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Oct 18th, 2018
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  1. <html>
  2. <head>
  3. <title>Formularz</title>
  4. <meta http-equiv="Content-Type" content="text/html; charset=UTF-8">
  5. </head>
  6. <body>
  7. <form action="formularz1.php" method="post">
  8. <b><font size="4"> <b> Formularz kontaktowy </font></b><br><br>
  9. Nazwisko:<br/>
  10. <input type="text" name="nazw" value=" " size="30"><br>
  11. Imie<br/>
  12. <input type="text" name="im" value=" " size="30"><br>
  13. Zawód<br/>
  14. <input type="text" name="zaw" value=" " size="30"><br>
  15. Adres email:<br/>
  16. <input type="text" name="adr" value=" " size="30"><br>
  17. Numer telefonu:<br/>
  18. <input type="text" name="tel" value=" " size="30"><br>
  19.  
  20. <b>Wyksztalcenie</b>
  21. <input type="radio" name="wykszt" value="podst" checked>Podstawowe<br>
  22. <input type="radio" name="wykszt" value="srednie" checked>Srednie<br>
  23. <input type="radio" name="wykszt" value="wyzsze" checked>Wyzsze<br>
  24. <input type="radio" name="wykszt" value="zaw" checked>Zawodowe<br>
  25.  
  26. <input type="checkbox" name="opcje" maxlength="1">
  27. Zgadzam sie na przetwarzanie moich danych osobowych<br><br>
  28. <input type="submit" name="Wyslij" value="Wyslij">&nbsp; &nbsp;
  29. <input type="reset" name="zeruj" value="Wyczyść" >
  30. </form>
  31. </body>
  32. </html>
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