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Jan 24th, 2018
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  1. <!DOCTYPE html>
  2. <!-- Vũ Đức Khải / khaivdse05574 -->
  3.  
  4. <html>
  5. <head>
  6. <title>TODO supply a title</title>
  7. <meta charset="UTF-8">
  8.  
  9. </head>
  10. <body>
  11.  
  12. <table>
  13. <h1> Register by filling in the form </h1>
  14. <tr>
  15. <td align="right"> First name </td>
  16. <td> <input type="text" name="firstname" size="40"> </td>
  17. </tr>
  18. <tr>
  19. <td align="right"> Last name </td>
  20. <td> <input type="text" name="lastname" size="40"> </td>
  21. </tr>
  22. <td align ="right"> Home run </td>
  23. <td>
  24. <input list="HomeRun">
  25. <datalist id="HomeRun">
  26. <option value=" Phú Thọ "></option>
  27. <option value=" Hà Nội "></option>
  28. <option value=" TP.Hồ Chí Min "></option>
  29. <option value=" Đà Nẵng "></option>
  30. <option value=" Quảng Nam "></option>
  31. <option value=" Quảng Ninh "></option>
  32. <option value=" Sơn La "></option>
  33. <option value=" Lai Châu "></option>
  34. </datalist>
  35. </td>
  36. </tr>
  37. <tr>
  38. <td align="right"> Gender </td>
  39. <td>
  40. <input type="radio" name="gender" value="male" checked> Male
  41. <input type="radio" name="gender" value="female"> Female
  42. <input type="radio" name="gender" value="other"> Other...
  43. </td>
  44. </tr>
  45. <tr>
  46. <td align="right"> Date of Birth </td>
  47. <td>
  48. <input type="date" size="40" name="DOB">
  49. </td>
  50. </tr>
  51. <tr>
  52. <td align="right"> Running Club Unattached </td>
  53. <td>
  54. <input list="Club" placeholder="Choose one!">
  55. <datalist id="Club">
  56. <select>
  57. <option value=""></option>
  58. <option value=" No Club "></option>
  59. <option value=" No Shy "></option>
  60. <option value=" Vovinam Club "></option>
  61. <option value=" Guitar Club "></option>
  62. <option value=" ESport Club "></option>
  63. <option value=" Photography Club "></option>
  64. </select>
  65. </datalist>
  66. </td>
  67. </tr>
  68. <tr>
  69. <td align="right"> Email </td>
  70. <td>
  71. <input type="email" name="email" size="40" placeholder="abc@gmail.com">
  72. </td>
  73. </tr>
  74. <tr>
  75. <td align="right"> Confirm Email </td>
  76. <td>
  77. <input type="email" name="email" size="40">
  78. </td>
  79. </tr>
  80. <tr>
  81. <td align="right"> Postcode </td>
  82. <td><input type="password" name="password" placeholder="Enter - Password"></td>
  83. </tr>
  84. <tr>
  85. <td align="right">I would like to be sent news about parkrun:</td>
  86. <td>
  87. <input type="radio" value="Yes" Checked> Yes </br>
  88. <input type="radio" value="No"> No
  89. </td>
  90. </tr>
  91. <tr>
  92. <td align="right">
  93. Over the last 4 weeks, </br>
  94. how often have you done </br>
  95. at least 30 minutes of moderate exercise </br>
  96. (enough to raise your breathing rate)? </td>
  97. <td>
  98. <input list="week" size="40">
  99. <datalist id="week">
  100. <option value=" First "></option>
  101. <option value=" Second "></option>
  102. <option value=" Third "></option>
  103. <option value=" Forth "></option>
  104. <option value=" Fifth "></option>
  105. <option value=" Sixth "></option>
  106. </datalist>
  107. </td>
  108. </tr>
  109. <tr>
  110. <td align="right">Please briefly list any medical conditions</br>
  111. you have, that a first aider should</br>
  112. know about, in the case of an emergency.</br>
  113. If none, please state 'None'. </td>
  114. <td><textarea rows="5" cols="50" name="comment" form="usrform"></textarea></td>
  115. </tr>
  116. <tr>
  117. <td align="right"> Who should we contact in Case of Emergency... </td>
  118. <td><input type="text" name="Contact"></td>
  119. </tr>
  120. <tr>
  121. <td align="right"> ...and what is their contact number? </td>
  122. <td><input type="text" name="Contact number"></td>
  123. </tr>
  124. <tr>
  125. <td align="right"> I accept the terms & conditions (see below) </td>
  126. <td><input type="checkbox" name="Yes"> Yes </td>
  127. <td><input type="checkbox" name="No"> No? </td>
  128. </tr>
  129. <tr>
  130. <td></td>
  131. <td align="left"><input type="submit" value="Check Form"></td>
  132. </tr>
  133. </table>
  134. </body>
  135. </html>
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