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Jan 29th, 2015
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  1. <html>
  2. <head>
  3. <title>Reservation Form</title>
  4. </head>
  5. <body>
  6. <!-- TITLE ON THE TOP -->
  7. <h1 style="padding-left:440px;padding-top:10px;color:SlateGray">RESERVATION FORM
  8. <div style="padding-left:140px;padding-top:10px;">FOR</div>
  9. <div style="padding-top:10px;"> E-LEARNING CONFERENCE</div></h1>
  10. <p><h3  style="padding-left:450px"> Please insert your personal details below:</h3>
  11. <h3 style="padding-left:450px">All columns are required to fill in.</h3></p>
  12.  
  13.  
  14.  
  15. <form action="WebAssgn2.php" method="POST">
  16. <label style="padding-left:450px">Title&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp:
  17.     <select name="gender">
  18.         <option value="Male">Mr</option>
  19.         <option value="Female">Mrs</option>
  20.     </select>
  21. </label>
  22. <p style="padding-left:450px">First Name&nbsp: <input type="text" name="firstname" placeholder="First Name" required /> </p>
  23. <p style="padding-left:450px">Last Name&nbsp: <input type="text" name="lastname" placeholder="Last Name" required /></p>
  24. <p style="padding-left:450px">Affiliation&nbsp&nbsp: <input type="text" name="affiliation" placeholder="Affiliation" required /></p>
  25.      <p style="padding-left:450px">Email &nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp:&nbsp<input type="email" name="mail" placeholder="E-mail" pattern="^[_A-Za-z0-9-\+]+(\.[_A-Za-z0-9-]+)*@[A-Za-z0-9-]+(\.[A-Za-z0-9]+)*(\.[A-Za-z]{2,})$" required/></p>
  26.      
  27.      <p style="padding-left:470px"><br><input type="submit" value="Submit">
  28.      <span style="padding-left:10px"><input type="reset" value="Clear"></span>
  29.      <span style="padding-left:10px"><input type="button" value="Go to Query Form" onclick="window.location.href='queryForm.php'"></span></p>
  30. </form>
  31.  
  32. </body>
  33. </html>
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