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- <!DOCTYPE html>
- <html xmlns="http://www.w3.org/1999/xhtml">
- <head>
- <title>Web Form</title>
- <style type="text/css">
- table, td, th
- {
- border: 1px solid #615C5C;
- border-collapse: collapse;
- padding: 5px;
- }
- th
- {
- text-align: right;
- }
- input
- {
- width: 300px;
- }
- input[type="radio"]
- {
- width: 20px;
- }
- tfoot
- {
- background:#11CBEE;
- text-align: center;
- }
- tfoot input
- {
- width: auto;
- }
- #address
- {
- width: 300px;
- height: 70px;
- }
- #city, #state
- {
- width: 100px;
- }
- #countryCode, #areaCode
- {
- width: 40px;
- }
- #phone
- {
- width: 80px;
- }
- #birthDay, #birthMonth
- {
- width: 30px;
- }
- #birthYear
- {
- width: 50px;
- }
- #comments
- {
- width:300px;
- height: 100px;
- }
- .left
- {
- width: 200px;
- }
- </style>
- </head>
- <body>
- <form action="01WebForm.html" method="post">
- <table>
- <colgroup>
- <col class="left" />
- <col class="first" />
- <col class="second" />
- <col class="third" />
- </colgroup>
- <tfoot>
- <tr>
- <td colspan="4">
- <input type="submit" value="Submit" />
- <input type="reset" value="Clear This Form" />
- </td>
- </tr>
- </tfoot>
- <tbody>
- <tr>
- <th>
- <label for="lastName">
- Last Name</label>
- </th>
- <td colspan="3">
- <input id="lastName" name="lastName" type="text" value="Nakov" />
- </td>
- </tr>
- <tr>
- <th>
- <label for="firstName">
- First Name</label>
- </th>
- <td colspan="3">
- <input id="firstName" name="firstName" type="text" value="Svetlin" />
- </td>
- </tr>
- <tr>
- <th>
- <label for="address">
- Address</label>
- </th>
- <td colspan="3">
- <textarea id="address" name="address">17 Hristo Botev Str.
- floor 3, apt. 12</textarea>
- </td>
- </tr>
- <tr>
- <th>
- <label for="city">
- City</label>
- </th>
- <td>
- <input id="city" name="city" type="text" value="Kaspichan" />
- </td>
- <th>
- <label for="state">
- State</label>
- </th>
- <td>
- <input id="state" name="state" type="text" value="" />
- </td>
- </tr>
- <tr>
- <th>
- <label for="postCode">
- Zip/Postal Code</label>
- </th>
- <td colspan="3">
- <input id="postCode" name="postCode" type="text" value="9325" />
- </td>
- </tr>
- <tr>
- <th>
- <label for="country">
- Country</label>
- </th>
- <td colspan="3">
- <select id="country" name="country">
- <option>Bulgaria</option>
- <option>Romania</option>
- <option>Brazil</option>
- <option>Turkey</option>
- </select>
- </td>
- </tr>
- <tr>
- <th>
- <label for="phone">
- Phone (country code,
- <br />
- area code, number)</label>
- </th>
- <td colspan="3">
- (+<input id="countryCode" name="countryCode" type="text" value="359" />)
- <input id="areaCode" name="areaCode" type="text" value="88" />-
- <input id="phone" name="phone" type="text" value="8334343" />
- </td>
- </tr>
- <tr>
- <th>
- <label for="eMail">
- E-mail</label>
- </th>
- <td colspan="3">
- <input id="eMail" name="eMail" type="email" value="nakov@kaspichan.org" />
- </td>
- </tr>
- <tr>
- <th>
- Birth Date
- </th>
- <td colspan="3">
- <label for="birthMonth">
- Month</label>
- <input id="birthMonth" name="birthMonth" type="text" value="06" />
- <label for="birthDay">
- Day</label>
- <input id="birthDay" name="birthDay" type="text" value="14" />
- <label for="birthYear">
- Year(4 digit)</label>
- <input id="birthYear" name="birthYear" type="text" value="1980" />
- </td>
- </tr>
- <tr>
- <th>
- <label for="gender">
- Gender</label>
- </th>
- <td colspan="3">
- <select id="gender" name="gender">
- <option>male</option>
- <option>female</option>
- </select>
- </td>
- </tr>
- <tr>
- <th>
- Starting Date
- </th>
- <td colspan="3">
- <input id="spring2006" name="startingDate" type="radio" checked="checked" />
- <label for="spring2006">
- Spring 2006</label>
- <input id="summer2006" name="startingDate" type="radio" />
- <label for="summer2006">
- Summer 2006</label>
- </td>
- </tr>
- <tr>
- <th>
- <label for="comments">
- Comments/Questions</label>
- </th>
- <td colspan="3">
- <textarea id="comments" name="comments">Please send me more information about the lodging.
- </textarea>
- </td>
- </tr>
- </tbody>
- </table>
- </form>
- </body>
- </html>
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