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- <!DOCTYPE html>
- <!-- Vũ Đức Khải / khaivdse05574 -->
- <html>
- <head>
- <title>TODO supply a title</title>
- <meta charset="UTF-8">
- </head>
- <body>
- <table>
- <h1> Register by filling in the form </h1>
- <tr>
- <td align="right"> First name </td>
- <td> <input type="text" name="firstname" size="40"> </td>
- </tr>
- <tr>
- <td align="right"> Last name </td>
- <td> <input type="text" name="lastname" size="40"> </td>
- </tr>
- <td align ="right"> Home run </td>
- <td>
- <input list="HomeRun">
- <datalist id="HomeRun">
- <option value=" Phú Thọ "></option>
- <option value=" Hà Nội "></option>
- <option value=" TP.Hồ Chí Min "></option>
- <option value=" Đà Nẵng "></option>
- <option value=" Quảng Nam "></option>
- <option value=" Quảng Ninh "></option>
- <option value=" Sơn La "></option>
- <option value=" Lai Châu "></option>
- </datalist>
- </td>
- </tr>
- <tr>
- <td align="right"> Gender </td>
- <td>
- <input type="radio" name="gender" value="male" checked> Male
- <input type="radio" name="gender" value="female"> Female
- <input type="radio" name="gender" value="other"> Other...
- </td>
- </tr>
- <tr>
- <td align="right"> Date of Birth </td>
- <td>
- <input type="date" size="40" name="DOB">
- </td>
- </tr>
- <tr>
- <td align="right"> Running Club Unattached </td>
- <td>
- <input list="Club" placeholder="Choose one!">
- <datalist id="Club">
- <select>
- <option value=""></option>
- <option value=" No Club "></option>
- <option value=" No Shy "></option>
- <option value=" Vovinam Club "></option>
- <option value=" Guitar Club "></option>
- <option value=" ESport Club "></option>
- <option value=" Photography Club "></option>
- </select>
- </datalist>
- </td>
- </tr>
- <tr>
- <td align="right"> Email </td>
- <td>
- <input type="email" name="email" size="40" placeholder="abc@gmail.com">
- </td>
- </tr>
- <tr>
- <td align="right"> Confirm Email </td>
- <td>
- <input type="email" name="email" size="40">
- </td>
- </tr>
- <tr>
- <td align="right"> Postcode </td>
- <td><input type="password" name="password" placeholder="Enter - Password"></td>
- </tr>
- <tr>
- <td align="right">I would like to be sent news about parkrun:</td>
- <td>
- <input type="radio" value="Yes" Checked> Yes </br>
- <input type="radio" value="No"> No
- </td>
- </tr>
- <tr>
- <td align="right">
- Over the last 4 weeks, </br>
- how often have you done </br>
- at least 30 minutes of moderate exercise </br>
- (enough to raise your breathing rate)? </td>
- <td>
- <input list="week" size="40">
- <datalist id="week">
- <option value=" First "></option>
- <option value=" Second "></option>
- <option value=" Third "></option>
- <option value=" Forth "></option>
- <option value=" Fifth "></option>
- <option value=" Sixth "></option>
- </datalist>
- </td>
- </tr>
- <tr>
- <td align="right">Please briefly list any medical conditions</br>
- you have, that a first aider should</br>
- know about, in the case of an emergency.</br>
- If none, please state 'None'. </td>
- <td><textarea rows="5" cols="50" name="comment" form="usrform"></textarea></td>
- </tr>
- <tr>
- <td align="right"> Who should we contact in Case of Emergency... </td>
- <td><input type="text" name="Contact"></td>
- </tr>
- <tr>
- <td align="right"> ...and what is their contact number? </td>
- <td><input type="text" name="Contact number"></td>
- </tr>
- <tr>
- <td align="right"> I accept the terms & conditions (see below) </td>
- <td><input type="checkbox" name="Yes"> Yes </td>
- <td><input type="checkbox" name="No"> No? </td>
- </tr>
- <tr>
- <td></td>
- <td align="left"><input type="submit" value="Check Form"></td>
- </tr>
- </table>
- </body>
- </html>
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