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- <!DOCTYPE html>
- <html>
- <head>
- <title></title>
- <meta charset="utf-8" />
- </head>
- <body>
- <table border="1" cellspacing="0" cellpadding="3">
- <tfoot>
- <tr bgcolor="#87ceeb">
- <td colspan="2" align="center">
- <input type="submit" value="Submit" />
- <input type="reset" value="Clear This Form" />
- </td>
- </tr>
- </tfoot>
- <tbody>
- <tr>
- <td align="center"><b>Last Name</b></td>
- <td>
- <input type="text" value="" size="50" />
- </td>
- </tr>
- <tr>
- <td align="center"><b>First Name</b></td>
- <td>
- <input type="text" value="" size="50" />
- </td>
- </tr>
- <tr>
- <td align="center"><b>Addres</b></td>
- <td>
- <textarea cols="35" rows="5"></textarea>
- </td>
- </tr>
- <tr>
- <td align="center"><b>City</b></td>
- <td>
- <input type="text" value="" size="35" />
- State
- <input type="text" value="" size="10" />
- </td>
- </tr>
- <tr>
- <td align="center"><b>Zip/Postal Code</b></td>
- <td>
- <input type="text" value="" size="10" />
- </td>
- </tr>
- <tr>
- <td align="center"><b>Country</b></td>
- <td>
- <select name="country">
- <option>Bulgaria</option>
- <option>Greece</option>
- </select>
- </td>
- </tr>
- <tr>
- <td>
- <b>Phone(country code,<br /> area code, number)</b>
- </td>
- <td>
- (+<input type="text" value="" size="10" />)
- <input type="text" value="" size="10" />
- <input type="text" size="20" />
- </td>
- </tr>
- <tr>
- <td align="center">
- <b>E-mail</b>
- </td>
- <td>
- <input type="text" value="" size="50" />
- </td>
- </tr>
- <tr>
- <td align="center"><b>Birth date</b></td>
- <td>
- <input type="text" value="" placeholder="DD . MM . Year" size="35" />
- </td>
- </tr>
- <tr>
- <td align="center">
- <b>Gender</b>
- </td>
- <td>
- <select>
- <option>Male</option>
- <option>Female</option>
- </select>
- </td>
- </tr>
- <tr>
- <td align="center">
- <b>Starting date</b>
- </td>
- <td>
- <label>
- Spring 2015
- <input type="radio" name="spring" />
- </label>
- <label>
- Summer 2015
- <input type="radio" name="spring" />
- </label>
- </td>
- </tr>
- <tr>
- <td align="center"><b>Comements/Questions</b></td>
- <td>
- <textarea cols="35" rows="8"></textarea>
- </td>
- </tr>
- </tbody>
- </table>
- </body>
- </html>
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