Untitled

<!DOCTYPE html>
<html>
<head>
  <meta charset="utf-8">
  <meta name="viewport" content="width=device-width">
  <title>JS Bin</title>
</head>
<body>
<form  method="post" enctype="multipart/form-data">

<table width="419" border="1">
 <tr>
<td width="173">Enter your email </td>
  <td width="230"><input type="email"  name="eid"/>

</td>  </tr>  <tr>

   <td>Password</td>

<td><input type="password"  name="pass"/></td>

</tr>  <tr>    <td>Mobile</td>

   <td><input type="text"  name="mob"/></td>

  </tr>

 <tr>
 <td>Address</td>

 <td><textarea name="add"></textarea></td>

 </tr>
 <tr>
  <td>Gender</td>
   <td>

Male<input type="radio" value="m" name="g"/>
Female<input type="radio" value="f" name="g"/>

</td>

 </tr>

 <tr>

   <td>Hobbies</td>
    <td>	cricket<input type="checkbox" name="chlist[]" value="cricket"/>
singing<input type="checkbox" name="chlist[]" value="singing"/>

reading<input type="checkbox" name="chlist[]" value="reading"/>

</td>

  </tr>

  <tr>

    <td>Image</td>

   <td><input type="file" name="file" id="file" />

 </td>
  </tr>

  <tr>

   <td>DOB</td>

   <td>
	<select name="yy">
	<option value="" disabled="disabled" selected="selected">	Year</option>
	<?php
	for($i=1900;$i<=2013;$i++)
	{
	echo "<option value='$i'>$i</option>";
 	}
	?>

</select><select name="mm">

<option value="" disabled="disabled" selected="selected">	Month	</option>

	<?php
	for($i=1;$i<=12;$i++)
		{
		echo "<option value='$i'>$i</option>";
 		}
		?>

	</select>

	<select name="dd">

<option value="" disabled="disabled" selected="selected">	Date</option>

		<?php
		for($i=1;$i<=31;$i++)
		{
		echo "<option value='$i'>$i</option>";
 		}
		?>

</select>	</td>

  </tr>

  	<tr>
 		<td colspan="2" align="center">	<input type="submit" name="ins" value="Insert"/>

<input type="submit" name="disp" value="show"/>

</tr>

</table>

</form>


</body>
</html>