name="form1">
<table border="1px" cellspacing="0px" cellpadding="3px" bgcolor="#CCCCCC" align="center">
<tr >
<th colspan="2"><h2>Akshar Tutorials Registration</h2></th>
</tr>
<tr>
<td>Reg. Id</td>
<td><input type="text" readonly name="reg_id" /></td>
</tr>
<tr>
<td>User Name</td>
<td><input type="text" name="username" id="username" /></td>
</tr>
<tr>
<td>Password</td>
<td><input type="password" name="pasword" id="pasword" /></td>
</tr>
<tr>
<td>First Name</td>
<td><input type="text" name="firstname" id="firstname" /></td>
</tr>
<tr>
<td>Last Name</td>
<td><input type="text" name="lastname" id="lastname" /></td>
</tr>
<tr>
<td valign="top">Address</td>
<td><textarea name="address" id="address" cols="25" rows="3"></textarea></td>
</tr>
<tr>
<td>City</td>
<td><select name="city" id="city">
<option>Select City</option>
<option>Mehsana</option>
<option>Ahmedabad</option>
</select></td>
</tr>
<tr>
<td>State</td>
<td><select name="state" id="state">
<option>Select State</option>
<option>Gujarat</option>
<option>Maharastra</option>
</select></td>
</tr>
<tr>
<td>Country</td>
<td><select name="country" id="country">
<option>Select Country</option>
<option>India</option>
</select></td>
</tr>
<tr>
<td>Mobile</td>
<td><input type="text" name="mobile" id="mobile" /></td>
</tr>
<tr>
<td>Email</td>
<td><input type="text" name="email" id="email" /></td>
</tr>
<tr>
<td>Gender</td>
<td><input name="gender" type="radio" id="gender_0" value="Male" checked="checked" />
Male
<input type="radio" name="gender" value="Female" id="gender_1" />
Female </td>
</tr>
<tr>
<td>DoB</td>
<td><select name="date" id="date">
<option>Date</option>
for(i=1;i
{
document.write(""+i+"");
}
</select>
<select name="month" id="month">
<option>Month</option>
for(i=1;i
{
document.write(""+i+"");
}
</select>
<select name="year" id="year">
<option>Year</option>
for(i=1900;i
{
document.write(""+i+"");
}
</select></td>
</tr>
<tr>
<td>Security Question</td>
<td><select name="question" id="question">
<option>Select Question</option>
</select></td>
</tr>
<tr>
<td>Answer</td>
<td><input type="text" name="answer" id="answer" /></td>
</tr>
<tr>
<td valign="top">Hobby</td>
<td><input type="checkbox" name="hobby" value="Cricket" />
Cricket <br />
<input type="checkbox" name="hobby" value="Music" />
Music <br />
<input type="checkbox" name="hobby" value="Reading" />
Reading <br />
<input type="checkbox" name="hobby" value="Traveling" />
Traveling <br /></td>
</tr>
<tr>
<td>Attech C.V.</td>
<td><input type="file" name="file" id="file" /></td>
</tr>
<tr>
<td> </td>
<td> </td>
</tr>
<tr>
<td colspan="2" align="center"><input type="submit" name="submit" id="submit" value="Submit" />
<input type="submit" name="reset" id="reset" value="Reset" /></td>
</tr>
</table>
</form>
</center>
</body>
</html>
EmoticonEmoticon