Advertisement
Guest User

Untitled

a guest
Jan 26th, 2015
341
0
Never
Not a member of Pastebin yet? Sign Up, it unlocks many cool features!
text 1.26 KB | None | 0 0
  1. <h2><span>Formulario De Inscrição</span></h2>
  2. <form class="ContactForm" action="enviar.php">
  3. <div>
  4. <div class="wrapper">
  5. <span>Nome Completo:</span><input type="text" class="input" name="nome" required="required">
  6. </div>
  7. <div class="wrapper">
  8. <span>Nascimento:</span><input type="date" class="input" name="nascimento" required="required">
  9.  
  10. </div>
  11. <div class="wrapper">
  12. <span>Sexo</span><input type="radio" name="sexo" value="masculino" checked > Masculino
  13. <input type="radio" name="sexo" value="Feminino" > Feminino
  14. </div>
  15. <div class="wrapper">
  16. <span>E-mail:</span><input type="text" class="input" name="email" required="required">
  17. </div>
  18. <div class="wrapper">
  19. <span>Telefone:</span><input type="tel" class="input" name="telefone" >
  20. </div>
  21. <span>Porque ser rosariano?</span>
  22. <div class="textarea_box">
  23. <span></span>
  24. <br/>
  25. <textarea name="porq" cols="1" rows="1" required="required"></textarea>
  26. </div>
  27. <div class="enviarbutton">
  28. <input type="submit" id="send_message" value="Enviar" />
  29. </div>
  30. </div>
  31. </form>
  32. </article>
Advertisement
Add Comment
Please, Sign In to add comment
Advertisement