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- <html>
- <head>
- <style>
- </style>
- </head>
- <body>
- <table width="400px" cellpadding="10" cellspacing="0">
- <tbody><tr bgcolor="#de8704">
- <td colspan="2">Sign Up</td>
- </tr>
- <tr bgcolor="#222536">
- <td align="right">First Name</td>
- <td><input type="text" placeholder="Enter First Name"></td>
- </tr>
- <tr bgcolor="#222536">
- <td align="right">Last Name</td>
- <td><input type="text" placeholder="Enter Last Name"></td>
- </tr>
- <tr bgcolor="#222536">
- <td align="right">Date of Birth</td>
- <td><select>
- <option>Date</option>
- <option>1</option>
- <option>2</option>
- <option>3</option>
- <option>4</option>
- <option>5</option>
- <option>6</option>
- <option>7</option>
- <option>8</option>
- <option>9</option>
- <option>10</option>
- <option>11</option>
- <option>12</option>
- <option>13</option>
- <option>14</option>
- <option>15</option>
- <option>16</option>
- <option>17</option>
- <option>18</option>
- <option>19</option>
- <option>20</option>
- <option>21</option>
- <option>22</option>
- <option>23</option>
- <option>24</option>
- <option>25</option>
- <option>26</option>
- <option>27</option>
- <option>28</option>
- <option>29</option>
- <option>30</option>
- <option>31</option>
- </select>
- <select>
- <option>Month</option>
- <option>January</option>
- <option>February</option>
- <option>March</option>
- <option>April</option>
- <option>May</option>
- <option>June</option>
- <option>July</option>
- <option>August</option>
- <option>September</option>
- <option>October</option>
- <option>November</option>
- <option>December</option>
- </select>
- <select>
- <option>Year</option>
- <option>1980</option>
- <option>1981</option>
- <option>1982</option>
- <option>1983</option>
- <option>1984</option>
- <option>1985</option>
- <option>1986</option>
- <option>1987</option>
- <option>1988</option>
- <option>1989</option>
- <option>1990</option>
- <option>1991</option>
- <option>1992</option>
- <option>1993</option>
- <option>1994</option>
- <option>1995</option>
- <option>1996</option>
- <option>1997</option>
- <option>1998</option>
- <option>1999</option>
- <option>2000</option>
- <option>2001</option>
- <option>2002</option>
- <option>2003</option>
- <option>2004</option>
- <option>2005</option>
- <option>2006</option>
- <option>2007</option>
- <option>2008</option>
- <option>2009</option>
- <option>2010</option>
- <option>2011</option>
- <option>2012</option>
- <option>2013</option>
- <option>2014</option>
- <option>2015</option>
- <option>2016</option>
- <option>2017</option>
- <option>2018</option>
- <option>2019</option>
- <option>2020</option>
- </select>
- </td></tr>
- <tr bgcolor="#222536">
- <td align="right">Gender</td>
- <td><input type="radio" name="gender">Male
- <input type="radio" name="gender">Female</td>
- </tr>
- <tr bgcolor="#222536">
- <td align="right">Country</td>
- <td><select>
- <option>Country</option>
- <option>India</option>
- <option>USA</option>
- <option>UK</option>
- <option>Japan</option>
- </select></td>
- </tr>
- <tr bgcolor="#222536">
- <td align="right">E-mail</td>
- <td><input type="text" placeholder="Enter E-mail"></td>
- </tr>
- <tr bgcolor="#222536">
- <td align="right">Phone</td>
- <td><input type="text" placeholder="Enter Phone"></td>
- </tr>
- <tr bgcolor="#222536">
- <td align="right">Password</td>
- <td><input type="password"</td>
- </tr>
- <tr bgcolor="#222536">
- <td align="right">Confirm Password</td>
- <td><input type="password"</td>
- </tr>
- <tr bgcolor="#222536">
- <td></td>
- <td><input type="checkbox">I Agree to the Terms of use</td>
- </tr>
- <tr bgcolor="#de8704">
- <td colspan="2" align="right">
- <input type="Submit" class="submit">
- <input type="Reset" value="Cancel" class="reset">
- </td>
- </tr>
- </tbody></table>
- </body>
- </html>
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