<center>
<form action="<?php $_SERVER['PHP_SELF'] ?>" method ="POST">
    <table>
        <tr>
            <td class=list align=right><p>User ID: </p></td>
            <td class=list><input type=text name=username maxlength="12"></td>
        </tr>
        <tr>
            <td class=list align=right><p>Password: </p></td>
            <td class=list><input type=password name=pass maxlength="12"></td>
        </tr>
        <tr>
            <td class=list align=right><p>Retype Password: </p></td>
            <td class=list><input type=password name=vpass maxlength="12"></td>
        </tr>
        <tr>
            <td class=list align=right><p>Email: </p></td>
            <td class=list><input type=text name=email maxlength="50"></td>
        </tr>
        <tr>
                <td class=list align=right><p>Birthdate: <br><font size="1"><i></i></font></p></td>
                <td class=list><input type=text name=dob maxlength="15"></td>
        </tr>
        <tr>
        <br><td><input align = "center" type="submit" name = "sub" value="Complete registration" />
        </tr>
</form></center>

<?php
if(isset($_POST['sub'])){

    $username = addslashes($_POST['username']);
    $password = $_POST['pass'];
    $password2 = $_POST['vpass'];
    $email = addslashes($_POST['email']);
    $birthdate = addslashes($_POST['dob']);

    $dbhost = "localhost"; // put your host here
    $dbuser= "root"; // db user here
    $dbpass= ""; //dbpass here
    $dbname= "test";
    $table= "giac_test"; //table name here

    mysql_connect("localhost", "root", "") or die ("error");
    mysql_select_db("test") or die ("Error with db!");

    $error = array();
        if (empty($username))
            $error[] = "You must enter a username. <br/>";
        if (empty($password))
            $error[] = "You must enter a password. <br/>";
        if (empty($password2))
            $error[] = "Please enter your password a second time. <br/>";
        if (empty($email))
            $error[] = "You must enter an email address. <br/>";
        if (empty($birthdate))
            $error[] = "You must enter your BirthDate. <br/>";
        if ($password != $password2){
            $error[] = "Your passwords do not match!<br/>";
        }
    foreach ($error as $err){


        echo $err;
        if (!$err){

            mysql_query("INSERT INTO $table (`id`, `username`, `password`, `email`, `date`) VALUES (
                        '',
                        '".$username."',
                        '".md5($password)."',
                        '".$email."',
                        '".time()."'
                        )") or die(mysql_error());
    echo "Registration Successful!";

        }else
    echo "Fail";

  }
  }



?>