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apl-mhd

reg

Sep 11th, 2018
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HTML 5 0.73 KB | None | 0 0
  1. <!DOCTYPE html>
  2. <html>
  3.  
  4. <head>
  5.     <title> Registration </title>
  6.     <style>
  7.  
  8.     </style>
  9. </head>
  10.  
  11. <body>
  12.  
  13. <form action="reg.php" method="get">
  14.     Name :              <input type ="text" name ="name">
  15.     <br><br><br>
  16.     Mobile Number :     <input type ="text" name ="mobile">
  17.     <br><br><br>
  18.     Insitute's Name :   <input type ="text" name="insName">
  19.     <br><br><br>
  20.     Insitute's Adrress : <input type ="text" name ="address">
  21.     <br><br><br>
  22.     Type : <select name="type">
  23.     <option value="type"> Type </option>
  24.     <option value="Provider"> Provider </option>
  25.     <option value="Receiver"> Receiver</option>
  26. </select>
  27.     <br><br><br>
  28.     <input type="submit" value ="Done">
  29.  
  30. </form>
  31.  
  32. </body>
  33.  
  34. </html>
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