Untitled

<html>
<head>
</head>
<body>

<form name="frm"action="newreg.php"method="POST">
<table border="1">
<tr>
<td>

 NAME:
 </td><td>
<input type="text"name="name" required="required"/> </td></tr>

<tr><td>
EMAIL:</td><td>
<input type="email"name="email" required="required"/></td>
</tr>
<tr>
<td>
CARD NUMBER:</td><td>
<input type="number"name="cnumber" required="required"/> </td>
</tr>
<tr><td>
DATE:
</td>
<td>
<input type="date"name="date" required="required"/></td></tr>
<tr>
<td>

</td>
<td>
<input type="submit" name="submit"value="SUBMIT"/>
</td>
</tr>

</form>

</body>
</html>